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Time to think differently about mental health care

Posted on 31 January 2013 | 12:01pm

The King’s Fund has launched a debate about the future of health and social care, called ‘Time to think Differently.’ They asked me to write a piece on mental health. To find out more about the King’s Fund debate, visit here. Meanwhile here is the piece I have done for them…

So it is time to think differently. As an ambassador for the Time to Change mental health awareness campaign I am all in favour of that. I’m all in favour too of echoing the theme of Christina Paterson’s recent piece about shifting power back to patients, but that is a tricky issue when you are talking about people in a mental health crisis. I mean a real crisis, when the mind is scrambled, the meltdown is happening, and it is hard to allow or expect the person at the centre of that crisis to make lots of rational decisions. This is when talk of rights, choice and control tends to go out of the window. Sometimes, that can be understandable. But it doesn’t always have to be so. There are still ways of respecting the knowledge and views of the patient in crisis. Sometimes it happens. Often it does not.

Crisis tends not to happen suddenly. There are warnings; there is a build up. If the warnings and the build-up are spotted, then hopefully preventive action can be taken. You won’t be told (effectively or actually) to go away until you’re really ill or imminently suicidal. If you know what helps and what doesn’t, this will be trusted as valuable expertise and will shape the care you receive if and when crisis comes. In fact you’ll have a crisis plan that you’ve negotiated with your care team and signed off yourself that sets out what you want to happen and where you want to go when you’re in crisis. It won’t happen in every set of circumstances. But it could happen in many more situations than it does now.

This may sound obvious, but Mind’s crisis care inquiry found that too often people are turned away and struggle to get help. Their crisis calls may go unanswered or they are told they are not ill enough to qualify for help. But the fact that they are there at all means they could be well down the road towards crisis already. Too few people have a crisis plan, and those who do are often not involved in deciding it, or say it is stuck in a filing cabinet and rarely referred to. The Care Quality Commissionprioritises care planning as something that needs to improve for detained patients.

In a better future vision of health care, your definition of your own crisis will count, and the plan you have co-written will determine the care you get. The benefits of peer support from other people with experience of mental health problems will be obvious and the people providing it will be valued as equals by other health care workers. Alternative models of service that are massively valued by the people who use them – including Leeds Survivor Led Crisis Service and Maytree – will spread rather than being rare and isolated examples. It’s an overused term, but with the right changes, the postcode lottery of good access to crisis care beyond hospitals will end. And when you go into hospital or other services you’ll be treated with courtesy as a welcome guest. Boredom, insecurity and abuse on wards will be a thing of the past. Cultures of restraint will be replaced by respect and dignity.

How do we get to that vision? This is partly about health service cultures, but wider society sets the tone. Attitude change – underpinned by law – is fundamental. We need to see mental health as being about ‘us’ not ‘us and them’ – to end the stigma and discrimination. There is still a long way to go, as the three-quarters of people with a mental health problem who lost friendships as a result know too well, and those who lose their jobs – or never get one – because of it know even better.

But there is hope too. For instance, last year, MPs in Parliament and Assembly Members in the Welsh Assembly spoke about their own experience of mental health problems. They didn’t know when they took that step that their colleagues and the media would respond warmly. The fact that their stories were so well received shows that as a society we are slowly moving in the right direction.

Parliament is important but it isn’t in people’s daily lives the way that employers are. When it comes to helping people understand mental health and how to look after it, employers have a big part to play. Creating amentally healthy and open workplace where employees feel supported enough to discuss a problem – that’s another marker of progress that is good for business as well.

Which brings me back to the staff–patient dynamic in health care. The NHS is a huge employer and its staff are rightly expected to care for people using clinical skills, respect and kindness – often in very high-demand situations, which in mental health settings include the risk of self-harm or suicide. If we expect people to be kind and empathic in their work, that is how they should be treated by their employer too. If we want staff to work in partnership with patients, respecting their wishes and knowledge of their own needs, they should feel safe enough to discuss their own mental health. And if a small organisation like Leeds Survivor Led Crisis Service can provide staff with supervision, reflective practice groups, experiential training and individual wellbeing budgets we should expect the NHS to support its frontline staff just as well.

The NHS should have been at the forefront of the Time to Change campaign – as an employer not just as the main provider of services. They are getting there – but as with the rest of the country, the journey is too slow, and too long, and the time for change is now.

  • Anonymous

    Think the main danger of good mental health is if one goes through an elongated period of being misunderstood, nurture like, especially obviously what happens in the Freud supposition on the streets of “tell me about your childhood?”.

    But even if survived relatively unscathed, adult experiences can amplify how close you actually are to that line – the most common these days when soldiers return from some work, and feel as if the environment that they left is now alien to them, with people about in a high percentage of being jolly, as before, while they have to try and fit in with their experiences going around their mind.

    Uncounselled, this just gets magnified through generations, in various ways, until it snaps, if it hasn’t already seriously.

    Hope I am making sense here.

  • Anonymous

    Where’s everyone Ali? Haven’t seen This Week from last night with yourself – have it planned to watch it on beeb iplayer.

    But anyway, what I said previous, humour helps, and when I watch this vid from th 1980′s, it does help to lift the spirits. But yes, when the body is drained totally in some way that is incomprehensable, it is baffling. There is a thought that evening primrose oil and tinned red/sockeye wild alaskan salmon is good at lubricating the synapses, since essential fatty acids are full with it, and has been confirmed that it is connected to how the mind works, and in some, the enzymes of such are different in some people. It is something called ancestral evolved diets or something.

    Anyway,
    http://www.youtube.com/watch?v=V83JR2IoI8k

  • Anonymous

    Shit biscuits! Clicked enter before edit on previous, again. So I apologise for the spells not put right, and the lack of paragraphs.

    Anyway part two,

    http://www.youtube.com/watch?v=V83JR2IoI8k

    And no doubt you remember Dr. Magnus Pike from the telly then, Alastair.

  • John Addy

    I thought this was a very important piece if it is right for their to be legally required contingency plans for fire and other foreseeable harmful incidents then logically the same should apply to mental health issues in a careing society

  • http://www.facebook.com/people/GillandDes-Currie/741511881 GillandDes Currie

    Thank goodness!
    Judging by reponse to this article they now have all the mentaly perturbed people under wraps in a warm blannket basking under neon lamps where they can’t respond to articles like this.
    Except Etch. He must of used his forgred ”get out free card”
    again.
    Des Currie

  • lucy

    I agree that the NHS needs to be at the forefront of the Time to Change campaign. In the hospitals that I work in there is still a definite stigma surrounding mental health issues. From managers down to colleagues, I’d say 70% of people believe that depression is a sign of weakness and can be fixed by “getting a grip” and “cheering up” and that’s only if they don’t think you’re skiving. Occupational Health departments are very good but they don’t have enough staff to help those of us who are struggling. A large proportion of us struggle along for far too long before we seek help. By the time we reach crisis point it can be too late. Therefore the idea that a plan could be in place beforehand is a good one, but with the cuts to services I’m pessimistic that there will be any NHS to support people by 2015. I desperately don’t want good mental health to become some kind of privilege.

  • Anonymous

    Some call it the irish seacoast problem, mainly affecting celts, when ancestors ate a high percentage of fish, with omega-3 fats, also with borage salad. which is high in the omega-6 gamma linolenic fatty acid.

    Something like that anyway, ancestral evolved. It is is said why celts/native north americans/innuits/aborigines suffer when they follow a modern mid-european grain only based diet, and tend to fall into the alcohol trap, since alcohol promotes certain fatty acid enzymes that are low active in certain peoples as above.

    It’s all science.

  • Anonymous

    If only the ‘Broken Mind’ can be visible to an ‘Ordinary Eye’ the community would be emphathetically moving forward to safe and vote for the vulnerable who are the hardest hit and support and bridge the partnerships with not only the NHS but the Service Providers, Front Line Help, Carers for their patience, compassion and understanding front roles. Its seems with so many changes happening the vulnerable will be left with only a few fragile strings to cling on to for their care and survival…Anyway its too late, its a shame physcial disabilities are noticeable and not the broken mind…

  • Anonymous

    Say no more what is going on in LA and the outskrits of it, in the snow covered Californian montains at the moment.

    Ex-serviceman victimised by his returning jealous “fellows” society? And look what those such cops did – shot up a pickup truck with two older women delivering morning papers, like wild animals.

    So for me, he seems to have some sort of point.

    linky,
    http://www.dailynews.com/ci_22557608

    http://www.dailynews.com/

  • Anonymous

    Bizarre that Skyfall got an award of Top Brit movie award ahead of Les Miserables, when Les Emms was in the catagorie for best international film of all, unlike Skyfall?

    Cameron’s tory funny handshake intervention?

    But Danny Craig on his take on the LA movie scene, from a few years ago, as an english born actor there, experiencing such things, there – a right mad microcosmic world,

    http://www.youtube.com/watch?v=vlDXoAVar48

    Good to see Quentin T getting something from us for D’Jambo, or however you spell it. : )

  • susannah

    Alistair I share the vision but with little optimism. The crisis led organisations are phenomenal and I have used Maytree. But they won’t get expanded or funded until mainstream MH services are willing to accept that the expertise does not always lie with them, that alternative models of crisis care are valid and that the individual living with serious MH problems is the real expert on what they need. I submitted to Mind’s Crisis Care enquiry and attended parliament to present to MP’s and Peers.

    We live in the same locality and apparently within a 5 star CQC service.
    However try accessing crisis care at night and you will find that when you telephone the crisis team they wont have time to talk and simply tell you to go to A&E. They also will not talk to someone not known to them so if that is your first port of call when you are suicidal forget it.It;s a way of rationing services to seriously vulnerable people.

    Compare that with the Samaritans who manage to support people with very severe complex issues – not just depression -and will talk for an hour and in daytime see people face to face. Statutory services seem to have very little knowledge of non statutory services in their area and an unwillingness to find out. Possibly because the voluntary services are seen as competitors.

    Add in to the mix that those with severe MH problems often can’t access therapy in or out of statutory services because they are considered too unwell, too at risk and lacking internal resources and you get a picture of why in our borough the suicide rate is consistently the highest in the country.

    MH services are about 20 years behind mainstream medicine in accepting the concepts of autonomy and choice. There is little dignity involved and very little real collaboration with patients/service users, An obsession with diagnostic criteria that clusters people as currencies to fund or cut services is a tick box response that stops ‘professionals’ hearing and responsing humanely and appropriately to someone in crisis.
    Until they grasp these concepts, accept the role of the critical friend and are better regulated nothing will change.

  • susannah

    Alistair I share the vision but with little optimism. The crisis led organisations are phenomenal and I have used Maytree. But they won’t get expanded or funded until mainstream MH services are willing to accept that the expertise does not always lie with them, that alternative models of crisis care are valid and that the individual living with serious MH problems is the real expert on what they need. I submitted to Mind’s Crisis Care enquiry and attended parliament to present to MP’s and Peers.

    We live in the same locality and apparently within a 5 star CQC service.
    However try accessing crisis care at night and you will find that when you telephone the crisis team they wont have time to talk and simply tell you to go to A&E. They also will not talk to someone not known to them so if that is your first port of call when you are suicidal forget it.It;s a way of rationing services to seriously vulnerable people.

    Compare that with the Samaritans who manage to support people with very severe complex issues – not just depression -and will talk for an hour and in daytime see people face to face. Statutory services seem to have very little knowledge of non statutory services in their area and an unwillingness to find out. Possibly because the voluntary services are seen as competitors.

    Add in to the mix that those with severe MH problems often can’t access therapy in or out of statutory services because they are considered too unwell, too at risk and lacking internal resources and you get a picture of why in our borough the suicide rate is consistently the highest in the country.

    MH services are about 20 years behind mainstream medicine in accepting the concepts of autonomy and choice. There is little dignity involved and very little collaboration with patients/service users, Until they grasp these concepts, accept the role of the critical friend and are better regulated nothing will change.