I wrote the following article for
the House Magazine March 2008
For those involved with Mental Health services, Lord
Darzi's vision of more health services provided in community settings is nothing new.
The majority of mental health services are now
delivered in the community, and it is recognised that they should be designed around the
needs of the individual and focused on crisis prevention and recovery.
However, the development of "care in the
community" had a tricky start. It was
wrongly blamed for some high-profile homicides and deemed to have failed.
The image of community care as a failure is at odds
with the views of many service users, carers and mental health professionals who largely
prefer a policy which has at its heart effective and therapeutic treatment within the home
environment. In reality, the number of
homicides committed by mentally ill people hasn't increased during the massive expansion
of community care. This is despite a marked
overall increase in homicides.
As well as first class healthcare, people with mental
health problems also need more support when re-entering the field of work and employers
need to do more to combat discrimination in the workplace.
A real turning point came in 1999 with the introduction
of the National Service Framework (NSF) for mental health. This
set out national standards for community services, backed up by an increase in funding to
provide early intervention and crisis intervention teams.
The emphasis on the need for health and social services to combat
discrimination against individuals and groups with mental health problems and promote
their social inclusion was particularly welcome.
The structured framework has resulted in significant
improvements in services that have given people the opportunity of a more stable and
productive life. There are now many examples
of innovative and effective services and these are best when service users are enabled to
shape and lead their development. Suresearch
network of Service Users in Research and Education that provides user expertise in the
research and development of services. ED-IT is an early detection and intervention service
in Birmingham working with young people in mental distress referred from education, health
and the youth justice system. Early
intervention especially if a psychotic episode can be prevented leads to a
much better prognosis. There are good examples
in almost every area but they are beacons in a service that is still significantly
under-regarded and under-funded.
The Audit Commission found in 2006 that access to
talking therapies, out-of-hours crisis care, and information for people who use community
mental health services needs to improve.
The Improving Access to Psychological Therapies
project, and the recent £170 million boost it has received, represents a commitment on
the Government's part towards ensuring that more people get the talking therapies that are
recommended in NICE guidelines.
Whilst a national framework and standards were an
important step forward, as we approach the end of the current NSF next year, many of the
standards are still not being met.
It is also important that, in concentrating on
community treatments, the Government must not take their eyes off the situation for those
who do still need to be treated in hospital wards.
The Mental Health Act Commission's recent biennial
report In place of Fear painted a worrying picture of the state of mental
health wards in England. It reported that
patients often find their hospital stay frightening, and that their basic rights to safety
and dignity are not always met.
The stigma attached to mental illness still means that
mental health services are the soft target for cuts when budgets are tight those
affected are less likely to fight back and engender less public sympathy. But spending that enables people with mental health
problems to live fulfilling lives is the example par
excellence of spending to save both money and lives! User led mental health services must be
strengthened and developed to work alongside other agencies to address problems such as
worklessness, substance abuse, homelessness and bad housing that disproportionately affect
people suffering mental ill health.
Click here for further
information about my policy work on mental health and to read about my work as co-Chair on
the All Party Parliamentary Group on Mental Health
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