A better future for mental health care: acceptance, choice and dignity

Comments: 20

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 Patterson'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 Commission prioritises 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 a mentally 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.

Alastair Campbell is a writer and strategist best known for his role as former British Prime Minister Tony Blair's spokesman, press secretary and director of communications and strategy.

This blog is also featured on the Health Service Journal website

Comments

#39987 Philip Green
Clinical Hypnotherapist
Hypnofix

Hi Alastair. I have an innovative idea to reduce the time to treatment and reduce doctor visits at the surgery. 70% of all visits to the GP surgery are stress related at least initially. Stress and anxiety, primary or essential hypertension, OCD, IBS, PTSD etc. the approach I have is to radically change the way in which the system NHS should deal with stress related illnesses in the community. To whom would you recommend I speak. I have found apathy all around. I guess the individuals who have the stress want a positive outcome quickly. I feel I have an idea that could reduce expenditure to the NHS and raise the GDP eventually by having a fitter workforce and public at large. I would like to point out its not about clinical hypnotherapy. Your article above triggered a line of thinking I have had for a while. Regards Phil Green My name is Phil Green Dip.H,MNCH(Reg.),MNRPC,LAPHP,LHS

#39989 Sheila Crabb Di...
Office Manager/Counsellor
Family Resource Centre UK counselling

I attended 2 Mental Health Forums in Croydon yesterday & I think it would be fair to say that Croydon's Mental Health is in potential crisis. With massive underfunding of IAPT & CIPTS there are only 11 Counsellors available in the IAPT service, & they only offer CBT with a long waiting list (one man I have spoken to has been waiting 3 years). With no more money available, we have to have some joined up thinking for those who experience MH issues & what is best practice, rather than leave them floundering in isolation. I have proposed in Croydon, that agencies such as ours, who only use qualified Counsellors, can be part of an information sheet given to someone who presents at a GP surgery with low-medium anxiety/depression etc so that the patient can have a choice as to what service, model of therapy they would like to choose to best support their mental health. We do charge for our service, but it is low fee & paying for their therapy can help a client to invest in their own prices & mental health. There needs to be constructive discussion across Parliament and the various parties as projections of worsening MH issues, plus in 2011 an 11% rise in middle aged men committing suicide should be addressed in the UK in 2013 as a priority! There's no health without mental health is failing at the present time!

#39990 Cecilia Weightman

I have only once approached the out of hours crisis team in this area. I was suicidal and could barely speak as I was crying so much. They told me that they didn't think it appropriate for me to contact them as I could verbalise my feelings. Until those sort of attitudes change nothing will.

#39992 Julian Hendy
www.hundredfamilies.org

"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"

That's just not true in very many cases I'm aware of - people in desperate need of services are turned away to avoid dealing with them. These cases included people who have just attempted suicide and others who went on to kill themselves or others.

Until there is change of culture within mental health services itself nothing will change. Blaming the attitudes of the wider society is an easy target but won't affect change where arguably it's needed most.

#39993 Nick
Rethink manager/MH support worker/Manicdepress
Departm of Wrk & Pens.

I worked on behalf of hundreds of fellow sufferers over nearly 20 years. Many were unaware of the help they received because, humanistically, humility was a major skill allied to the healing process. Most psychiatrists don't "get" this. Unfortunately. Now I'm enduring a pretty severe breakdown and my rallies are harder fought and less complete. I am an Atos guinea pig and shattered, after 20 minutes of unfriendly grilling, that I would be forced back to work..
I want to comment on your interesting post later or tomorrow. Nick.

#39994 nationalhealth@...
Founder / Director
CBRT International Ltd

I have just read all the above posts and feel compelled to write. It is definitely “Time to Think Differently” and that includes decision makers within the NHS becoming more supportive of new ideas and techniques which can support the existing mental health services for Patients. The report “How Mental Health loses out in the NHS” by Lord Layard is evident that those writing here aren't biased!

I would be very grateful to anyone who can please help support my campaign to implore NHS Trusts and newly formed NHS Clinical Commissioning Groups to provide Patients with the choice and dignity to have the opportunity to attend freely available structured, guided, relaxation support sessions throughout the NHS. I have even written to the Prime Minister about this as the mental health and well being of an individual and group affects everyone, like a ripple affect - families, friends, communities.

CBRT is an effective mindfulness approach to relaxation, using Colour Breathing Disks as the point of focus, awareness of breathing pattern and positive affirmations. CBRT has proven popular with Users and is an easy to learn relaxation technique, (UK Invention "Innovation") which already has 15 years research and development. CBRT is to be showcased again at the "2013 Healthcare Innovation Expo" in March. We have worked in the mental health sector in communities within Northern Ireland since 2005.

CBRT has a two day Training Programme for NHS staff (developed since 2004) – where they learn how to use CBRT for individuals or groups of up to 20 Patients. The RCN and COT have already shown great interest - long before the 6 C’s became mentioned) and we intend to apply for their accreditation. In 2005 we trained our first NHS GP and Dr K.T.Birinder is a National Trainer.

Since the last “Healthcare Innovation Expo” (22 months) I have been dedicated to writing a QIPP focused (NHS cost saving) CBRT Training Initiative to train 28 Staff and 5 Trainers per Trust / CCG to enable a swift uptake. All we need now is some support to encourage commissioning teams within remaining NHS Trusts and newly formed NHS Clinical Commissioning Groups to support this initiative and uptake.

Last March we scored 92.53% on the NHS National Innovation Centre Technology Scorecard. Our users’ feedback demonstrates overwhelming positive feedback with measurable outcomes. Having an easy to access network of structured, relaxation support sessions can provide much needed support and help thousands of Patients with depression and long term conditions now.

I also find it so frustrating to read how many millions ££ the NHS has freely spent on homeopathy. Doe this have NICE approval?? CBRT is a practical and effective mindfulness based relaxation technique. Our intention is “to help Patients help themselves relax” and for CBRT to become a NICE approved technique. Dare I say it, not all Patients wish to have CBT treatment?
Can you help us?

#39995 kae
nursing
n/a

it's time to think of have wards with no more than 18 beds and more psychology input

#39996 RMN
CAMH mental health nurse
CPFT

Alastair

your article is thought- provoking and very much inline with all the theory that underpins more recent mental health initiatives within NHS mental health particularly IAPT and the more recent child and adolescent IAPT- quick early treatment at an early stage of the person's worries and concerns about their sense of well- being.

The reality is sadly different and unlikely to change soon. Financial pressures; staff and societal cultural attitudes to mental health/ illness & questions around what is wellness/ unwellness; and an increasingly medicalised model of care in mental health services- these are all contributing barriers to an urgent dialogue between all stakeholders as to how mental health services should develop.

The CPFT CAMHS early intervention service was scrapped mid- 2012- this would seem to speak volumes regarding the regressive nature of mental health care at this present time.

#39997 Briony Norris
Own Boss - now (recently resigned)
LCM Environmental Consultants Ltd

Read your article with interest. Have recently had to resign due to suffering from PTSD. Work were not willing to support me. As a public health professional, I feel very strongly about everyone's well being. As a sufferer, I know how hard it is to get the right help and support. It is virtually non existent. Work places are not supportive, medical professionals find it hard to understand unless you find the right one and families are also unhelpful. It is a pit of loneliness. Having friends and people you can trust to talk to is essential. More supportive services are needed. Including sufferers who have come through the other side would be a good idea. This is an area i am passionate about as a sufferer myself who has been treated badly, and also now my husband who is also suffering and receiving very little support, I think something needs to be done about it and i am willing to help if it makes things change

#40001 Julie Blower
Founder of Salford Based Counselling Service
Tree Tops Counselling Salford

The access to choice and unmet adequate need of psychological services needs addressing, The Depression Report stated this in 2006 and this is 2013.

Tree Tops hear stories of crisis and unmet needs every day and feel power less to change things.

#40002 william Hodgson
Team Leader CRHT

It is very difficult not to agree with your comments Alistair, but I cannot help but feel there is more than a degree of idealism to them. I do believe that attitudes towards mental illness within in the NHS, even by some mental health professionals leaves much to be desired. The on-going campaign -Time to Change- is so very welcome and if it prompts people to stop and think and question their own attitudes to mental health, so much the better. I'm sure you would agree that historically, mental health care has never had a good press, the old asylums were condemned as uncaring and institutional, care in the community didn't fare any better either, in fact I cannot remember a time when anything positive has ever been said regarding mental health care, which in the in the UK, is still the best in the EU and the rest of the world. Presently there is unprecedented demand, as alluded to by previous comments, for IAPT services and they are struggling to meet that demand, crisis services struggle with the ever increasing referrals from A&E departments, GP's and other professionals and on top of this are often unrealistic expectations from patients about what can reasonably be offered by the NHS. This is no easy nut to crack Alistair, I've been a mental professional for thirty years and have witnessed many changes both good and bad, but I have never witnessed such a demand for treatments and help as I do presently, and in the present economic climate I really cannot see any real improvement for the immediate future.

#40006 peter patrick ...
ukip health activist
cott campbells ozone therapy trust

my friend and i recently had a meeting with our head chief medical sir harry burns nhs in glasgow , regarding setting up of bobbeck.com and edskilling.com my youngest son and daughter barbara recently died from cancer and mental illness through not there doing ?...but our failing uk nhs not following world medicine regarding electro medicine ? were it is fact cancer and alzhiemers are being cured in japan russia etc my aim as ukip with there support will hope to change these failings , awaiting feed back from sir harry ?

#40049 peter patrick g...
ukip health activist
UKIP SCOTLAND

HI ALISTOR MY WIFE RECENTLY DIAGNOSED WITH DEMENTIA ? I AM PRESENTLY TREATING HER ELECTRO MEDICINE PRODOCOL OF WWW.EDSKILLING.COM AND BOBBECK.COM BRAIN TUNER OF WHICH SHE SEEMS TO BE RESPONDING , MY FRIEND AND 76 YR OLD SCOTTISH CHAMPION WEIGHT LIFTER GEORGE BYING MET OUR SIR HARRY BURNS REGARDING WHO WAS AMAZED BY OUR EFFORTS TO HELP OTHERS , NOW AWAITING HIS REPLY ? LET ME KNOW YOUR COMMENTS ?

#40057 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 internak 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.

#40072 Jane Moore
Dementia Alliance Co-ordinator
Camelford Dementia Action Alliance

DEMENTIA PATIENTS AND THOSE WHO DO THEIR BEST TO CARE BUT WHO ARE NOT SUPPORTED.

Thousands of dementia patients, suffering, frightened and bored sitting in carehomes, waiting to die and feeling cheated out of their last years on this earth.

How can we let this continue?
People should not be “dying from” but trying to “live well” with dementia.
Dementia patients do not have the capacity to occupy their time because of a diseased brain and for many just one word a day from another human being is all they can look forward to. Time must be spent with people with dementia, helping to allay boredom by pointing the way and helping with occupation of time. Therapy, activity and entertainment are at the core of alleviating anxiety, depression and boredom which create anger, frustration and distress. Care equals compassion and empathy. Because of dementia’s confusion, special needs must be met. More regular interaction for psychological support must be given together with assistance to occupy time. To promote contentment in dementia, a declaration of likes and dislikes should be insisted upon from family, friends and carers (i.e. what time main meal is taken; liking for hot drinks and meals; what that person has done throughout their life) To this end families must play a greater part in the care of their relative to support staff in carehomes.
Some prisoners have a better quality of life. Bastoy Prison in Norway supplies exercise, fresh air, outings to the beach and occupation.

How does one address the failing system of so called “care”?
Families feel they cannot complain because homes may close, they may face a ban or their loved one could be moved. Homes are understaffed, and carers won’t complain for fear of losing their jobs.
The National Dementia Strategy for England Objective 15:
Improved registration and inspection of carehomes:
CQC are failing to identifying activities and occupation at carehomes and should increase staff ratios for coping with dementia. CQC are failing dementia patients. It’s not enough to just talk to dementia patients to find out if they are happy – they lack the capacity to understand. Many elderly deaths are connected to low self worth and loss of the will to live. I have heard people say:” I just want to die”.

This is a barbaric treatment of our elderly. If a child or a prisoner was treated this way, there would be an outcry.

Southwest Dementia Partnerships suggest that 6 out of 10 homes have little or no provision for meaningful activity. We lock people away from life. We have consigned our elderly to a safe but stagnant existence.
Dementia patients need leading into activity.
We need more staff provision, better staff awareness training and better outdoor spaces.
Staff in carehomes are asking for more than basic dementia training. Training should include how interact compassionately and in the proper way with a dementia patient.

End of life care should be re-thought with particular attention being paid to the transition to unfamiliar places which increase confusion and families should be more aware of the decisions they may have to take.

---o0o---

Mini-mental State Examination (MMSE) needs updating and unification. Different test are at present carried out all over Britain and questions should be the same and truly reflect ability of a dementia person.
The Board of Directors of Torbay – South Devon Healthcare NHS Trust have agreed to take up the challenge from Torbay Dementia Action Alliance. They will be using the purple angel logo and are making changes to their test questions in consultation with a dementia patient. The same set of questions should be used throughout the country and I am asking Cornwall NHS to collaborate with Devon Healthcare and at least get unification throughout the South West.

Camelford Dementia Action Alliance

#40197 peter patrick ...
ukip health activist
cott campbells ozone therapy trust

as i head to our ukip spring exter conference this weekend , my thoughts are to do battle with our present nhs on alzheimers and dementia care , especialy as my wife is responding to my alteretive care like www.edskilling.com www.bobbeck.com we must open the doors of truth regarding cure for this evil illness ? there is much that can be done , like microchip bracelet on all patients , my wife went missing last christmas in a snow storm? but with grace of god she was found safe and well in a school nearby my home ? many are now going a missing and not being reported by the media or police ? there are many cures and its for our nhs to let the public know ? the rule of the nice and medical mafia is coming to end ? like poison chemo , and locking our loved ones in care homes to waste away until death ? this is not on, www.petercampbell.faithweb.com i had a meeting with our cheif scottish medical nhs officer on january 25th 2013 , my freind and i still awating his report back to us , know matter how much we phone and try to get an answer back ? why is he avoiding ?...we will cry wolf for the truth to be known ? god bless peter campbell ukip skys the limit mobile 07906877404 or 01475803529

#40238 susie
post - doctoral researcher

Dear Alistair,

I agree with all your comments and keep my fingers crossed that things do change but it's not looking good. I think that there are lots of problems with the NHS's attitude to mental health and have for sometime now being researching the ward environments in which service-users are treated. These are poor and badly need to be looked at so vulnerable are treated like human beings not animals or criminals. This I fear is emblematic of attitudes towards mental health more generally. I suggest we start here - the locus of treatments.

#40393 Rai

I have been begging the NHS for help for 20 years but get very little. I have now lost my job due to a breakdown and have very little support. I am waiting for yet more therapy - hopefully this time I won't be humiliated and sent away with no hope. Even a suicide attempt did not give me any more help from my GP etc. I was simply looked at as if I was disgusting and naughty.
This is my last hope of help. My life is in pieces.

#40395 Sarah Tucker
Digital Communications Officer
The King's Fund

Hi Rai

Please do get in touch with these organisations who may be able to help:

Patients' Association http://www.patients-association.org.uk/

Mind http://www.mind.org.uk/

Sane: http://www.sane.org.uk/what_we_do/support/

Centre for Mental Health: http://www.centreformentalhealth.org.uk/index.aspx

Sarah

#40960 Rachel Battersby

A friend of mine is currently being detained against his will under section 2 of the Mental Health Act when he is clearly not ill. The ability for relatives and doctors who are not familiar with a person to section the formerly ill under this section is highly inappropriate. He is not a danger to himself or anyone else. He isn't currently ill. And yet he was made to go to hospital where he cannot have a shower in public or have access to clean clothes, marched there by 4 police officers, a doctor and CPN with a locksmith threatening to break in and take him by force with no justifiable reason other than his sister having a hissy fit because he refused to see her. Sane people would refuse to see the poisonous bitch with her determination to have her own way (whilst whining like a little girl). Should anyone who doesn't like their relatives now be detained? This section of the Mental Health Act needs to be immediately abolished as it is a licence to treat anyone who has ever been mentally ill as if they have no rights whatsoever. He hasn't needed help for more than 10 years - though of course when he did need help he couldn't get it. Now he's well, he's forcibly detained with strange men urinating next to him whilst he showers, and yet again people in real need will not be able to get any help whatsoever.

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