An alternative guide to mental health care in England

Good mental health isn’t just the absence of mental illness – it’s how we cope with our lives, how we handle situations, relate to others and make choices. It’s about how we think, act and feel.

Every year, one in four of us will experience a mental health problem. The experience will be different for each of us, as will the type of support we need.

But what mental health services are there? And how do they fit in with other health and public services? We’re going to follow three people to find out more.

Asif

Asif has diabetes. He manages it with support from the diabetic nurse at his GP surgery – although he doesn’t always find this easy.

His health deteriorates which affects his work and family life. He feels low all the time, and finds it hard to concentrate.

Even though depression is common among people with diabetes, his nurse has little mental health training and doesn’t ask the right questions to spot it. Eventually though, his GP does, and they talk through his choices.

His GP refers him for talking therapy. She also gives him some leaflets and details for a patient group.

The group and the self-help guides help at first, but there’s a waiting list for therapy, and during this time his depression gets worse and he’s signed off work. He’s less motivated to manage his diabetes so his physical health declines.

His GP decides he needs more support and refers him to a specialist diabetes clinic. Ideally, the team there would include mental health professionals and they would draw up a care plan together, but integrated services like this are quite rare. Without this, Asif’s mental health will continue to be treated separately to his physical health even though the two are related.

Alicia

Alicia has started hearing voices. She moved back home after graduating and is feeling overwhelmed by her future. She thinks the TV and radio are talking to her which she finds very distressing.

Her parents do their best to support her but one evening she locks her bedroom door and threatens to harm herself. Her parents don’t know what to do so they take her to A&E.

A psychiatrist decides that she needs to be admitted to a psychiatric hospital. The team there draw up a care plan, including anti-psychotic medication to help with the voices.

When she’s well enough to be discharged an early intervention team takes over. These teams help young people experiencing their first psychotic episode. They work with Alicia, providing psychological therapy and support to her and her family.

Everything goes well at first. Alicia feels much better. She stops taking the medication because it makes her feel drowsy and she stops attending appointments with the team.

Her mental health deteriorates again. She’s picked up by the police while wandering the streets in a distressed state. They take her to a dedicated place of safety and call for the crisis team. These teams provide intensive support, helping people stay at home rather than go into hospital. They assess Alicia’s needs and visit her at home for a few weeks while she recovers.

She joins a support group run by a local charity, which helps her regain her confidence. With ongoing support, Alicia learns to manage her condition and get on with her life.

Mary

Mary has dementia. Her memory is failing and she gets confused about where she is.

Her husband looks after her, with some help from social services and an older people’s mental health team. Because of this she’s been able to stay living at home.

One day though she has a fall and has to go to A&E. She needs surgery so she’s admitted as an inpatient.

The hospital ward is busy and noisy - an upsetting environment for Mary. After a couple of days a liaison psychiatrist visits her on the ward. She helps staff understand Mary’s condition and what they can do to make her feel comfortable, but it’s still a confusing and distressing place for her.

She returns home, but her husband’s health gets worse and, despite increased support from social services, he’s finding it hard to care for her. The local authority assesses her needs and, with Mary, her husband and family, agree that she should move into a care home.

It’s difficult finding a place in a local care home where the staff are trained to care for people with dementia, but eventually, one becomes available. Mary isn’t better, but she has the care she needs.

Wrap-up

As we’ve seen, mental health covers a range of different conditions and experiences.

People’s needs vary considerably and the services that are meant to support them don’t always work as well as they should. Asif’s depression could easily have gone unnoticed, Alicia could have been caught in a cycle of repeated crises, unsupported by community services, and Mary’s family might never have found a care home able to provide the specialist dementia care she needs.

Just as mental health is part of our overall health, mental health care is an issue for the entire health and social care system – from GPs to hospitals, community services to care homes.

All health and care services need to be designed with mental health in mind, and all health professionals have a part to play helping people get the right support at the right time.