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

This content relates to the following topics:

Part of Time to Think Differently

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

Philip Green

Position
Clinical Hypnotherapist,
Organisation
Hypnofix
Comment date
31 January 2013
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

Sheila Crabb D…

Position
Office Manager/Counsellor,
Organisation
Family Resource Centre UK counselling
Comment date
31 January 2013
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!

Cecilia Weightman

Comment date
31 January 2013
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.

Julian Hendy

Organisation
www.hundredfamilies.org
Comment date
31 January 2013
"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.

Nick

Position
Rethink manager/MH support worker/Manicdepress,
Organisation
Departm of Wrk & Pens.
Comment date
31 January 2013
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.

nationalhealth…

Position
Founder / Director,
Organisation
CBRT International Ltd
Comment date
31 January 2013
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?

kae

Position
nursing,
Organisation
n/a
Comment date
31 January 2013
it's time to think of have wards with no more than 18 beds and more psychology input

RMN

Position
CAMH mental health nurse,
Organisation
CPFT
Comment date
31 January 2013
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.

Briony Norris

Position
Own Boss - now (recently resigned),
Organisation
LCM Environmental Consultants Ltd
Comment date
31 January 2013
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

Julie Blower

Position
Founder of Salford Based Counselling Service,
Organisation
Tree Tops Counselling Salford
Comment date
01 February 2013
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.

Add your comment