Transforming mental health
The government’s mandate for achieving parity of esteem between physical and mental health has put the spotlight on mental health provision. In London, meeting the mental health needs of the large and diverse population poses major challenges, and the London Health Board has identified improving the mental wellbeing of Londoners as a priority. But so far, there has been little consideration of what is required to meet the future mental health needs of London’s population and how this can be achieved.
This report describes a vision for the future of mental health provision in London, generated through a process of engagement with key stakeholders in the capital. The vision is based on a collaborative, integrated approach towards mental health that is relevant in London and elsewhere.
Key findings
A number of key steps have been identified to support systemic implementation of this vision:
- developing a process of collaborative commissioning to facilitate change
- driving change through collective systems leadership
- ensuring that service users and clinicians are at the core of provision
- using contracting systems to support integration
- building a public health approach to mental wellbeing
- developing pan-London solutions to increase impact
- improving the availability of meaningful outcomes data
- utilising London’s academic infrastructure to disseminate best practice
- creating a new narrative for mental health.
These steps reflect the strengths of individual stakeholder groups but also the importance of working collaboratively and adopting a shared agenda. Commissioners and providers are at the heart of this process, drawing together key organisations around the voice of service users, carers and clinicians in order to deliver improved outcomes. Other organisations have an important role to play in creating the infrastructure to do this, including Public Health England, NHS England, academic health science networks and centres, Collaborations for Leadership in Applied Health Research and Care and strategic clinical networks.
Policy implications
Achieving this vision will require the many and diverse stakeholders working on improving mental health in London to adopt new ways of working. The main stakeholders need to take the lead in bringing different groups together to develop a shared agenda and plan of action. They will need to address and overcome barriers to collaborative working, including different political and historical agendas, and unconstructive communication.
On the ground, certain approaches can support better integration of care and better outcomes. These include adopting collaborative leadership strategies, supporting and strengthening commissioning, and using contracting tools to facilitate integration. The strategic dissemination of evidence and development of data and outcomes can help ensure that change is systemic.
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Comments
trustee
Great title!
Applaud the focus on care and care commissioning. Our organisation is working on the evidence-base supporting interventions and health care practices. We look forward to contributing to the changes recommended here!
I agree, and see that people need to be taught how to better look after themselves, which would improve their mental and physical health. In equalities are caused by the rich doing this through complementary therapy (such as yoga classes) , so to reduce them we should make them free at the point of use, by enabling GPs to prescribe the NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 8 weeks as easily as (and instead of ) Prozac. That is the only way to 'end the Prozac nation (which was the objecting of IAPT) but antidepressant prescribing has since doubled. See my papers on section 9 of www.reginaldkapp.org, or e mail me at johnkapp@btinternet.com
Agree. We need to assist individuals and families to look after themselves and better understand their physical and mental health needs. Health Care professionals need to understand the importance of integrating physical and mental health care. It is too separated. Coaching and mindfulness are absolutely key in helping people to live healthier and happier lives.
Cross-sectoral working is very important as too many organisations still work in silos. Also encouraging people and showing them how to look after themselves better, for example using the 5 wellbeing principles, one of which is noticing (this can equate to mindfulness practice). One of the keys is encouraging self-directed action rather than thinking of health interventions as something done to them by a professional.
Culture is a must but this needs to happen more broadly in the society. The stigma surrounding mental health and lack of understanding about the need to see physical and mental health together for a person centered care is a real barrier. GPs need to be more aware about mental health and should pick it up early enough. Most mental health patients enter the system in crisis. Simple talking therapies can do wonders. Medication is not always the answer.
I have been asked to write a short summary key message piece for the MHNA practitioner journal on this report - The MHNA is the mental health nurse association with circa 3,000 members.
Our publication is widely read and will have an influence on attitudes and opinion on the content and contribution the report will have.
My initial thoughts prior to my second reading is it misses the essential point about funding pressure and squeeze on MH services overall and needs a bit more punch in being seen as a commissioning template for service support and change - the lack of enough headline on integration also I feel is a missed opportunity for emphasising one of the King's Funds loudest messages of the moment - my re read may modify my views however
The barriers to improvements to mental health care must be addressed to provide more consistent, joined up support for people with mental health difficulties. It is right to place collaborative working at the heart of the needed culture change and it is something we fully support as a national alliance of voluntary mental health care organisations. The voluntary sector can be looked to for support in service provision, for specialist services, but also for support to get mental health on the agenda with local authorities and CCGs. Many voluntary organisations are working at a local level and can better inform local service provision. They should be looked to for that knowledge and expertise.
We definitely need to educate and empower the public due to limited professional capacity and funding. But we must ensure it starts with an awareness and knowledge of child development, secure attachment and positive parenting skills.
Until the realisation that 'Integration' is not just the latest 'buzz' work' it has to understand that the meaning of what 'integration' means and what agencies are involved in the process to this end.
There has to be a 'tool' bar for agencies to refer to: and the process of how this programme works in reality is achieved.
The CQC could do more!
The CQC inspect GP Surgeries, why do thy not inspect the medical records of those subject to section 117. this would be a good starting point.
The CQC would be the 'Masters' and have at their disposal all the tools required to ensure that these particularly vulnerable patients are receiving all their entitlements as per the relevant laws including the Care Act 2014, and 'crisis and emergency assessments' the latest to come out of the DOH.
The MONITOR the other half of the coin, are completely inactive when it comes to Monitoring NHS Patients. Do they know patients are being discharged from Section 117 while still receiving care and treatment, left in 'limbo' I think not.
The arrogance of Kings and the CEO's of so called "mental Health" institutions is staggering... The money spent on this research is wasted money. It could have been spent on housing and people's basic human rights. The money wasted on psychiatric drugs that make people physically ill is staggering .Illness is big business so is Research like this I would draw people's attention to Pat Bracken , Ben Goldacre and Micheala Amering's work. Hope you will find this information interesting. I do not need overpaid academics telling me what I already know. I find "authority " scary some socialists and Buddhists do not believe in leadership ... Jimmy Saville ,
Rotherham , Rochdale , do we learn nothing as a society ?
Some voice hearers do not like talking in the voices, mouthing words without speaking
I have heard voices in languages I do not understand, others have too
250 million across the world hear voices in all countries of the world often due to trauma
People who are the survivors of torture ( 80% according to some figures , perhaps Amnesty International ) are voice hearers / hallucinate
In the UK people with so called learning disabilities and physical disabilities
sometimes grew up on mental health wards. Often people with so called learning difficulties
do not communicate in the same way but could easily be voice hearers.
Autism was sometimes misdiagnosed as Schizophrenia
People with Dementia may also hallucinate
The Schizophrenia commission report states page 56 people traditionally known as voice hearers are no more violent than anyone else.
I am a voice hearer with no diagnosis.
I take no drugs legal or illegal.
Some think the doctor's diagnosis are often WRONG
Some think the psychiatric drugs cause huge problems as does the Mental Health system
I would recommend Pat Bracken's Copenhagen talk and the Schizophrenia report ( which I have signposted below )
What would you like for yourself, what are your dreams and aspirations ?
EAT WELL, SLEEP WELL, EXERCISE, TAKE NOTICE, KEEP LEARNING,
YOUR RELATIONSHIP WITH THE PLANET IS SO IMPORTANT,
DRINK 6 CUPS OF WATER OR HERBAL TEA EACH DAY
with support you can come off the drugs but I know from family and friends how scary the psychiatric system can be, be kind to yourself you are a good person.
Here is some information which I hope you will find useful
This is another disturbing terrible case to do with the mental
health system in the UK
http://www.bbc.co.uk/news/uk-england-birmingham-21904422
It is not an illness to hear voices or hallucinate
1 in 20 hear voices or hallucinate
For more information contact
HVN, Limbrick Centre, Limbrick Road, Sheffield,S6 2PE
Tel: 0114 271 8210
Email : nhvn@hotmail.co.uk Website : http://www.hearing-voices.org/
Hearing voices network also publish 4 magazines a year with very interesting articles !
The HVN website features some of the HVN groups across the UK
The local group I am involved with (in Richmond Surrey )
is as follows :-
11:30 am at the Richmond Royal on Thursdays please contact
0203 513 3200 for more information
FREE to attend for as long as you like
FREE cup of tea and biscuits!
ALL WELCOME we are just a friendship group
Other useful web links:-
http://www.youtube.com/watch?v=cV5RKT6Q8qU&feature=player_embedded
Postpsychiatry -Reaching beyond the technological paradigm in mental health by Dr Pat Bracken on YOUtube
http://www.swlstg-tr.nhs.uk/news-and-media/events/hearing-voices/
Ben Goldacre books ( Bad Pharma and Bad science) and the Schizophrenia commission report
make very interesting reading.The Schizophrenia report is available through the link above for your
information. I also have the following quotes from various people :-
There is also a good piece in the British Journal of Psychiatry
Dr Pat Bracken sent me a copy of the article :-
"Psychiatry beyond the current paradigm"
For medical staff it can be accessed via the following link:-
http://bjp.rcpsych.org/content/201/6/430.full
For non medical colleagues, you can get a copy of the article from me (via email).
It is a brilliant article which mentions the HVN and
challenges CBT, the NICE recommendations and of course
ECT treatment, if I have read the article correctly.
The article was written by approximately 29 people,
some of whom are (I think) members of the critical Psychiatry network.
Their website :-
http://www.criticalpsychiatry.co.uk/
To quote from the article:-
There is also evidence that many patients who are not active
in the service user movement find psychiatric interventions
problematic and sometimes harmful. In their study of users’ views
of services, Rogers etal found that many service users did not
really value the technical expertise of the professionals. Instead,
they were more concerned with the human aspects of their
encounters such as being listened to, taken seriously, and treated
with dignity, kindness and respect.
To quote from Prof. Micheala Amering:-
While the complex,as well as polarized, discussions about recovery are
both fruitful and necessary, I would like to suggest that in order to
meet the challenges outlined by these debates we might profit from a
simple formulation for our efforts. To guarantee
the human rights of people who come in contact with psychiatry could be
the main focus for all of us in the international mental health
community , be it as peers , clinicians, family and friends, advocates,
therapists or in our research work as scientists.
Such a focus might have far reaching implications.
To paraphrase from the HVN magazine autumn edition 2012, Twinkle O'Sullivan.
Twinkle describes lying to the people "in control" about ECT and voices
because the "ECT treatment" was so bad.
This is a powerful campaign as well :-
http://www.mind.org.uk/crisiscare/restraint?utm_medium=email&utm_source=...
I have problems with some approaches that are suggested
I do not talk out loud to my voices ( I did scream for hours once and it was scary )
I speak to them without speaking out loud,
so I talk but do not make any noise out loud
You can ask your voices a simple question :-
"are you a person , you do not have say"
The answer is often that they are people
Some in the Hearing voices group I attend are so kind
and they say you DO NOT have to work out who your voices represent
If it is non controlling positive telepathy then making other vulnerable
people, as we all are, pretend to be people they are not in the voices
could cause them huge problems
Have been involved in the MH field (as employee & "service user") since 1991. I can mouth the platitudes verbatim; the same vernacular throughout. I have heard this stuff regularly & routinely since that time; it is no more convincing now than it was then or at any point in between. A major step forward could be taken by closing down much of what constitutes statutory Services as literally unfit for purpose & being not what it purports to be.
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