Severe and Enduring

'Severe and enduring mental health problems' is the category description for people in secondary care in the UK.  The description applies to anyone who's been sectioned or who is under the care of a Community Mental Health Team (CMHT).  People with severe and enduring mental health problems live with their conditions, cope and often recover from their illness.  Not necessarily full recovery  but a return to mainstream life while coping with the longterm condition.

The care provision for secondary or 'severe and enduring' clients is different from the primary care pathway.  Primary care clients are under a GP and have access to psychological therapies such as cognitive behaviour therapy (CBT) and counselling.  Secondary care clients can also receive therapy, but delivered through the Community Mental Health Team and not through GP referral.

Severe and enduring mental health conditions can mean extra limitations for certain clients. Limitations above and beyond the condition itself, barriers on the individual's return to mainstream.   It shouldn't be the case but it is sometimes. At a crucial stage, the recovery path is held back by what amounts to a reinforcement of something that Professor Pat Deegan has described as 'a career in mental health'. 

Current practice around mental health care delivery emphasises as quick a return to mainstream life as is possible and viable.  But the length of time that an individual may have spent in hospitals and under the benefits that are geared to support him or her, can prevent, delay or permanently impair the return to mainstream.  A 'severe and enduring' diagnosis may mean access to appropriate support, but it may also mean a long term stay in the mental health system, supported but cut off from aspiration and opportunity.  This can still be the case after a patient is discharged and living in the community.

Clinical and community teams expend a lot of effort in signposting clients back to mainstream and onto a recovery pathway.  The practical ability to reach for these opportunities may be impaired by a loss of self-worth and empowerment by the time he or she is directed to this part of the care plan.  Clients with severe and enduring conditions may comply in being signposted to mainstream providers because they feel it is required by their teams or because they fear not doing so might lead to losing benefits, not because they have made a genuine individual choice.