Mental Health 2010 - Review of the Year 2010 part II

Questions

What was the mental health scene like in 2010 for those at the grittier end of the stick?  What was 2010 like for people in secondary care?  For people under community mental health teams?

Was there more recovery in 2010?  Were people in secondary care able to access mainstream more in 2010?  Were they less doomed to what Dr. Pat Deegan calls 'a career in mental health'?

Did people with severe and enduring mental  health conditions receive enough support from services? Did they receive the right support? Did the support help them or hinder them?

Some answers

Throughout 2010, statutory and voluntary services responded to the health challenge of independence and mainstream in several key ways.  Firstly, mental health teams set up some important initiatives.  These were geared towards client independence and recovery.  Many predominantly service-user led.

Recovery University in the south-west London borough of Merton enables secondary care  clients to access a wide spectrum of trainings and skillsets.  These include preparing for work, independence and life skills, confidence building, anger management and  many more.  Recovery University also trains service users as trainers for forthcoming courses.

Other community initiatives are also up and running, including wellbeing programmes and access to psychological therapies.  However, pyschological therapies in non-clinical settings are still not available should you happen to have a severe and enduring mental health condition.

Training the trainers often draws upon experiences and qualifications which service users have already gained within their life journeys.  Mainstream groups have also utilised service user skills as part of their own training programmes in areas such as visual  arts, music and creative writing.  This has taken the recovery university one stage further, providing paid employment and access to mainstream.

Statutory services continued to  have success in keeping people out of hospital or limiting hospital stays to a minimum.   The downside of this is that more and more people are being discharged from statutory services altogether.  In 2011 this will inevitably result in more pressure on GP services, as it is these practitioners who will become responsible under the latest government directives.

The rolling-out of the personalisation programme should mean more access to direct payments for many clients under mental health care plans.  It should also mean more and more creative uses of direct payments, as DP is being promoted for any activity or outcome that a client deems relevant to his or her recovery.  The Personal Stories videos on the NMHDU site bears witness to some of these outcomes.  With more and more people being discharged from mental health services, it is crucial that personalisation is a success in the new year.

Talking Therapies - are they all they're cracked up to be?

Lord Victor Adebowale, Chief Executive of the charity Turning Point, calls access to psychological therapies as 'the biggest shift in mental health provision in the last 50 years'. (Big Issue April 5th 2010). Lord Victor goes on to state that IAPT (Improved Access to Psychological Therapies) 'gives a lot of people access to psychological treatment who suffer from depression and anxiety, whose relationships may have broken down or who have housing issues. It's the first intervention in that triage, and it's a path for people to get their lives back together'.

It's great that Lord Victor feels so positive about Improved Access to Psychological Therapies (IAPT). Turning Point as an organisation may well be equipped to help deliver therapies to more and more people in an increasingly effective way. It's also the case that psychological therapies are more readily available in some areas, through being delivered in community settings such as family centres and libraries.

However, for many people in the mental health system, particularly those diagnosed as having a 'severe and enduring' condition, psychological therapies can be exceptionally difficult to obtain. Firstly, the IAPT programme is only available to people in primary care who are under a GP. There is no eligibility for IAPT if you happen to be in secondary care or under a community mental health team. The reason for this is that people in secondary care are deemed to have therapeutic provision 'in-house' or within the professional team. If an individual is under section and hospitalised, he or she has the legal right to psychological therapies within 2 or 3 days of their request.

What happens in practice is often very different.  A colleague desperate for therapy applied for it from his secondary care team (his legal right).  Pushed from pillar to post, he finally received therapeutic treatment only through the intervention of the local MP. In the absence of a therapist being in post at the time, the treatment was delivered by the Head of Clinical Services.

It is great that charities like Turning Point are promoting greater access to psychological therapies. It is also great that therapies are being delivered in some locations through a slimmed-down faster process such as a well-being service. Nonetheless, if you happen to be someone with a 'severe and enduring' mental health diagnosis you will have no access to the IAPT programme. The accessible therapies under secondary care depend entirely on whether there is a suitable professional in post within your community mental health team. Despite rights enshrined in law, service users with a 'severe and enduring' condition are often denied psychological therapies.