Community, Choice and Collaboration.
Attitudes to mental health and wellbeing are going through a major change. Alongside increased public awareness of mental health issues, there are also significant changes in the way that individuals are cared for.
The recent review of the 1983 Mental Health Act, with recommendations from Professor Sir Simon Wessely, focuses on the reduction of restrictions and detention. It is estimated that implementation of the recommendations could mean that some 10,000 fewer people will be subject to detention, with a continued move of patients from hospital into the community.
Alongside this is a drive for reduction in restrictive practices. The Mental Health Units (Use of Force) Act (implementation date awaited) continues the focus on new national approaches and reduced levels of restraint. There is also a call for more patient autonomy, with reduced use of coercive treatment, more choice for patients, even if they are detained, and patients having a clear voice in these proposed changes.
There will be significant shifts in the mental healthcare landscape, towards a more collaborative approach to patient care, where possible. The recently published NHS Long Term Plan promotes technology-based approaches as part of the wider solution to the challenges faced by the sector. Mental health is now leading the way within healthcare, with its uptake of digital healthcare technology, in proactively diagnosing and treating the rising rates of mental illness, particularly when it comes to children and young people.
In support of this, a new cadre of education mental health practitioners will be trained to form relationships with schools and colleges, the police and local authorities, as well as Child and Adolescent Mental Health Services (CAMHS), young people and families.
However, there are challenging systemic, financial, legal and societal obstacles to achieving the laudable aims of providing accessible, effective care, with patient choice and autonomy at its heart.
In this report, DAC Beachcroft examines these challenges, alongside experts in mental health who call for better contracting and new models of funding and care to ensure proper integration between health and social services and housing and care providers so people receive appropriate and safe care for mind and body.
These challenges include addressing the fact that inpatient wards are increasingly becoming places for only the most severely ill, who are usually detained under the Mental Health Act. This results in precious little space to admit less acutely unwell patients on a voluntary basis. Whilst every detained patient has the right to access an independent mental health advocate (IMHA), our experts worry that cash-strapped local authority commissioners won't be able to continue to pay for them. They call for more money for local authorities so that patients can be treated in the community.
A key concern, repeated by several interviewees, was the importance of specialist community support and therapy services, and 'soft' community support to keep people out of hospital living an independent life.
We'd like to take this opportunity to thank our experts: Dr Gill Bell (Assistant Medical Director at Northumberland, Tyne and Wear NHS Foundation Trust), Dr Lynne Green (Consultant Clinical Psychologist and Clinical Director at XenZone), Dr Ahmad Khouja (Medical Director at Tees, Esk and Wear Valleys NHS Foundation Trust), Sue McLaughlin (Interim Deputy Director of Nursing for Patient Safety and Quality at Berkshire Healthcare NHS Foundation Trust), Dr Keith Reid (Associate Medical Director for Positive and Safe Care at Northumberland, Tyne and Wear NHS Foundation Trust), Dr Tony Romero (Chief Executive Officer at Cygnet Health Care) and Mel Wilkinson (Head of Mental Health Legislation at Tees, Esk and Wear Valleys NHS Foundation Trust).
Click hereto download the report in full, or see below for the relevant articles:
FROM HOSPITAL TO COMMUNITY
Years of hospital bed closures and policy changes have already seen a significant shift of patients from hospital to community settings...
Click here to read article on from hospital to community.
COMPULSION VERSUS AUTONOMY
Mental health professionals welcome the main thrust of legislative reforms to provide the 'least restrictive' treatment. However, they note that detention is now the rule on some wards...
Click hereto read article on compulsion versus autonomy.
CHILDREN AND YOUNG PEOPLE
The NHS Long Term Plan puts great emphasis on the need to improve access to mental healthcare for rising numbers of children and young people. Demand is rising but CAMHS staff and funds are in short supply...
Click here to read article on children and young people.
The mental health landscape is changing rapidly, and the potential for improvements in access, care pathways and patient autonomy comes across clearly from these valuable insights from colleagues across the sector...
Click hereto read the report summary.
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