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Welfare Reform on the Web (November 2006): Mental health services - UK

A better place for everyone

V. Essler, T. Stickley and A. Arthur

Mental Health Today, Oct. 2006, p.16-18

Mental health promotion in schools has been suggested as one way of tackling the stigma associated with mental illness. This article reports on a project which ran a series of drama workshops in a secondary school with the aim of challenging pupils’ negative attitudes towards people with mental health problems. The results suggest that creative interventions can improve awareness and dispel myths about people with mental health problems, at least in the short-term.

Commissioning outcome-focused mental health services

M. Slade

Mental Health Review, vol.11, Sept. 2006, p.31-36

The government is promoting a move towards funding arrangements in which resourcing of mental health services is linked directly to the impact of the work done, using the “payment by results” system as a lever. This new approach requires information about both inputs to the mental health system (what is being paid for) and outputs from it (outcomes achieved). This article outlines some of the challenges and opportunities for mental health service commissioners in fostering this transition, with a particular emphasis on understanding and addressing the reasons why the measurement of mental health outcomes has proved difficult.

Connecting with children in care

M. Conlon and G. Ingram

Mental Health Today, Sept. 2006, p.16-18

Current government policy in Scotland proposes that the principal method of enhancing the mental health of children in residential care is to build up the knowledge and understanding of care staff. The process of working with staff in this way is known as “capacity building“. This article presents the results of an evaluation of the work of Edinburgh Connect, a multidisciplinary team established in 2003 with the remit of developing new ways of meeting the mental health needs of young people in care by building up the capacity of staff to work therapeutically with them.

The Costs of race inequality

Sainsbury Centre for Mental Health

London: 2006 (Policy paper; 6)

This paper examines the financial costs of the differences in specialist mental health service use among people from different ethnic groups in London. It found that the over-representation of African and Caribbean people in psychiatric hospitals, in secure services and in community services costs the NHS in London up to £100m a year. It concludes that if mental health trusts had the funds to invest in more appropriate community-based services for these groups, they could save money on inpatient provision. Community and voluntary groups are key to providing more acceptable and accessible support.

Doing well by yourself

J. Wallace

Mental Health Today, Sept. 2006, p.12-13

Three years ago, NHS Scotland launched the national Doing Well by People with Depression programme which explores innovative new approaches to the treatment of depression at primary care level. All focus on ways to enable people with mild to moderate depression to help themselves, including the use of non-medically trained self-help coaches.

Dustbin diagnosis

C. George

Mental Health Today, Sept. 2006, p.10-11

Many people with difficult and complex mental health problems which doctors cannot easily identify are given the diagnosis of “borderline personality disorder”. They are then abandoned by the system and left unsupported, because personality disorders are considered untreatable. The Department of Health is currently funding 14 pilot projects which are exploring different approaches to treating personality disorder.

Equal treatment: closing the gap

Disability Rights Commission

2006

This report is based on a review of 8 million primary care records, plus interviews with patients in one health board in Wales and three primary care trusts in England. The research showed that people with severe mental illness have higher rates of obesity, smoking, heart disease, diabetes, respiratory disease and stroke than the rest of the population, and are more likely to die younger if they do become ill. It also found evidence of blatant discrimination by the NHS. It recommends that people with severe mental illness should be targeted for health checks, and calls for an end to the assumption that anything wrong with such people is related to their mental health.

Expert inspectors

N. Smith and F. Hasler

Community Care, Oct.5th-11th 2006, p.34-35

Describes a project in Birmingham which supported people with learning difficulties to help inspect registered care homes. The people with learning difficulties who led the project were called experts by experience. They were supported by workers from a self-advocacy organisation, Sandwell People First, to collaborate with inspectors from the regulator, the Commission for Social Care Inspection, in formal inspections of 45 residential homes.

Home from home

C. Jackson

Mental Health Today, Oct. 2006, p.14-15

Duddon Mews is an innovative “extracare” housing complex designed specifically for older people with dementia and other mental health problems. It aims to enable and promote the continued independent living of people normally consigned to residential care.

Is it time to close the doors?

M. Kinton

Mental Health Review, vol.11, Sept. 2006, p.19-22

The Mental Health Act Code of Practice states that the practice of locking psychiatric inpatient wards should be avoided through the maintenance of adequate staffing levels. However, in reality, inpatient wards are now more likely than not to be locked. This regressive move is due to heightened concerns about the risks of patients leaving the ward and harming themselves or others.

(See also Mental Health Review, vol.11, Sept. 2006, p.23-26)

Managing organisational change

D. O’Driscoll

Community Living, vol.20, no.1, 2006, p.18-19

Staff resistance can occur when changes are implemented in services for people with learning difficulties. Change can give rise to stress and anxiety in staff, who respond with anger and resentment.

Opening young minds

R. McCartan and S. Small

Mental Health Today, Oct. 2006, p.27-29

Parents and professionals surveyed in this study of their need for information about mental health services believed that mental health promotion should begin at an early age and should be offered by schools, colleges and youth organisations. The survey also revealed a need for information, training and support for parents and professionals such as teachers who have a vital role to play in the early identification of mental health problems. Services need to make themselves more acceptable to young people by offering informal, non-threatening environments and confidential and non-judgmental practice.

Out of harm’s way

E. Dent

Health Service Journal, vol.116, Oct. 26th 2006, p.22-24

Psychiatric intensive care units are intended to serve patients who are too ill for treatment on general wards but are not offenders. They are locked and service users cannot come and go as they please. There are about 350 psychiatric intensive care units, but standards vary. Best practice guidelines have been published but there is no obligation to follow them. A number of units are inappropriately equipped, for example, 35% lack single-sex facilities. Many beds are blocked by patients who should be treated in low-secure units.

Out of sight

C. Jackson

Mental Health Today, Sept. 2006, p.8-9

There is an alarmingly high incidence of sexual assaults and harassment of women patients in psychiatric wards. Campaign groups say that the problem is being swept under the carpet, and that a Department of Health target that all psychiatric wards should provide separate female sleeping areas and bathrooms has not been fully met.

Overcoming barriers to supported living

S. Lynn

Community Living, vol.20, no.1, 2006, p.8-10

Discusses problems which arise when people with learning difficulties are placed in residential care outside their own local authority area. Remote placement can lead to loss of contact with family and friends. If the residential home closes, the host local authority is often unwilling to take responsibility for supporting people from other areas in the community.

People with learning disabilities in “out-of-area” residential placements. 1, Policy context

J.L. Mansell and others

Journal of Intellectual Disability Research, vol.50, 2006, p.837-844

This paper presents an analysis of the guidance governing out-of-area placement of people with learning difficulties and shows that it is inconsistent and incomplete. The guidance creates a framework of incentives for health and social services authorities that could lead to people being placed out-of-area against their own best interests, with negative consequences for them and for the receiving authority.

People with learning disabilities in “out-of-area” residential placements. 2, Reasons for and effects of placement

J. Beadle-Brown and others

Journal of Intellectual Disability Research, vol.50, 2006, p. 845-856

Information was collected for 30 people placed in residential care out of their own area, through interviews with them, their families, home managers and care managers. The main reasons for out-of-area placement emerged as insufficient local services of acceptable quality and loss of family contact due prior institutionalisation. The effects varied, with the most disabled people experiencing the worst outcomes. Some aspects were worse than comparison studies (choice, community involvement, number of homes meeting all the minimum standards), some were the same (participation, family visiting, and other contact), and one was better (visits to families).

The politics of choice

D. Crepaz-Keay

Mental Health Review, vol.11, Sept.2006, p.16-18

The author reflects on the application of the Labour government’s patient choice agenda to the mental health services and its expectation that voluntary sector organisations will become large-scale service providers. He concludes by calling for the development of strong independent service user voices to empower patients to firstly get involved in their own care and secondly to participate in service development.

Support and services for young people with learning disabilities and mental health problems

J. Davies and A. Giraud-Saunders

Mental Health Review, vol.11, Sept. 2006, p.8-15

Young people with learning disabilities are more likely than their counterparts in the general population to develop emotional difficulties such as depression and anxiety. However, few currently receive a formal psychiatric diagnosis and appropriate support. By the end of 2006/07 Child and Adolescent Mental Health Services (CAMHS) are required to include care pathways for children and young people with learning disabilities and mental health problems under the Public Service Agreement (PSA) Targets. This article describes how services have traditionally supported this group, explores the policy context for change, and discusses some of the projects currently underway to meet the PSA target.

The voices don’t like it …

S. Meddings and others

Mental Health Today, Sept. 2006, p.26-30

It is generally accepted that about 10% of the general population hear voices. Many people who hear voices do not have a mental illness diagnosis. Romme and Escher have pioneered hearing voices groups as a way of helping people to live with negative or intrusive voice hearing experiences. The first hearing voices group in the UK was set up in 1988. This article presents the results of an evaluation of the work of a hearing voices group set up in 2002 in Sussex.

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