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Tuesday 16th July 2019

Mental health in the slow lane

5th November 2008

Charles Kaye, a mental health consultant and former NHS chief executive, and Michael Howlett, director of the Zito Trust, write in the Health Service Journal about the state of mental health care.

manindespairQInformation published by the King's Fund shows "wide geographical variations" in the amount spent on treatment for mental health by NHS trusts. The Healthcare Commission has reported that nearly 50% of mental health patients cannot find "out of hours" treatment and many patients have absconded from hospital under current laws.

In addition, the Independent Police Complaints Commission has said that police premises are employed much too frequently as a "place of safety" for mentally ill people.

These reports raise many issues about the standard of mental health treatment in England and Wales.

We have conducted research over several years which points to a number of questions, including "why, historically, have there been so many defects in the service and why do they persist when current investment is at a record high?"

A couple of reports - published this year - have looked at the problem, including The Cabinet Office's Excellence and Fairness: achieving world class public services document and Lord Darzi's review of the health service.

Both pointed to "user control", with the Darzi review setting out more reforms for the NHS. However, what relevance do these reports and reforms have for mental health?

Our research has revealed that despite the reforms of the past ten years, mental health has missed out.

Mental health treatment in England and Wales has been subject to nearly constant change, since the beginning of this century.

"The service is awash with aspirations, replete with rhetoric, turgid with targets" - but there is no proof that the standard of its care is better than it was ten years ago.

The people who use the NHS - the patients - may ostensibly have more involvement in their care, but how important is that in real terms?

In the case of mental health care for the elderly, the demand placed on carers is bigger. The establishment of specialist community teams could mean that patients and their carers fall "through the gaps".

So how could changes really improve mental health care? We think three steps are necessary.

"Recognition. Accept that mental health services and their outcomes cannot be addressed in the same linear fashion as acute services."

"Adjustment: Dismantle the well-intentioned but counter-productive target culture (which is largely input obsessive) and the micromanagement culture."

"Definition: Collaborate with professionals and users, using their skills and enthusiasm, to understand and define key questions that are difficult - and often ignored."

Using these three steps would be a positive way for the NHS to forge ahead with mental health care and take it out of the "slow lane".


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