At the Summit (post 2)

I just had a call from the Campaign Manager at Rethink, who had read my blog (well, I did point to it on Twitter).  She was very sweet, reassuring me that, despite my fears, I was coherent in my 'summing up' yesterday, telling me that I was not the only person to find these sort of events exhausting, and saying that Rethink would be happy to involve me in future events, should I change my mind. 

Anyway, I got to thinking that I really should report on what actually happened at the Summit yesterday, rather than what happened in my head.  So, there were various workshops, on Crisis Care, Primary Care and so on, as I mentioned in the previous blog post.  During these workshops (each delegate attended two) we were invited to discuss what is in place locally and what was needed to improve the system, also what barriers to such improvements existed and how they could be overcome. 

The major conclusion to come out of the day was that more communication is needed, or, as the CCG Commissioner at my table in the physical health workshop put it, more 'inter-operability within systems'.  She said that, for example, psychiatry is still operating largely on a paper system, whereas GPs have long since had access to computers, and that this is a huge bar to communication and monitoring. 

This lady was of the opinion that there was no point starting from scratch, trying to put new facilities in place (like the wonderful sounding mental health centre at Bondi Beach we were told about in this workshop.  Motto:  Keeping the Body in Mind.  Catchy).  She said that would cost too much and take too long. 

In the Commissioner's opinion, the only way to make improvements in physical healthcare of the mentally ill, such as getting people to give up smoking, and tackling the over-eating and consequent weight gain caused by the medication, would be to link to third-party providers.  She said social prescribing would be useful - like giving people a year's free gym membership, or sending them on Stop Smoking programmes.  She also mentioned that there are some great tools available - like a drug called Champix which she says is miraculous at stopping people smoking - but that there is too much risk associated.  She said Champix carries a small risk of depression and suicide, so nobody dares to prescribe it.

In my opinion, risk is a big problem in mental health care, and the risk is often over-estimated.  An example given yesterday was the need to do a risk assessment before a patient can use a gym in a mental hospital - meaning that these gyms are under-used (and presumably then in danger of being closed as a result).

 In the Crisis Care workshop, we heard from Sunderland's Initial Response to Urgent Enquiries (or something like that) team.  They seemed to be doing a good job of getting to people more quickly, by use of telephone and home assessments.  They were treating people in their home for two to four weeks, providing mainly psychological support, and thereby avoiding a lot of referrals to IAPT or secondary services.  (Personally, I would like to see an increase in referrals to IAPT for CBT, but in my local area there's already a wait of a year, so I guess that would be impractical).

We also heard, from one of the London Trusts, that provision was being made for more Crisis Houses, set up for short stays, which prevented hospital admissions.  Which, in my opinion, has got to be a good thing, as long as the crisis houses are run and staffed by good and gentle people.  (Oh, and incidentally we learned from the Minister for Care that we can now choose where we want to be treated for mental health problems, as for physical health.  Great news is theory, although recently whenever I have been sent a 'Choose and Book' appointment letter for myself or a member of my family (for any physical health problems) there is only one choice available).

What I would like to know is how the system plans to deal with people who refuse treatment.  One lady in the workshop was very emotional as she told us how her daughter was recently sectioned after she refused an injection, which makes me think that things have perhaps not changed all that much.  Once you are in the system, it is very hard to get out, and force is over-used - the mother said herself that on this occasion she did not think her daughter needed to be hospitalised.    

I really think that people should not be forced to take medication, and I said so to one of the Sunderland clinicians after the workshop.  He started to talk about forensic cases and how progress is being made with those who refuse medication.  But I made the point that the mentally ill in the criminal justice system should not be treated in the same way as those who have not broken the law. 

I know this seems harsh to those people, or their children, who maintain that they would not have committed crimes if they had not been ill.  It is harsh.  But I still think it would be a good thing if those who had not offended were not treated forcibly in the mental health system.  Ever.  It would stop 'risk' being used as an excuse for brutality, in some cases at least.  It would be a starting point.

I am rambling now!  I am tired again, and it's hard concentrating on writing while supervising children - I try not to do it usually.

Anyway, I suppose yesterday was an interesting and educational day.  In that workshop I learned, for example, that the fear of service overload stands as a barrier to developments that might otherwise be useful, like the use of email for patients to communicate about mental health problems.  It's necessary to know about these things, because we need to create conditions that mental health professionals can operate in.  Making their jobs harder, or impossible, would not help the patients. 

I still wonder what I can do with all this knowledge.  I came home with umpteen pamphlets, leaflets, and several pages of handwritten notes about all sorts of aspects of mental health care, and after sifting through them I am still no clearer about how improvements will actually be implemented.  All I know for sure are the things I went into the conference convinced of - that the label 'schizophrenia' needs to go, and that we need a mental health system we can trust to help us.

I am glad to be able to say that progress is being made.

I think.