I wrote the following article for the House Magazine March 2008

For those involved with Mental Health services, Lord Darzi's vision of more health services provided in community settings is nothing new.

The majority of mental health services are now delivered in the community, and it is recognised that they should be designed around the needs of the individual and focused on crisis prevention and recovery.

However, the development of "care in the community" had a tricky start.  It was wrongly blamed for some high-profile homicides and deemed to have failed.

The image of community care as a failure is at odds with the views of many service users, carers and mental health professionals who largely prefer a policy which has at its heart effective and therapeutic treatment within the home environment.  In reality, the number of homicides committed by mentally ill people hasn't increased during the massive expansion of community care.  This is despite a marked overall increase in homicides.

As well as first class healthcare, people with mental health problems also need more support when re-entering the field of work and employers need to do more to combat discrimination in the workplace.

A real turning point came in 1999 with the introduction of the National Service Framework (NSF) for mental health.  This set out national standards for community services, backed up by an increase in funding to provide early intervention and crisis intervention teams.   The emphasis on the need for health and social services to combat discrimination against individuals and groups with mental health problems and promote their social inclusion was particularly welcome.

The structured framework has resulted in significant improvements in services that have given people the opportunity of a more stable and productive life.  There are now many examples of innovative and effective services and these are best when service users are enabled to shape and lead their development.  Suresearch is a network of Service Users in Research and Education that provides user expertise in the research and development of services.  ED-IT is an early detection and intervention service in Birmingham working with young people in mental distress referred from education, health and the youth justice system.  Early intervention – especially if a psychotic episode can be prevented – leads to a much better prognosis.  There are good examples in almost every area but they are beacons in a service that is still significantly under-regarded and under-funded.

The Audit Commission found in 2006 that access to talking therapies, out-of-hours crisis care, and information for people who use community mental health services needs to improve.

The Improving Access to Psychological Therapies project, and the recent £170 million boost it has received, represents a commitment on the Government's part towards ensuring that more people get the talking therapies that are recommended in NICE guidelines.

Whilst a national framework and standards were an important step forward, as we approach the end of the current NSF next year, many of the standards are still not being met.

It is also important that, in concentrating on community treatments, the Government must not take their eyes off the situation for those who do still need to be treated in hospital wards.

The Mental Health Act Commission's recent biennial report “In place of Fear” painted a worrying picture of the state of mental health wards in England.  It reported that patients often find their hospital stay frightening, and that their basic rights to safety and dignity are not always met.

The stigma attached to mental illness still means that mental health services are the soft target for cuts when budgets are tight – those affected are less likely to fight back and engender less public sympathy.  But spending that enables people with mental health problems to live fulfilling lives is the example par excellence of spending to save – both money and lives!  User led mental health services must be strengthened and developed to work alongside other agencies to address problems such as worklessness, substance abuse, homelessness and bad housing that disproportionately affect people suffering mental ill health.
 

Click here for further information about my policy work on mental health and to read about my work as co-Chair on the All Party Parliamentary Group on Mental Health

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