Mental healthcare has changed a lot in the past decade but there is no shortcut to national happiness and policy must now focus on promoting social cohesion, says Andy Young
The Labour government has achieved much since coming to power in 1997. The landscape of health and social care has changed dramatically and arguably for the better with the introduction of NICE and national service frameworks.
There is now a clear emphasis on evidence based practice, interventions focusing on health promotion and a real expectation that service users (and carers) will be actively involved in care processes.
However, other developments have been less positive. Mental health law reform was a long time coming, and it finally arrived in the form of the Mental Health Act 2007,which was not a standalone act but a bundle of key amendments that had to be read in conjunction with several other documents.
The introduction of deprivation of liberty safeguards (DOLs) has also been problematic. The provisions are well intentioned, but unnecessarily complex and the precise meaning of “deprivation of liberty” is ambiguous.
Overall, the fragmented nature of mental health law is potentially confusing - at a time when it needs to be crystal clear. Policy around Agenda for Changeis now beginning to bear fruit and there are now growing numbers of associate and specialist practitioners. Consolidating legislation would make life easier for practitioners, service users and advocates.
In terms of statutory roads not taken, dangerous severe personality disorder (DSPD) has proven to be an ill-defined and costly quasi-political construct. The DSPD programme aims to improve public protection, provide new services to improve mental health outcomes and reduce risk, and increase understanding of what works in treating and managing those who meet DSPD criteria. It commissioned research which found the outcomes of treatment are the same or worse than doing nothing.
On one level the programme may be viewed as a bold attempt to ascertain whether clinical interventions can have a positive impact on personality disorder. Insofar as it has opened up the debate and led health authorities to provide facilities for this group, it has been a success and has strengthened the skills and knowledge bases for treatment. However, if the early research findings are accurate, the programme might also be viewed as a rather costly white elephant.
Several actions are needed to improve mental health services over the next decade. First, there must be a sea change in professional attitudes and practice. However well-meaning they may be, long, overly aspirational policy documents do not save lives and paper responses to tragedies are inadequate. Crucially, they do not change how practitioners think and act. While there is an expectation that health and social care professionals should work in partnership with service users and carers, does this actually happen in practice?
In the next policy phase, genuine inter-professional training and education must be prioritised to ensure the new workforce actually ‘works’ in a different way. All practitioners must be non-judgemental and have the confidence to challenge discrimination, inequality and prejudice.
Second, we must be realistic about what can reasonably be achieved. By investing so heavily in improving access to psychological therapy, the government has effectively put a lot of eggs in one policy basket. While it is true that psychological interventions such as cognitive behavioural therapy are highly effective, they are not a panacea or a shortcut to national happiness. To achieve this, the government must focus less on the individual and more on family and society as a whole. We need practical initiatives that promote social cohesion and human flourishing – easier said than done.
ANDY YOUNG is senior lecturer in mental health nursing, Sheffield Hallam University
- Click here to read a Changing Practice article on services for personality disorder.