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Practice comment

Good mental health is rooted in social cohesion, not the individual


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.



Readers' comments (5)

  • Andy sounds like he is arguing for family values and arguing against the nanny state which is complicated political territory for a nurse to tread. As far as the evidence base goes I was hoping he would quote the Whitehall II study findings that both physical and mental health depend upon social control and participation in organisations. Thus a prescription of shallower social gradients at work (Marmot) and reduced social inequalities in the economy (Wilkinson) would have been more appropriate: A radical Equality and Diversity agenda is required if we are to entirely remove social disability from Layard's 'economic happiness' = IAPT equation and thereby improve mental health recovery rates/times as a whole.

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  • As a mental health practitioner. I have come to realise that mental health issues is far wider than mental illness. So much work still needs to be done at community level to protect and safeguard the mental wellbeing of each of us. There is a need for more community activities for babies, toddlers, teenagers, adults and elderly. I would like to see more accessable sport clubs, tennis courts, basket ballcourts, dance clubs, competitons in local communities so that people will get to know their neighbours and develop informal support network. As much as I agree that the economy has a great impact on our mental health. I have to stress a focus on family values, integrated communities and social inclusion in the short term may have more positive outcome than grasping at unrealistic plitical goals.

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  • The decision to exclude Patient Choice from the 'New Horizons' Inequalities and Mental Health agenda is evidence that social control has completely trumped the healthcare , equality and human rights dimensions of mental health.

    Non sectioned mental health patients , who can make a range of choices about other healthcare services as of right are still unable to choose their mental health service providers even when relationships have broken down as they often do.

    For all the talk of 'Wellbeing' how we regard and treat patients within the mental health system , obviously a very unfashionable subject to the enlightened looking to extend their expertise to the whole population , is a better indication of where we are at as a society .There again , perhaps the idea is to keep the core mental health system choiceless and oppressive to encourage 'Wellbeing'.

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  • Re: MMJJ, I would say many of the facilities you desire are already available, but only through publicly subsidised (not 'family financed') initiatives (e.g. MIND drop in centres). However, the reality is the majority of MH pts do not find 'basket ball' or 'dance lessons' accessible or amenable to their needs which is precisely why they become disenfranchised; You need to answer why people become disenfranchised in the first place before you can be serious about increasiing the social capital of the mental health community.

    Re: anonymous. I would point to the current governments New Horizons focus on well being at work and Tory proposals to allow MH Trusts to compete for business in the workplace. These visions for the future of MH open up new revenue streams, increase pt. choice, reduce the burden on GPs and keep people well and wealthy, rather than destroy the already fragile MH infrastructure of the NHS through internal markets.

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  • Steve ,

    All mental health services are excluded from the Patient Choice agenda and the New Horizons documentation reduces this issue to a mere footnote stating that Patient Choice in mental health will be further explored and costed outside the ' Inequality and Mental Health' scope of the New Horizons iniative. So rather than increasing Patient Choice as you project the New Horizons agenda is discriminatory and amounts to the same old Choiceless vision for anyone using mental health services. I forsee the Government being sued over this ongoing discrimination.

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