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Critically Examine Priorities over the Last Decade for People with Mental Health Issues in the Uk

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Critically Examine the Priorities over the last Decade in Provision For People With Mental Health Issues.

Mental health provision is targeted according to the severity of illness i.e. separate provision for those with common mental health problems such as depression and severe and enduring mental health problems such as schizophrenia, which the Mental Health Foundation defines as:

“ Sufficient disability to seriously impair a persons’ ability to lead his or her life… affecting functioning within work, living arrangements or in the family”

(Mental Health Foundation, 1994 p15)

For the purposes of this study, terms discussing the effects of policy on people with mental health problems will be used in relation to people with severe and enduring mental health problems.

In 1998 the Government denounced the policy of care in the community as a failure and announced the introduction of the third way to mental health policy in which a middle path would be steered between community and institutionalised care (Health Committee 2000 pxiv). The key points of current policy are:

Ð'* The introduction of national standards of care via the National Service Framework.

Ð'* Enhanced powers of compulsory treatment and care both in hospital and the community.

Ð'* Safeguards for service users- increased access to advocacy services

Ð'* The inclusion of severe personality disorder as a mental illness

Ð'* Extra funding to improve the provision of mental health services.

Ð'* An emphasis on social inclusion and user involvement

Although changes in policy such as the increased priority and funding of mental health provision have been welcomed by mental health organisations, other areas such as the use of compulsory care and treatment have been subject to criticism (MHF 2001, SCMH 2000). Discussion of these arises in three key areas:

v Which issues motivate current policy and who benefits from it?

v The extent to which previous policy was deficient.

v Questions over the efficacy of new Government policy in relation to previous provision.

The Government states that new policy will provide a balance between the safety of the public and the rights of the individual. Some have questioned this stance arguing that high profile media attention over murders committed by people with mental health problems has ensured the primacy of public safety over the interests of those suffering from mental health problems (Goodwin 1997). Others argue that mental health policy should be shaped solely by the therapeutic benefit to the individual (MHF1994, p17) .The perceived risks to public safety have also been challenged; some argue that the incidence of homicide related to mental illness is small and the numbers of such deaths are in decline (Taylor and Gunn 1999,quoted in Szmukler 2000,p6). In contrast to this there are a reported fifty deaths a year of people with mental health problems caused by drugs administered to control behaviour (Goodwin 1997,p9).

There is also debate over the extent to which service users views have been considered in the policy process. Critics argue that service users’ views have been marginalized in the past (SCMH 2000). The current Government has emphasised a commitment to user involvement in mental health services (DoH 1998). However there are indications that service users were marginalized in current policy discussions (Health Committee 2000,pxxix). Two examples support this claim: although users can plan for periods of crisis and have their wishes considered this is only included as guidance i.e. the service users right to choose a nominated contact can be overridden by professionals( DoH 2000 Para 5.6). Additionally the right of service users to be consulted over their care plan is not written into the National Service Framework in contrast to the position of carers. There is also evidence to suggest that many service users are unaware that they even have a care plan (SCMH 2001,Fleischmann and Wigmore 2000,p30)

Another area of debate covers the extent to which previous government policy was a failure. Although some suggest that the discharge of long- term patients from psychiatric hospitals failed because community care was less efficient at supporting people with mental health problems than hospital care (Chapman, et al 1992). Others argue that the ideal of community care-people with mental health problems managing their illness in a community setting-was feasible but that the policy failed due to the lack of support ex patients received once discharged (Craig and Timms1992).

One possible cause for this failure was that resources were often diverted from expenditure on long term care into acute care provision - hospital beds rather than community support (Pilgrim 1992,p 111).

There is also evidence of a lack of co-ordination between support services because adequate planning was not made both centrally i.e. in the lack of national policy on supported housing provision and locally in the lack of joint planning (MHF1994 pp23-25). Little research was also carried out on the availability of informal care (Chapman et al 1991, pp10-11)

Other causes were structural-The NHS and Local Authorities operated separate systems of assessment and support вЂ"the Care Programme Approach and Care Management. This caused confusion and left some ex patients without a key worker to coordinate their care.Current policy aims to combine Local Authority and NHS structures thus removing some of the structural causes of failure in service delivery.

The final area of debate is the efficacy of current policy in securing its objectives namely a service, which is “safe, sound and supportive” and will act to improve the health and provision of care for people with mental health problems (Department of Health 1998). Some argue that the increased use of compulsion may deter people with mental health problems approaching statutory services for help (Goodwin 1997,p10, MHF 2001). Others argue that when service users did approach professionals for help at an early stage of illness their problems were not addressed (Fleischmann and Wigmore 2000,p20).

Although current policy promotes assertive outreach and a pro- active approach to mental health, current provision gives little recognition



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