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Mind supports Frontline First
Posted Wednesday 1 December 2010
Originally posted on the Frontline First blog.
Mind supports the RCN’s Frontline First campaign because of the vital mental health care provided by nurses.
Mental health is a core part of the health and wellbeing of our society. One in four people will experience mental distress at some point in their lives and the cost of mental health problems stands at £105bn in England alone. The World Health Organisation has estimated that by 2020 depression will be the second largest single cause of ill health in the developed world. And it is mental health nurses who make up the majority of staff providing therapeutic care, particularly to those with more serious problems.
Frontline staff work in a range of diverse settings and have a number of different skills to help people’s recovery. Psychiatric liaison nurses based in emergency departments assess and support people who have harmed themselves. Mental health nurses in crisis resolution and home treatment teams work with people in acute distress who would otherwise have to go into hospital. Those nursing staff in hospital care for people at their most distressed and vulnerable.
Nursing professionals have diverse skills, some are trained in providing particular therapies, some specialise in particular mental health conditions such as eating distress. Nurses in community teams are welcomed as a lifeline or reach out to people who reject services.
Mind’s Care in Crisis campaign is investigating the state of acute mental health services; difficulties accessing care and the importance of continuity are two of the many themes people are raising with us. The economic downturn is likely to increase the demand for mental health services even more.
There are already problems in parts of the acute care sector but these only become more difficult to resolve if services and their nursing staff are stretched further. Research into acute care shows that therapeutic contact with staff increases service user satisfaction. The mental health nursing frontline needs to be supported to provide that.
Allison Cobb, Senior Policy and Campaigns Officer
8 Comments
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In the last 14 months I have had such problems with Cpn's to the extent I am making a complaint to the local PCT. NHS have moved from previously cultivating a dependancy model based on mental health for support, medication and monitoring to their idea of patient self responsibilty. This is a massive change for long term patients who have been been forced into NHS policy change without proper explanation I was given an abrupt diagnosis of changed diagnosis. I have been told after 18 years of Lithium treatment for Bipolar diagnosed despite records showing that after weeks in a psychiatric hospital in 1991. The new psychiatrist said I was merely mildly depressed causing distress and means I have been taking Lithium for 18 years due to misdiagnosis. The case is continuing with Icas support.
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Service users will have much less contact with nurses now because services are being reconfigured so that unless actively psychotic or a danger to others many people will find themselves discharged back to their GP's at the behest of commissioners. GP's have already stated they don't have the time nor training to take on masses of people who were under the CMHT. GP's prescribe or refer and average appt times are 5 mins, they won't have time for mental health with their new commissioning responsibilities, and certainly not for report writing for benefit reviews. Some nurses have also reported the DWP 'instructing' GP's to not issue further sick notes to claimants failed by the WCA. CMHT's are very concerned about their service users - it's a pity healthcare workers didn't stand together and take a stand here because commissioners couldn't discipline or sack all of them. Access to secondary services for those discharged back to GP's will only occur during periods of crisis and access to crisis/recovery services will be much more time limited because discharge equals recovery apparently and will mean more people can access services. Consultants will increasing only be overseeing the 'complex' cases, far fewer people will have a CPN and certainly not long term as this has been classified as 'dependency' by commissioners [ditto day centres] although 'dependency' doesn't apply to all long term service users if they are seen as important to keep in contact with to ensure they take medication, so the description of 'dependent' seems to apply to anyone who wants a service and whoever commissioners want to offload. They want people to use community services or attend set groups in the voluntary sector, so local associations can expect to be inundated with those who can handle groups, those who can't will get nothing because users simply socialising is not good enough for commissioners, not normal enough, not independent enough.
Apparently service users were asked about this and wanted this, but I just can't remember when... -
There are major changes to mental health community services/CMHTs (as expressed in previous comments) which I hope that Mind will take on board, campaign, raise and act on?
I have also been told that use of secondary care services will only be at certain points in someone's life, in line with other chronic conditions eg diabetes. Those on caseloads of community mental health teams face being discharged back to the GP, primary care. Commissioners set a Recovery target that mental health Trusts have to follow, which amounts to discharges (rather than about mental wellbeing and positive change). It often looks as though only those who meet criteria for assertive outreach teams would get a longer term service. For others it will be short term interventions eg several months.
Some charities may claim that this model is good, fits with social inclusion, reducing stigma, patients can be seen in GP surgeries like everyone else. But it will be a shock for many people who have used mental health services for a long time. it's as though therapeutic relationships, consistency, and true recovery values are thrown out in what amounts to a need to save costs. I also was informed that this approach benefits new people who need to use the service.
Early intervention in new cases is obviously important, but it does leave the issue of what will happen to those for whom early intervention came too late. The thought of re-referrals during times of relapse isn't really about recovery, more about expecting things to go wrong in future but since the service has to change none of this matters.
As well as Mind's acute crisis campaign, it does need to look at what is happening in the community which may in future be contributing to crises.
Charities will have to fill the gaps where people were previously under community mental health teams. But what about those ex service users who can't find what they are looking for in their area, and also have other external pressures at the moment (I can think of many....) -
Good points @concerned.
Mind will need to consider whether it's local associations are able to take over what nurses have been doing i.e. CPN's, and offering a service to all the people discharged back to their GP's as apparently it's now down to you to offer counselling, self help and groups - presumably you knew this? Psychiatrists have been telling service users to seek counselling/groups from Mind.
I would like to know what part Mind will have in the Work Programme:
2.1.i. Set up a new procurement framework, identifying the key private and voluntary sector providers with whom the Department will contract.
Are you going to be part of the procurement and tender for contracts? I think members need to know because if Mind is going to be working alongside the private employment agencies contracted to get people jobs that would change the face of the voluntary sector because welfare is now all about conditions and sanctions and we need to know if you will be a part of that.
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I've witnessed similar things to what the above commenters have mentioned. Namely community psychiatric nurses adopting a bolshy pseudo-recovery attitude towards service users who were really suffering and struggling badly despite their best efforts but were being told they weren't doing enough and weren't pushing themselves enough and basically needed to stop being so silly.
Yet at the same time, another CPN care coordinator refused to allow 'her' long-time service user to even learn about proper paid employment opportunities, not that it was her right to dictate that.
In one case someone really needed a proper recuperative period in a properly supported residence, but all he could get was a few days on a confusing clinical ward where he was neglected by the nursing staff who couldn't even be bothered - well they would say they didn't have the staff numbers - to accompany him outside for 10 minutes each day, or chat to him with any regularity to avoid him just becoming isolated and suspicious again.
In another case the ward staff had totally failed to put together the mandated care plan for a patient, which meant they couldn't get move-on accommodation when it became available. That didn't stop them illegally trying to tell the patient where he could or couldn't go while on leave, while at the same time not officially sectioning him so they didn't have to bother with the paperwork for themselves or to inform the patient of his rights.
And I've also seen psychiatrists manipulating diagnoses to suit whatever their service agenda was with a patient.
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Hi Mindreader, sorry for the delayed response.
Mind is part of a newly formed consortium called Disability Works UK, a not-for profit group of nine charities from across the disability sector. The government’s ‘work programme’ is still in development so it’s early days yet, but the idea is that Disability Works will be able to bid for employment support contracts to offer people with disabilities and health problems specialised vocational support to help them prepare for work, and help them find employment. All the charities have different areas of expertise covering mental health, learning disabilities and physical disabilities, and if Disability Works wins any contracts, it will share the work out to the charities in the consortium with the most relevant expertise.
From Mind’s perspective, this will be carried out by Local Minds, many of whom already work day in day out with people with mental health problems who want extra support to help them get a job. The involvement of Mind in this process means that people with mental health problems will have access to the support that meets their needs, and is specifically tailored to address the barriers they face in getting back to work. This is something that many Local Minds are able to offer in a far more effective and supportive way than private employment agencies can, to the benefit of the individual seeking to return to work.
Mind does not believe that sanctioning is helpful for getting people with mental health problems back to work and will not be applying them. Sanctions are applied by Job Centre Plus, not the operators of employment support schemes.
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How can Mind seek to win contracts and yet not be supporting the sanctions? If you're delivering any scheme, no matter how well you think you may be doing it, you're part of the sanctions whether you like it or not.
Personally, if I'm told to attend a workshop or meeting or course or session of any kind in order to continue to receive benefits, that's going to have me cowering in a corner and probably result in a trip to casualty to go with it. It matters not to me if it's run by the Shaw Trust or Mind or Satan himself; the sheer pressure that I MUST attend or lose everything will be enough to send me over the edge.Will I be allowed to phone the mindinfoline in order to get help when I'm in crisis because I've been told to attend a session run by Mind?
A smiling tea-making firing squad is still a firing squad. -
You will be part of the sanctions Mind because as Annika says, if people do not attend sessions run by the employment project [whoever they are] as required they will be subject to sanctions. Local associations may well provide superior support to people than private companies but I foresee that becoming the major function of local associations - finding people employment. Do local associations want to do that at the cost of for example doing less of other sorts of support?
I still cannot get away from the fact that failure to attend workshops/groups/courses/1-1 sessions run by ANY back-to-work scheme, whoever it's run by would result in sanctions for people irrespective of whether that scheme directly reports to Jobcentres/DWP or not. There is a world of difference between offering back-to-work support as part of a local associations services and being contracted and paid to do so by the DWP. Local associations I fear will be compromised - they could be expected as part of their work to report on individuals progress, report voluntary work [which would prejudice an appeal]. The blurring of statutory and voluluntary sectors could backfire
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