There is a great deal of pressure on mental health services to
move people from acute services to community-based provision. I am
surprised, however, that the statutory sector has yet to grasp that
it is not possible to make a major investment in specialist
services, such as therapeutic communities, and then expect people
to cope at home with very little support.
As someone who has been using mental health services for 17
years, I find myself at a crossroads because following a detention
under section 3 of the Mental Health Act 1983 I spent eight months
in a therapeutic community. This was very challenging and a major
step forward for me in terms of enabling me to find more effective
ways of managing my emotional distress.
However, while never an easy place to be, a therapeutic
community is a very safe and contained environment; the real work
of learning to live with and manage emotional distress only really
starts when returning home.
The process of leaving a therapeutic community and learning to
live at home can be a real struggle. It is at this stage that
service providers need to intervene and offer support to ensure
that the progress an individual has made during their stay in a
therapeutic community is not lost, but is consolidated and built
For me, a lack of therapeutic support since my discharge has
presented a major problem. Try as I may, I struggle to understand
how anyone can be expected to spend eight months in a very
intensive environment with therapeutic group and individual support
everyday, to then come home to no therapeutic input. I completely
understand resources are limited but it makes no economic or
logical sense to invest approximately £75,000 on sending
someone away to a therapeutic community and then stop it in its
tracks as soon as someone returns home.
In the long term, I need much more input from mental health
services, which in turn means more resources. Should this happen,
statutory service providers will be frustrated with me and yet
again we will end up having discussions about whether community
care is a realistic option.
Therapeutic communities (like many other specialist services)
are never a complete wonder cure. But they are invaluable for
putting people on the road to recovery, and enabling them to
develop the skills, knowledge and insight for what they need to do
to make themselves better. However, the real challenge for all
concerned is to ensure that service users can continue improving
when they return home. To really yield the benefits of the initial
investment, a reduced amount of investment needs to continue for a
while. One would not expect to make a major investment in a home or
vehicle without being prepared to continue some level of investment
after the initial payment.
Humerah Miah is a mental health service