One Stop Mental Health

    Mental health has been in an ambiguous position in recent years. On
    the one hand, since Labour came to power in 1997 mental health has
    been one of the top three priorities for the health service
    alongside cancer and coronary heart disease. This enhanced status
    has brought some improvements, notably with the creation of new
    specialist services.

    On the other hand, the draft Mental Health Bill reveals an agenda
    for mental health focused on risk management, and the controversy
    over its provisions may have elbowed some more basic issues off the
    table, such as access to psychological treatments.

    Despite priority status, it remains the case that many people with
    mental health problems have a poor quality of life. There are
    people with long-term, serious but stable mental health problems,
    leading isolated lives. They often lack adequate options on making
    long-term recovery, and on rejoining the labour market. Beyond this
    group, there is an even larger number of people with relatively
    common mental health problems who find few options for treatment
    beyond a prescription for pills.

    In June, the Institute for Public Policy Research published a
    report setting out a vision for mental health in 20 years’ time,
    where mental health is taken as seriously as physical health both
    by politicians and the public.(1) The report advocated developing
    walk-in centres where people can get advice on all aspects of
    healthy living, including mental health. So for instance, if an
    individual had concerns over their own health or that of a friend
    or family member, the walk-in centre would be a place to find
    books, information, IT resources or information about local support
    networks.

    People would also be able to talk to “access workers”, trained
    professionals who could offer advice, support, or counselling.
    These workers would be able to suggest ways for people to look
    after their mental health, perhaps through exercise, reading or
    volunteering. Where appropriate, access workers could help open up
    a quick route into specialist services.

    The walk-in centres would also champion mental health issues, by
    taking a lead on mental health promotion activities in schools and
    workplaces, and co-ordinating local campaigns to tackle stigma and
    discrimination against people with mental illnesses. In fact,
    creating the kind of services that people feel comfortable to
    access in the first place could go some way to reduce the stigma
    around mental illness.

    Developing this kind of grassroots support could help to fill some
    important gaps. About nine in 10 mental health problems are treated
    in primary care, and between 30 and 50 per cent of people with a
    severe mental health problem only use primary care services.(2) For
    many of these people, GPs offer a front door into the health
    service. However, while there are some GPs who offer very good
    support for people with mental health problems, this does not
    appear to be the case for most people most of the time. Relatively
    few GPs are interested in mental health issues.

    In a study of one local area, three-quarters of GPs said they were
    more interested in general medicine than psychiatry.(3) In a survey
    by Norwich Union Healthcare of 250 GPs last year, eight in 10
    admitted they were over-prescribing anti-depressants and
    three-quarters said they were handing out more drugs than five
    years ago.(4)

    Moving mental health into the wider community is one way to focus
    on developing better treatments. But it could help to move mental
    health to become a mainstream priority outside the health service.
    This is critical, because for many people the key to being able to
    manage a mental health problem is about much more than medical
    treatments. Getting advice on housing or training and employment
    opportunities, or even just having someone to talk to are all
    elements that can be just as important in helping people feel well
    again.

    Walk-in centres could provide an interface between the health
    service and services such as Jobcentre Plus and Pathways to Work
    pilots. For example, the walk-in centres could offer training to
    people on incapacity benefit to help them prepare for the
    workplace.

    The type of community centres we envisage in this report are not
    dissimilar to other integrated community-based initiatives, such as
    Sure Start and children’s centres, or Link Age for older people.
    Last year the Institute for Public Policy Research also put forward
    the idea of connected care centres, a model to help provide health
    and social support for people with complex needs who live in
    deprived communities (5). Rather than a fixed blueprint, connected
    care centres are based on core principles, such as co-location of
    different professionals and providing a single point of entry into
    services.

    Although, it was envisaged that connected care centres would be
    based in deprived neighbourhoods, many of these principles could
    have a wider application in relation to a new community-based
    primary care agenda for mental health.

    There are already signs that primary care for mental health is
    rising up the agenda. Last year, the mental health “tsar”, Louis
    Appleby, suggested that the next phase in implementing the 10-year
    national service framework would see a new focus on primary care
    and mental health promotion. Also, the Labour manifesto for this
    year’s elections said: “almost a third of people attending GPs’
    surgeries have mental health problems… so we will continue to
    invest and improve our services for people with mental health
    problems”.

    This is short on specifics, but it could be a promising point of
    departure. For one thing, it suggests a new interest in the mental
    health of the whole community and a move away from the old, but
    still influential view that mental health is all about public order
    and risk management.

    Since 1997, there has been a significant increase in the number of
    integrated community-based initiatives to help tackle complex
    social problems and offer people joined-up support in different
    areas of life. Mental health needs to become part of the web of
    local community-based support. This is one way to ensure that
    tackling mental illness and promoting mental health becomes a
    mainstream concern for all local communities. 

    Jennifer Rankin is a researcher at the Institute
    for Public Policy Research, where she has written several reports
    and working papers on health and social care. Her main interests
    are mental health, social care and the future of public
    services.

    Connected Care Centres

    • Co-location of NHS, social care and voluntary sector
      professionals.
    • Common assessment procedure.
    • Established procedures for sharing information.
    • Shared training of staff.
    • Single point of entry.
    • Round-the-clock support.
    • Managed transitions – flexible approach to age boundaries.
    • Continuing support – no “closed cases”.

    Training and learning
    The author has provided questions about this article to
    guide discussion in teams. These can be viewed at
    www.communitycare.co.uk/prtl and individuals’ learning from the
    discussion can be registered on a free, password-protected training
    log held on the site. This is a service from Community Care for all
    GSCC-registered professionals.

    Abstract
    Many people with mental health problems have poor quality
    of life and a limited range of treatment options. A new agenda for
    community-based services could make a positive difference for
    people with mental health problems.

    References
    (1) J Rankin, Mental Health in the Mainstream, IPPR, 2005.
    Order from www.ippr.org.
    (2) Cases for Change, National Institute for Mental Health in
    England, 2002. Download from www.nimhe.org.uk
    (3) J Boardman et al, “Needs for mental health treatment among GP
    attendees”, British Journal of Psychiatry 185
    (4) Norwich Union Healthcare, Guide to services for a healthy mind,
    2004. Available at www.drfoster.co.uk
    (5) J Rankin and S Regan, Meeting Complex Needs: the Future of
    Social Care, IPPR/Turning Point, 2004. Download from
    www.turning-point.co.uk

    Further information
    * R Layard, Mental health: Britain’s Biggest Social
    Problem?
    , 2005. Available at www.strategy.gov.uk

    * The National Service Framework for Mental Health, Five Years
    On
    , Department of Health, 2004. Download from www.dh.gov.uk

    * Mental health and Social Exclusion, Social Exclusion
    Unit, 2004. Download from www.socialexclusion.gov.uk

    Contact the author
    By e-mail: j.rankin@ippr.org

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