Time and again in all medical specialties early intervention has been shown to yield superior outcomes and mental health is no exception. Focusing funding priorities on young people has the potential to change long term outcomes in symptom burden and functionality. It is clear from my practice over the past few years that mental health problems are becoming a major public health problem in children, adolescents and young adults. Any policy that will focus efforts upon prevention and early intervention is to be welcomed.
The transition from CAMHS to adult services can be fraught with danger. The needs of young people with anxiety, depression and self-harm problems will too often get crowded out by acutely psychotic adult patients and this can skew service design and delivery. If this government is serious about this issue- and I’m not convinced that it is – there needs to be a complete overhaul of the suite of interventions offered by mental health services. The acutely anxious and depressed young person needs a different offering to the middle-aged psychotic patient who requires another compulsory admission. Can our in-patient units provide a therapeutic space for these two – and there are more than two – potentially conflicting needs. NHS in-patient units have been allowed to become untherapeutic warehouses, very similar to the large mental hospitals of yore, only with a much shorter lengths of stay because they can be so untherapeutic. Hard pressed staff in in-patient units, community teams, liaison services and crisis teams know this only too well and try to prevent admissions partly because they realise how untherapeutic these spaces are.
More options are required to allow hard pressed acute services to offer the interventions that are needed. Crisis houses, access to therapeutic day care and quick and I mean quick – access to psychological therapies are just some of the possible solutions. However, until the Department of Health and the Secretary of State acknowledge the need for what amounts to a paradigm shift nothing much is likely to change and the brave words of Mr Hunt will seem like yet more rearranging of deckchairs.
Dr John Wilkins, Consultant Psychiatrist is commenting after reading the article http://www.bbc.co.uk/newsbeat/article/42272042/mental-health-jeremy-hunt-says-the-nhs-needs-to-be-better-at-dealing-with-crisis-patients
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