Funding priorities for MH care

[CanelliniBeans]

Just reading the latest on the failures in MH care in the sad case of Valdosta Calocane.
AIBU to think we should prioritise funding for serious mental health issues over the funding of treatment for lesser MH conditions like anxiety? There's not enough money to go round and we need to ensure people who are a risk get treatment.

What "treatment" do you think people with things like anxiety get? There is none.
Equally earlier interventions lead to better outcomes. Ignoring people until they reach crisis stage (which is mostly the current position) helps no one.

I don’t think it’s that simple though. There needs to be an overhaul without doubt but not to the point that “lesser” conditions are ignored. That won’t help anyone either.

What is needed is for people to be able to be treated before they hit crisis point. For stigma to be removed. For there to be much better long term support for those who need it. We need a system where people don’t fall though the net.

downplaying one persons issues and making it harder for them to get support won’t fix anything.

There is a difference though between crisis point with a condition like anxiety that impacts an individual and crisis point with an illness like schizophrenia that can have more wide ranging impact. Ideally we would treat both but if there's just not enough to go round then we should surely prioritise getting the care right for those with significant MH problems like bipolar or schizophrenia that is not controlled.

Having worked in mental health for close to 20 years there has been significant investment in mild to moderate mental health treatment. I don't believe that this should stop but overall mental health investment needs to be put on the same footing as physical health investment.
There is also a huge amount of work that needs to be done around expectations on mental health services and what can realistically treated.
Over the past 7-10 years there has been a huge shift with referrals being made to mental health services for all kinds of mental distress caused by societal issues. Much of this can not be treated by mental health services. The wider system needs to work together to address much of this.
For example people experiencing housing issues get referred regularly. It is a normal response to become distressed if your housing is at risk but it isn't something that can be resolved by mental health services. We may be able to advise on coping strategies and possibly medication but the reality is it is the provision of stable housing that will improve mental state not an actual mental health treatment which is all we have to offer.

The problem with your approach is that the people with "lesser conditions" (not sure I agree "Anxiety" is a lesser condition) without support and treatment may well go on to develop more "severe conditions".

That basically reads as it’s fine for people to kill themselves as long as they don’t harm others.

Problem is that there aren't the staff to recruit half the time anyway. We have vacancies unfilled for over a year.

The funding is already prioritised. People with serious and enduring MH conditions are often hospitalised, are mostly under community MH teams, crisis support team (home treatment team), sometimes live in sheltered accommodation/supported housing etc. People with anxiety do not receive (or need) this level of service and engagement. IAPT which is offered to people with anxiety cannot work with people with serious mental health condition. And, I would imagine, getting rid of IAPT will save very little money.
The problem is that there isn't enough staff in community services, isn't enough funding for hospital beds and, frankly, some people don't want to engage with any support and we can't make them unless they lack capacity.

Anxiety is very different to something like schizophrenia ,most people sufer with anxiety to varying degrees they do not go on to develop longterm,enduring mental illness,s such as schizophrenia .

1. anxiety is causing people to not being able to work at record levels. We can’t afford to not support people.

2. they don’t get any support

3. if MH is left unsupported it gets worse

4. you’re saying people like my daughter who has tried to kill herself several times should be left to die because she’s not at a risk to others

It stops people from working and if left unchecked or supported can lead to serious MH and a risk to life. I know because that is what has happened to two of my children. Schizophrenia isn’t the only serious MH condition out there. 🤔

The problem with your suggestion is that mental illnesses generally start off quite harmless but can soon ramp up in severity if left unmanaged. So someone who may present with ‘anxiety’ could soon develop more significant mental ill health if left to their own devices.
The best way to support any illness, be it physical or mental, is by prevention. We are getting much better at screening for physical diseases - breast, bowel and cervical cancers for example. As far as I know, there is no screening carried out for mental well-being.
There needs to be a 360 degree approach within the current healthcare system. Improved screening, early intervention, increased resources for significant health concerns and a massive increase in the funding of infrastructure and staffing.
I’ll start by suggesting we get rid of DEI staff, rainbow lanyards and other such pathetic cost heavy initiatives!

Why cut the services for anxiety?
Why not cut say cancer services because cancer doesn't cause someone to be dangerous. They can just suffer & die quietly without causing a problem to anyone else.

Alternatively we could properly fund services for all, regardless of whether it's mental or physical.

I think we need to be honest. For someone like your daughter, clearly anyone who is suicidal is suffering from more than ‘anxiety’. That makes it sound like someone feels a bit anxious so will attempt to take their own life. When in reality, to have got to that place one has to have some serious mental illness that has not been dealt with effectively.
Perhaps the use of the term ‘anxiety’ makes people think it’s something and nothing - we all have a certain level of anxiety over things from time to time such as taking a driving test, meeting new people, having a baby. So if someone has never experienced debilitating anxiety they might never understand it and therefore dismiss it as being something and nothing.
Far too many people are in the same situation and state of mind as your daughter and something radical needs to be done to change that. Both within the NHS and within society as a whole. I hope she gets the support and treatment she needs x

But the point is she wasn’t suicidal in the beginning.

And we shouldn’t be dismissing all mental health struggles as a bit of anxiety.

Maybe, but I know a few therapists who struggle to find work or apply for certain jobs in MH, despite having skills, qualifications and experience.

This isn't realistic, you can't really screen the huge numbers who present with anxiety and more moderate mental health issues. Not really comparable to cancer where you at least have some biomarkers and tests with decent (ish) sensitivity/ specificity. How many presentations of anxiety convert to SZ or BD 1? The prevalence rates haven't changed much compared to anxiety/depression which have rocketed. Some people will experience SMI no matter how well you try to prevent with public health strategies and broader social policy.

We aren't actually managing acute crises CURRENTLY. A huge amount of funding is required just to increase beds alone. That's before you even try to improve the quality and training of staff in inpatient settings. Or make wards halfway therapeutic (newsflash: they are grim and traumatising). The next thing is needed is ensuring high risk SMI patients have one psychiatrist and one CPN who have actually seen in them in sickness and in health. Maybe a therapeutic relationship with trust rather than a carrousel of phoning it in locums and agency staff?

I completely agree with the OP. Our concept of mental illness has expanded too far. The clue is in the name. SEVERE mental illness. Services are spread too thin and trying to address social issues they weren't set up for. Access to services must be based on need.

@Soontobe60
I’ll start by suggesting we get rid of DEI staff, rainbow lanyards and other such pathetic cost heavy initiatives!

I don't agree with that. How much do rainbow lanyards cost? £5 per person? Hardly a massive cost-saving measure. In an average team of 20, it won't even cover one day of hospital admission. Besides, they are not more expensive than regular lanyards and I had mine for about 6 years now.

As far as DEI staff, it may seem frivolous to you but they are 1. making sure patients and staff are safe and 2. often don't require additional resources. I have been a DEI champion in teams before and was responsible for making sure my team understands how people with disabilities should be best supported in treatment. This may include making sure accessible communication needs are recorded in care plans, hospital passports are circulated among the staff who come in contact with the patient, educating teams on needs of disabled patients on their case load and how these needs can be met. All of that probably took 30 min of work per week - hardly a huge cost to the trust. Striving to improve staff awareness in this area is not "pathetic initiative", it insures horrific cases like that of Oliver McGowan never happen again. It also ensures that people with ASD/LD and other disabilities receive appropriate support while detained in MH hospitals meaning they are more likely to engage with treatment and have a positive outcome.

As to the OPs point, I went and had a look at the details of supposed NHS failings. He was discharged to the GP by community mental health team for failure to engage. Which means he wasn't showing up for his regular appointments, probably wasn't home when they tried to do welfare checks etc. Quite what the public expects MH teams to do about that, I am not sure.

Access to services being based on need is what IS the issue!

Now if you try to take to your own life you are sent off home with medication and the home treatment team popping in for a few days. It’s a sticking plaster and you are left and don’t get any actual treatment UNTIL you get even worse. It’s a false economy.

Covid and the withdrawal of services during lockdown has shown how detrimental this is. The backlog after has been horrendous.

Are your friends psychologists? There is very little scope for psychology in acute services. Most patients are too unwell to benefit. The unfilled vacancies are mostly for nursing and occupational therapy posts.

How many people with anxiety alone end up detained under MHA let alone lifetime hospital order?

The Calocane case has resulted in 3 deaths, 3 serious injuries and the lives of four families destroyed.

Sorry if I was unclear - the whole point of my post was to say just that. We use the term anxiety as if it’s a minor thing, when in reality what may just appear as such can end up as a serious mental health condition.

Have you not seen the news? Hoards of young people are NEET and out of work due to anxiety and other MH issues.

A lot of complex MH issues are dismissed as a bit of anxiety as struggling people aren’t seeing any professionals.

I’m a MH nurse. Tbh, the biggest issue in cases like this one, and one we find almost impossible to address, is the tension between public safety and the right for someone who is unwell to make choices about their life. Ethically and legally, you can’t keep someone in hospital once they are stable-even if you know they are very likely to deteriorate and may pose a risk to others. You can only force someone to engage if there’s proven risk. The alternative is a society where people are made to undertake treatment because they might be dangerous-an idea which has much wider ramifications.