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.

You are the ignorant one. Why is schizophrenia defined as severe mental illness by default and anxiety not? The reality is anxiety can be safely managed in the community without any specialist input in most cases.

We have diluted our definition of mental illness too much. Same for the term 'crisis'.

Well obviously it’s not fine.

This is a tragic case. The doctors saw it coming so I think in this circumstance drastic measure should have been taken (ie. Court ordered injection).

But for every Valdosta there are 1000s of people who haven’t murdered anyone. Who have a right to their treatment options. This isn’t the 1920s when we lock people in institutions for life and dissect parts of their brains.

You should look into papers on the treatment outcomes for those with schizophrenia. It’s so dire that a good outcome is ‘are you alive, did you get rehospitalised). Get to the end of a 20 year period in these studies and theres barely anyone left standing. But do you know which ones are most likely to be? Those medicated for life, followed by those not medicated. Followed by those on medication for various lengths of time. Basically medicating can be worse of an outcome than medicating; unless you take it forever. Which causes other issues like trashing your organs and as a schizophrenic your not eligible for organ donation. If some patients want to take that chance then they should be able to.

Clearly Valdosta was past that point as they had relapsed so many times in a violent way. So in a way you’re right and it’s not comparable. But as a blanket statement which is what you have replied to. No it’s not ok.

Stop baiting people.

I'm not ignorant - I have SMI myself (BD) and the first response to my crisis was via the police because we don't have enough AMHPs to assess people promptly or have responsive crisis teams. The current system doesn't respond to people who are ACUTELY unwell. I have experienced florid psychosis and seen other very very unwell patients. I have supported family members with SZ and work ed with MHPs. I have a good idea of SMI. Please don't patronise me when I have a lot of experience of the system. It is also clear a lot of people have very unrealistic expectations about what the service can provide even in the context of significant funding increases.

The point is that 'taking chances' sometimes leads to the death of innocent people, at what point is it fair to leave the choice to someone who often can't make an informed decision? I was sectioned several times as a teenager, I'll be on medication for life which has a lot of negative physical effects on my body and my condition largely just affects me. I don't believe I said anywhere in my post that every single person should be locked away or medicated against their will, that's quite some projection, especially when it seems we agree that in cases such as this it's fine to have court ordered plans for medicating.

@Kebarbra

I agree in this case where he's relapsed frequently and been violent and a doctor has written he's going to kill someone.
But the reviewing doctor said in his whole career he's never seen that written in someone's notes. So this is an exceptional case.

I too have been sectioned for psychosis with suspected schizophrenia. I am not medicated and have chosen not to be against my nhs psychiatrists advice.

Thankfully that gave me a bargaining stick to demand other treatment. I had psychologist and CBT treatment.

And most importantly I was coached by someone close whom I trusted explicitly through my recovery.

Did I have schizophrenia or was it wrong? Do I still have it? Was it just an acute episode. I have no idea. Time will tell.

But I am very grateful for the fast treatment I received and the freedom to give myself that chance to see whether I can live unmediated.

I think there is lack of understanding of what HTT is. HTT is the alternative to hospital admission, they accept people who should have been in the hospital but deemed safe enough to be treated at home. Medication is part of treatment, but the HTT (which, I agree, is a bit of a misnomer) is there to primarily manage immediate risks and to avoid hospital admission. In hospitals, they also don't offer much in a way of treatment aside from providing medication and containment.
The wider "treatment" is a remit of community mental health team. But half my time at HTT was spent trying to convince CMHT that they need to take on a patient and them arguing with me that the patient is not going to benefit from treatment even though they have never met them. That is partially due to mistrust between different community services and, partially, due to lack of staff and funding meaning that the referral criteria tightens every year. Aside from CMHT, there is IAPT with lengthy waiting lists but they won't accept patients who are medium to high risk. So those who don't meet CMHT and IAPT criteria are left behind.
And this is not even considering that patients want treatment but cannot articulate what kind of support they need/want. They are offered psychological therapies which they deem useless out of the gate. They are offered medication which they don't like taking. There is no other "treatment" we can offer. We are not setup to deal with social or financial issues as many of our patients expect. But they decline a referral to social services. We cannot come around to provide company but there are no befriending services for people below retirement age. It's not all our fault. We are working within the system and many of us are doing our best. It's not particularly helpful to hear from people that we are "beyond shite" on top of all the frustrations with the system that we are having.
I left HTT not because I didn't feel passionate about it but because I felt constantly stuck in my fight against the system looking for a service who will accept my patient while knowing the perfect service doesn't exist. All while hearing that it is all my fault.

Time will tell indeed. If someone does refuse medication and their illness causes them to harm someone else the courts should take this refusal into account imo and give a suitable sentence rather than have mental illness as a mitigating factor; especially for those who are in fact able to make an informed decision and have capacity to make that. For those that don't have capacity then yes I don't see an issue with court mandated medication if they are any sort of risk at all.

Time will tell indeed

That's a twattish reply @Kebarbra

I haven't had thoughts to kill/harm someone so why would I assume if I had a relapse that I would kill/harm someone. So my choice to take or not take medication is not based on whether that's a risk or not.

If I did suddenly relapse then kill someone then me not being medicated would be no different to you crashing your car y and killing someone in an accident. Should you be put away for murder. You shouldn't have been driving the car after all. We all know car crashes can and do kill people. So you did know. It happens every day.

Anyway I'm not continuing this conversation with you because you have practically wished me ill. Vile behaviour

I was agreeing with you that time will tell, I wasn't suggesting you'd go on to harm anyone, hence 'someone' and the separation of one statement to the next. I'm not sure what your comparison with the car accident is, if someone is aware of an issue with their car/reason they shouldn't be driving and does so anyway then yes, I do believe their punishment should be harsher than someone for whom it was a genuine accident- is that controversial? I don't agree anyone should get off lightly with murder, but the mitigating circumstances should be considered differently between someone knowingly not taking treatment and someone who either is or didn't have a diagnosis.

Absolutely concur with this.

@Kebarbra

The point is that some people choose to come off medication when they are well rather than preemptively stay on them in case of a relapse. That is me.

This man seemed acutely unwell and refusing treatment during episodes. That is different.

Regarding the car comparison: for my scenario it's akin to your cars breaks failing, you getting it fixed and the car being 'fine' now. But cars do break. Inevitably. So it's more so a definite than someone off medication relapsing. But that doesn't mean you keep it in the garage being fixed indefinitely does it.

In the case your talking about the car has not been 'fixed' but it's clear he didn't have capacity to take his medication so criminalising him for that is also stupid.

There's just no scenario where it's morally right to criminalise someone more harshly for not taking medication/ treatment when they have schizophrenia. The onus here was on MH services to to ensure he does have treatment or they keep tight tabs on him rather than discharge him.

I'm glad people are talking about this. The answer is what the OP is suggesting. More resource thrown at early stage intervention to stop or delay progression of the illness and yes more input into those managing those with long term illness. He shouldn't have been discharged back to GP.

I'm a psychiatrist and completely agree with this.

There is already enough tension since the MHA was amended in 2008 which gave professionals more powers to detain - detentions under MHA have soared since then (admittedly reasons are complex) and people/politicians aren't happy about this so it's being reviewed again and in all likelihood will become less, not more, restrictive. The police are also currently backing off being involved with mental health calls/crises.

Another issue is how accurately professionals can realistically predict individual risk of suicide or homicide (suicide in particular is very hard to predict, even if we know a lot about risk factors). A lot of people seem to think that you can just admit people to inpatient wards to prevent these eventualities but it's not that simple, and sadly inpatient care is rarely therapeutic.

I didn't ever say anyone who has ever had any sort of mental illness should be forced to take medication against their will though? Just that those who have been identified as being a danger should, which I don't see an issue with. The original comment I was responding to was: The alternative is a society where people are made to undertake treatment because they might be dangerous-an idea which has much wider ramifications. You've just taken it all very personally rather than as a broader discussion, not everything is about you!

@BeatenbySassafras 'a lot of people have very unrealistic expectations about what the service can provide even in the context of significant funding increases'

I don't think that having an expectation of ANY treatment is unrealistic and I doubt you would proffer the same observation for a physical presentation. A decent course of psychotherapy costs far less to society than leaving mental health conditions untreated. There will be parents on this thread with children who have received zero support from CAMHS. In some places the threshold is so high that only the actively suicidal are admitted where they can then expect a two year wait for any therapy. We are light years off parity between physical and mental health largely because the bar has been set so low for mental health support and we are apparently 'unrealistic' for expecting any care from pretty much anywhere.

@Kebarbra

The key word was 'might' and you replied

I think that's fine, presumably if rhe extent of their MH condition is that they might murder strangers in cold blood, then it's surely not unreasonable to presume they can't make informed decisions about their health and whether to take medication or not therefore why not have it legally enforced?

The extent of the MH condition schizophrenia is that they clearly might murder strangers in cold blood.

I have explained to you why medication cannot be morally legally enforced on the basis of a MH condition.

In an individual circumstance yes.

It's clear what your say. It's clear what I'm saying. Your just trying to twisty turny out of being wrong.

And yes it is about me. Because that was my suspected diagnosis. So of course I'm entitled to explain to you why that's not ok. Of which I have been very patient in trying to explain.

Anyway we are clearly not going to agree. Thankfully you don't make the law.

People with anxiety aren’t getting treatment, so there’s nothing to be cut! You get medication and that’s all. If you push and complain you might get access to a self study website which tells you about CBT. Or if you’re super lucky you might get a couple of sessions of “therapy” where someone who isn’t a psychiatrist just listens to your worries to get them off your chest.

But people certainly aren’t getting the professional talking therapies they need, which would actually help them. Many of these people have decades of trauma, childhood abuse, bullying and other issues, which require professional support that’s simply not available.

I have tried to get MH support on several occasions. I keep getting a bit better than relapsing. It’s the same story every time. Take these pills and call Samaritans for a chat if you can’t cope. Read this information online. Listen to a meditation video on YouTube. This is when I’m saying I’m suicidal and I’m the primary carer for a small child. Nobody cares.

Yes people who are seriously mentally ill need more care. But the money can’t come from cutting “other services” because they don’t exist.

'Take these pills and call Samaritans for a chat if you can’t cope. Read this information online. Listen to a meditation video on YouTube' .

That's actually what most people with SMI are told too. Even in hospital. 'Use your distraction techniques' if you are having a panic attack or you will be given PRN benzo. We aren't getting any psychotherapy or even much compassion. Some of us aren't even allowed our phone so we can't watch YouTube videos! An inpatient admission is just a very restrictive environment with high doses of medication. And if you really kick off it's hands on, trousers down and big syringe of haloperidol or lorazepam in your backside.

I sympathise a lot of with your situation. The Samaritans are the only people who have been any use to me really. I see a psychiatrist every 9 months who asks me if I want to kill myself or others and pretends to manage the side effects of my medication. That's it. There is no capacity or will to manage illness /psychological problems holistically. Only a very small number will access long term psychotherapy.

It sucks.

While there should be funding to help with all mental health problems, it should be and is prioritised for serious conditions.
My son has been diagnosed with Schizoaffective disorder since 2021 after being hospitalised twice. He currently does not even have a care coordinator due to them being on sick leave with no cover. Never mind a support worker. And is only now being offered therapy. The whole system is disgustingly underfunded.

It does indeed suck when I was a nurse working in acute mental health
There just wasent the time to offer much more than medication,
Often it's one or if your lucky two qualified nurses / shift and 2or 3 health care assistants, with ward rounds ,drug rounds. endless paper work ,and phone calls to facilitate gett8ng through a shift with no major incidents is considered a successful day
I would like to think most staff are compassionate ,but in reality it's, good and indifferent staff with the odd member of staff who really shouldn't be doing the job.

'A decent course of psychotherapy costs far less to society than leaving mental health conditions untreated.' That is unrealistic.

We aren't currently able to manage acute psychosis very well i.e. emergency situations. We need to ensure the current system has capacity for assessment and the proper procedures to take place. This is how human rights get compromised more than they need to be.

Arguably inpatient admission is something to be avoided - it rightly should be a last resort. They are highly stressful, anti therapeutic settings. Increases in beds should happen with the goal of creating slack in the system and hopefully allowing admissions to be shorter ( although some will need longer).

I would love psychotherapy to be more available as much as the next person. But it is expensive and not as scalable as medication. We have a big shortage of clinical psychologists. Should we train more? Yes! But we need to get a safe, functioning system first that protects the most vulnerable patients. There is a lot of talk about prevention here - it is a nice idea but acute psychotic episodes can escalate very quickly. It isnt necessarily easy to predict who will develop a psychotic illness. ' High risk for psychosis' teams have been trialled but they haven't amounted to much and exposed some young patients to antipsychotics unnecessarily. The reality of our current system is based on risk.

I had severe postnatal anxiety after my first was really unwell in their first few weeks. Before I had it, I didn't really know what anxiety was, I thought it was 'a bit worried/stressed'. But I was so anxious I couldn't eat, I couldn't sleep, I kept throwing up, I couldn't sit still and no way was I able to care for my baby. If it wasn't for my mum quiting her job to care for me and baby whilst my husband worked to pay our mortgage, I dread to think what would have hapenned. I was suicidal as I couldn't keep living the way I was living. It took a fabulous psychiatrist, strong meds and therapy to put me back together, I honestly believe she saved my life, gave my husband back his wife, gave my daughter back her mum and I wouldn't be here without her. So anxiety doesn't just affect an individual, it affects whole families.

Arguably inpatient admission is something to be avoided - it rightly should be a last resort
I once called the NHS emergency line and told them I’m having a MH crisis and I’m the primary carer for a small child. I said I was thinking about methods for suicide and I begged them to lock me up. Because I was that desperate for help after a year or two of being ignored and fobbed off with pills. They refused! Said all they could do was talk to me on the phone and do exercises to calm my panic. There is no help available.

This is not a new state of affairs. In the 90s I was having the shit beaten out of me every day at school so I tried to kill myself. All I was offered was medication. Presumably the plan was that I would still be beaten every day but the medication would make me feel less upset about it? The school “therapist” asked me why I was isolating myself and not making friends with the other kids - as if it was a choice I was making, and not others bullying me by excluding me! There has never been any help available for people who are upset and anxious and scared.

That sounds terrible 💐

I also had PND. Got no help at all. You’re lucky your mum stepped up - I had nobody. Asked the HV to take my baby away because I couldn’t cope - they refused. Broke down crying and begged her to take him - nope. Progressed into a full on nervous breakdown which everyone just ignored.

This is a really insightful post.
We need more social care and support and free up MH services for treating severe MH problems.