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.

Just to be clear risk of harm to self and others should definitely be prioritised imo.
I don't think we can afford to treat milder conditions and adult ADHD assessments etc (although you can't get one anyway unless you pay).
I don't disagree that other MH issues impact individuals but where do we draw the line? There's insufficient staff and money to support everyone, and people who are high risk are slipping through the net.

Err you can get adult adhd diagnosis. There is a thriving adhd and ASC assessment service where I live. ADHD can often have compulsive and risky behavour and there is a big overlap with ASC. Both often come with MH difficulties. My dc is on the fast track diagnosis service due to his self risk. My other dc was also fast tracked and her suicide attempts are linked to her ND .The medication has been life changing as regards her MH but she still needs a particular therapy. If she gets this she could well cease to be a burden to the NHS. Adult ND assessments are very important as they inform treatments and can help MH hugely.

My mental health condition would have been classed as mild. Until it wasn’t. It was nowhere near the severe point but it was at the point if I hadn’t had treatment when I did I would have most likely posed a risk to myself. My “just anxiety” actually turned out to be more complicated. Thankfully I was able to access medication to stabilise and then good quality therapy which worked for me.

early intervention can save lives. We shouldn’t be telling people to ignore their poor mental health unless they are at the point of suicide or harming others. It becomes a lot harder to help someone from that position.

But how do you keep tabs on someone who doesn't show up for an appointment, doesn't open the door when you do a home visit and doesn't answer the phone?
CMHT doesn't have unlimited resources to place a guard by someone's door just in case they happen to show up at the address that they happened to give, even though they may no longer live there.
How do you insist someone takes medication when AMHP deemed them to have capacity to make a decision about their treatment?
Because this is the only legal recourse we have: attempt contact for as long as feasible, inform the GP and police (to do a welfare check), book a MH act assessment. Beyond that, there is absolutely nothing MH services can do with someone who doesn't engage with support.

Lots of conditions are mild. Until they aren’t.

Usually lack of treatment leads to worsening mental health.

Not that anyone cares. I tried to ask for help as I am struggling. I got a very blunt nurse who didn’t ask about any of the problems I was having or what they relate to - said if I wanted I could go on a months long waiting list but no there was nothing else.

Or did I “want some antidepressants?” I then informed her I’d been on them 20 years. Not that she’d bothered to check.

There really is nothing.

The thing is if they are taking their medication properly then people with schizophrenia are unlikely to be a danger to anyone, and if they are not taking their medication they're more likely to be a danger to themselves than anyone else.

So when they are sectioned and then made stable what do you do? You can't keep all the people with schizophrenia hospitalised to make sure they take their medication properly even if it was ethical because around 685.000 people in the UK have schizophrenia.

I think anyone showing any sort of violent behaviour with their mental health issues needs to be prioritised - but I'd assume that is generally already happening. Getting any help beyond anti depressants is probably extremely difficult unless you are in complete crisis. But MH services can't even cope with the extreme cases as numbers are so great, I expect that is why the people end up falling through the crack as in this case. They look for any reason to get people off their books because their books are so ridiculously full.

Are you suggesting that adults with ADHD, who were failed by the system as a child because they weren’t diagnosed, should therefore have to go the rest of their lives without medication to treat their condition?

Maybe this isn’t what you meant (as you sound nice) but I also think it would help if people realised that anxiety itself can directly cause suicidal thoughts, and even suicide. i.e. I think it’s really important to realise that anxiety alone can be that horrendous - there doesn’t necessarily need to be some underlying other thing.

Untreated anxiety often turns into a panic disorder. The level of fear that people feel leads them to suicide as an escape. If they had received timely and appropriate treatment it wouldn’t have escalated to that level.

I’m sure that can happen too, but I don’t think my loved one developed a panic disorder. He just didn’t want to live life anymore with that level of anxiety (which I don’t think implies a panic disorder). But yes, absolutely - better and earlier treatment is needed!

Have you watched the panorama documentary? It’s actually shocking.

I read the article this morning and only just watched it now.

This guy was arrested multiple times, broke into multiple peoples homes, caused a woman to jump out a window and break her spine in fear, attacked a housemate in Nottingham at the uni, and managed to walk out of three x Section 3 admissions (up to 3 month detainments for treatment) in a matter of days or weeks. I spent longer in there on a section 2!

It is absolutely crazy what the public services have done here. A complete failure over and over. He even had a warrant out for him 9 months prior for missing court for assaulting a police officer and no one picked him up. I am actually blown away.

Regarding your questions you can’t mandate medication to someone who’s well with capacity obviously. It’s quite clear this guy never was well with capacity but somehow fell through the cracks or masked his way out of it.

I believe there are a number of options if they were set up during a section 3. Section 117 aftercare, Community Treatment orders or conditional discharge (which basically mandate a care plan and that if someone doesn’t take the treatment they will be resectioned). And when you are resectioned they can give you the treatment against your will anyway.

This happens though people with severe mental illness can evade authorities for months it's not as simple as we will just resection everyone. Everyone needs to be on side.
I remember arguing with my local police force years,ago yelling them they were obligated to pick up absconded patients , who were detained under the mental health act .

I read the article, not watched Panorama. I'll have a look, thanks.
What I am trying to say is that everyone seems to be focusing on the failures of the MH team but nobody is actually questioning why the police who knew his address and had a police warrant (?for a year) didn't pick him up earlier.
Section 117 and the such are typically organised in a hospital. CMHT has little to do with it. If they couldn't make contact, they couldn't ensure he was assessed and detained, if necessary.
The family are very outspoken about the failures of CMHT which is not surprising given general attitudes towards MH professionals. But it's not the whole story.
I am sure the enquiry will dig up what actually happened in time. I am not holding my breath that the people/organisations responsible will actually get to answer for it. These enquiries rarely lead to any tangible outcome.

Absolutely!

I am not blaming CMHT here at all. Although the discharge back to GP I don’t think that was where the main failure was.

I genuinely believe this was a failure of the hospitals who when they had him in section discharged him without being treated or without a proper care plan.

I don’t know whether they just wanted him off ward as he was too dangerous. They knew he would kill someone so why did it have to be them? Having watched the panorama now I’m genuinely asking myself that question.

And yes I absolutely am asking what on earth where the police doing?! After he nearly strangled his housemate they released him to the same address. When they must have known he was a risk! I’m wondering in the timeline whether this was before or after the arrest warrant?! I can’t remember but if it was after and he had been picked up for assault and released without arrest. OMG.

It is shocking!

I think they are suggesting that psychiatric emergencies need to be prioritised. The system urgently needs more funding to increase beds, AMHPs, psychiatrists etc to allow prompt MHA assessment, treatment and follow up with continuity of care. I don't think people appreciate that schizophrenia in many cases results in poor functioning even with medication. High unemployment, social isolation is common. The suicide rate and morbidity is also very high. People need long term support. This population is being failed the most.

Crisis point with anxiety can cause suicidal thoughts so no, I don't think we should reduce the little funding there is!

'Lesser mental health conditions like anxiety'??

Oh dear, OP, I suspect this isn't going to go well...

Thank you 🙏

I really appreciate your advocacy for this group. The outcomes are so dire! Even ‘good’ outcomes the bar is set incredibly low. And it’s so stigmatised that it’s impossible to have conversations.

I do believe we can have better outcomes. With the right funding, more research, fast intervention, thorough treatment.

Im not sure I even believe schizophrenia is uncurable. The reason I say this is because logically it’s impossible to prove a negative so how can they say that it is. How many people with FEP have been saved from progressing to having repeated relapses and a diagnosis of schizophrenia? We can’t answer that question. But I am sure some have. Which makes me believe it is curable in its formative / early stages.

Interestingly we had an incredible spike in FEP April 2019 to April 2021. 30% increase! I will interested in the coming years to see whether the ratios of this group developing to schizophrenia diagnosis. Because they are unique. Likely having had poor treatment in Covid (against their favour) and also likely to overrepresent higher numbers of the environmentally triggered group (in their favour) as opposed the genetic trigger group. It’s an interesting cohort and I hope they look at this properly. Sadly this cohort might also be responsible for the incidents we have seen the last few weeks. Southport and Leicester Square.

I think it’s so important we look at this carefully. Not just because of the incredibly serious and dangerous outcomes that can happen if we don’t. But also because these people are people too! They also have lives, loved ones, and potential value for society.

@CanelliniBeans what if the person refuses to take their medication /engage with medical staff??? What happens then?? In a perfect world help would be available before the person reaches a crisis point but jts very rare that actually happens

There seems to be a substantial push towards using AI to screen people within Talking Therapies (was IAPT) and directing them towards appropriate levels of treatment.

Over time, it seems as if the NHS will move from using AI for screening to using AI guided therapy with people. Is it Silvercloud that is already in use for online CBT?

Does it seem realistic that early intervention using online guided treatment will be successful, given the substantial scale of need and current lack of resources available?