clinical practice 1 - services and recovery Flashcards
why are mental health services needed (3)
reduction of suffering
- lessening distress
- improved quality of life (meaningful)
- limit risks to individual and others
social benefits
- diverse, inclusive, fair society
- lower risk to self and others
economic cost and benefits
economic benefits of providing mental health care (3)
output effects
- employment
savings to NHS
- reduced costs
- reduced referrals to secondary sector and inpatients, less medication + GP consultations
- estimated £300 over 2 years
savings to the exchequer
- increased employment
- reduced benefits and increased tax receipts
- saving on NHS costs
economic costs of mental health
costs £105bn per year in England
this is from: service provision, lost work, reduced quality of life
over £2000 per person per year in England
how many people with mental health disorders get help for it (+ implications)
1 in 3
therefore need to think whether more resources should be put into services providing help
would paying to treat more people actually save money?
healthcare costs in England
all problems = £100bn
mental health problems = £13bn
- anxiety and depression = £3.75bn
- children and adolescent MH = £0.75bn
medically unexplained symptoms = £3bn
of all health research funding, only 5% to mental health (large chunk to dementia research)
highest healthcare cost on physical health
IAPT initiative - cost-benefit trade off
cost
4 treatment results
improving access to psychological therapies
for the cost-benefit trade off of investment into treating mental health
mean resource cost for treatment course = £750
result of treatments for all patients (whether they recover or not):
- employment increase by 18%
- absence from work decrease by 31 days/year
- economic output per person rises by £1100/month
- where present, cost of comorbid physical conditions go down by thousands
therefore this has found the benefits outweighed the cost
EIP - 3 outcomes
early intervention in psychosis
seeks to reduce amount of time between onset of symptoms of psychosis (1% of population) and when they receive help
this help aims to reduce impact of symptoms on ability to work, have relationships, be in education etc.
patients receiving EIP services (vs those with non-EIP services):
- 116% more likely to gain employment
- 52% more likely to get accommodation in a mainstream house
- 17% more likely to have improvement in emotional wellbeing (on HONOS questionnaire)
what % of population will develop psychosis
around 1% - then require longer term care
EIP - cost analysis
4 services
overall cost/saving
cost differences:
- lower mental health inpatient costs (£4,075)
- lower acute hospital outpatients costs (£59)
- lower A&E costs (£31)
- higher mental health community costs (£648)
overall:
less costly health services gives a mean annual NHS cost saving associated with EIP of £4,031
overview of NHS care offered
across life span
acute or long term care
physical and mental health
provides info and evidence of practices
general practice in the NHS - % of patient interaction, % who make apt for psychological distress
90% of NHS patient interaction is with primary care services: GPs, dental, or community pharmacy services
30% of people who make an appointment with a GP do so for help with psychological distress
CAMHS
child and adolescent mental health services
refer to them by a GP
- NHS
- assesses and treats young people with emotional, behavioural, or mental health difficulties up to age 18
- most work with whole family to support them
IAPT
improving access to psychological therapies
refer to by GP ( or by direct referrals )
- provide evidence
- often 6 sessions or fewer (very short term) - this is controversial - could feel that treatment is cut short and then not given any further
- for anxiety and depression, predominantly CBT principles
- also focus on economic improvement for patients isn’t liked by some people
EIP
early intervention in psychosis
integrated service for age 14-65 presenting with first episode of psychosis
multi-disciplinary team (doctor, nurse, social worker etc.)
CMHT and ABT
community mental health team
assessment and brief treatment
provide initial assessment for signposting to other services
OAMHT
older adult mental health team
families and adults 65+ who are in mental health crisis
list of services GP can refer to (short term care: (6)
CAMHS
IAPT
EIP
CMHT
ABT
OAMHT
longer term care services for mental health (4)
CRT = community recovery team
- age 18-65 with long term needs
high support/integrated care teams
- over 18s
- long term conditions (physical or mental)
- live at home or in nursing care
rehabilitation services
- undergone recent change in functioning e.g. from brain injury or illness
CLDS = community learning difficulties services
specialist services (4)
EDS = eating disorder services
EIP = early intervention in psychosis
personality disorder services
therapeutic communities / crisis houses
acute care for physical and mental health (2)
A&E
MHL = mental health liaison
- acute general hospital settings
- assess people for referral to mental health teams
inpatient mental health care - for who? (5)
provided where:
- admitted for short period for further assessment
- risk of safety e.g. self harm and suicide
- risk of harm to others
- cannot safely treat at home
- need more intensive support than can be given elsewhere
HTT (+inpatient)
HTT = home treatment teams
age 16-65
severe mental health crisis - would otherwise be admitted to hospital
HTT as a supplement to inpatient units
also can be called CRHT –> crisis resolution and home treatment teams
4 tiers of child and adolescent services
tier 1
- generalist workers (GP, school nurse etc.)
- low level psychotherapeutic interventions e.g. recommending self-help
tier 2
- generalist workers (GP, school nurse etc.)
- low-level SPECIFIC interventions
- e.g. counsellors, bereavement workers
tier 3
- mental health team workers
- high level psychotherapeutic interventions
- e.g. CBT for relatively moderate to severe cases
tier 4
- highly intensive or specialist services
- psychological therapy (highly specialised) - or part of wider care package
- e.g. inpatient units
- e.g. specialist eating disorder services
patient advice and liaison service (PALS)
confidential advice, support, and info on health
provides point of contact for patients, families, and carers
can be used for patient involvement and complaints
patient involvement: healthwatch England and ICBs
healthwatch England:
national consumer champion to ensure service users voices are heard
ICB = integrated care boards:
commission most hospitals and community NHS services in local areas
have public engagement and involvement
types of recovery orientated care (2)
clinical recovery
personal recovery
clinical recovery
getting rid of symptoms
restoring social functioning
getting back to normal
personal recovery
- changing attitudes, values, feelings etc.
- way of living a satisfying life
- even with limitations caused by illness
- involves development of new meaning and purpose
- growth beyond effects of mental illness
basic concepts of the traditional vs recovery approach to mental health (4)
traditional:
psychopathology –> diagnosis –> treatment
staff and patients
recovery:
distressing experience –> personal meaning –> growth and discovery
experts by training and experience
working practices in the traditional vs recovery approach to mental health
traditional:
description –> focus on disorder –> illness based
goal = bring under control
recovery:
understanding –> focus on person –> strengths based
goal = self control
against recovery orientated care - recovery in the bin
group of MH survivors who do not like how recovery is used in treatment
think they can’t live as they wish with this perspective
think they are seen as “fixed” when they still need further support
