Community psychiatry Flashcards
What is community psychiatry (Thornicroft and Szmukler, 2001)?
Providing mental health services for local population by:
- establishing population-based needs for treatment care
- delivering evidence-based treatments for people with mental disorders
- providing adequate, accessible services
How did community mental health care rise in the USA?
Community Mental Health Centers Act 1963:
- a network of community mental health centres which in practice focused on providing holistic psychodynamic therapy for people with minor psychiatric disorders
- > CMHC movement is seen as a failure
What is the difference of community care between wealthy countries and low-income countries?
Community care in wealthy countries:
- based on the infrastructure of a welfare state
- > state-benefits that support live-in care of people outside hospitals
Community care in low-income countries:
- care outside hospital depends on families, NGOs and outpatient services
What are the models of working (systems) in primary care in community psychiatry?
- Shifted outpatients: holding in clinics, within a GP practice (general practitioners)
- Education
- Consultation
- Shared care: good communication between primary and secondary care
- Easy access to specialist care and rapid refferal from specialist care
What is the current reality of specialist mental health services?
An enormous drive to return people from secondary to primary care, despite a potential false economy (money saved in short-term but more losses on the long-term)
What is the IAPT project (increasing access to psychological therapies) (Department of Health, 2011)?
An ambitious programme that provides access to psychological treatments, which may or may not work.
- we’re still waiting for definitive data on evaluation
What does the community mental health team (CMHT) consist of?
What does the PRiSM study show (Thornicroft et al., 1998)?
Mutlidisciplinary teams
- attached to locally-accessible team base,
- managing a catchment area geographically or in relation to local GPs (general practitioners)
- with a Care Programme Approach (CPA) -> offering continuity of care
- relate to an inpatient service
> Good outcomes (PRiSM study, 1998)
What are the specialist teams that potentially supplement to CMHTs?
- Assertive Outreach teams
- has enormous international literature
- developed by government policy under the Implementation Guide
- BUT data on Europe don’t show that they are not better than generic CMHTs, even though they Assertive Outreach teams are more resource intensive
- In recent years: increasing pressure on mental health service budget and closure of some assertive outreach teams - Early Intervention in Psychosis Services
- mandated in the Policy Implementation Guide
- specialist teams work with people in early stage of developing psychotic illnesses
- clinically very attractive, very sensible idea, very fashionable
- BUT significant criticism: evidence base suggests that any early gains are lost once patient reverts to “treatment as usual” - Crisis Resolution / Home Treatment Teams
- mandatory in England
- support to people instead of of admission, and for early discharge
- some evidence for a significant reduction in admissions
- BUT when it’s instituted there’s less reduction in bed days - “Functionalised” mental health services
- development of specialism
- split between the community and inpatients
- multiple specialist teams and services covering a broader catchment area
- e.g.: eating disorder specialist teams, adult ADHD specialist teams
With the elaboration of good quality community services, including services for high support care, has the need for admission diminished and was the need for long stay care abolished?
No:
- the admission rates are broadly similar
- new long stay individuals have continued to accumulate in acute mental health services
- > Psychiatric rehabilitation services and forensic services (for offender patients) are still part of the landscape
What is the third sector involved in?
> Social inclusion
Peer-led services
Carer support projects (e.g. led by Rethink Mental Illness)
> Specific role in a health and social care system
What does the Policy in England supports regarding the third sector?
The use of “personalised budgets”: allows people to purchase the care they need from wherever they want.
- Where this isn’t provided, the care is provided by social care providers
What’s currently neglected in community care?
The importance of creative, social and leisure activities
- services that try to address the barriers of stigma and social exclusion
- they are under-resourced and diminishing
- and they’re not valued by health or social care funders in times of shortage of funds
What are the current implications of community psychiatry?
> There is evidence that services developed during era of deinstitutionalisation worked well
“functional” split in contemporary services has strengths and weaknesses
We lack data about what should work for whom
Not everything works well everywhere
There are some general principles
Services aren’t treatments
Available technologies do not support a return to the community mental health movement of 50 years ago
