Lecture 9 - Mental Health Systems Flashcards
Whys is mental health important to us as individuals?
- Prevention of mental health disorders
- Wellbeing and quality of life
- Physical health (no health without mental health)
Why is mental health important for the health of our society?
- The development of society in learning and education
- Social impact and cohesion
- Economic impact
What is the prevalence of mental health in the UK?
NHS – 1 in 4 adults with a mental health challenge, 1 in 10 young people with a mental health challenge
What is the need for mental health services?
- 1.75M people accessed mental health services by the end of June 2023
- 424,645 new referrals received
What does the Darzi report tell us?
- As of April 2024 – more than 1 million waiting for mental health services
- 345,000 waiting for more than a year
What are the types of care given?
primary, secondary, and tertiary
What is primary care?
Typically the initial point of contact
- GPs, community mental health, counselling, talking therapies
- Assessment, low-level support, referral to specialised services
- Directly accessed, signposted or may have a light referral criteria
What is secondary care?
Specialised care for higher acuity or care
- Adult mental health teams, psychiatrists, clinical psychologists, psychotherapists, specialist nurses, and many more!
- Comprehensive assessment, safety planning, treatment planning, forms of intervention, and crisis management.
- May include outpatient or inpatient care
- Normally accessed via a formal referral process
What is tertiary care?
Highly specialised care for specific and complex disorders and/ or patient populations
- Specialist teams and units (e.g., specialist eating disorders, perinatal mental health unit, forensic mental health)
- Specialist teams like those in secondary care, but with a focus on a particular disorder/population
- Like secondary care, but with nuanced treatment models/care considerations
What approaches are there for mental health?
- Medical approach
- Biopsychosocial approach
- Recovery-oriented practice
- Trauma-informed care
What is the medical approach to mental healthcare?
- Diagnosis, clinical treatment and medication of mental health disorders
- Focus on clinical pathways with pharmacological treatments
- Consistency and a one-size-fits all approach to those with specific medical diagnoses
What are the pros of the medical approach to mental healthcare?
- Can make the care quicker
- More consistency when treating individuals
What are the cons of the medical approach to mental healthcare?
- Limited understanding of the patient as an individual
- Can miss the holistic aspects of support
What is the biopsychosocial approach to to mental healthcare?
- Biological, psychological, and social factors to understanding and treating mental health challenges
- Acknowledging the complexities
- Understanding all factors that may impact an individual
What are the pros to the biopsychosocial approach to mental healthcare?
- Holistic and person-centred
- Flexible and inclusive (important for inequities)
What are the cons of the biopsychosocial approach to mental healthcare?
- Lacks specificity and dependent on the skill of the service
- Can miss the holistic aspects of support
What is recovery-oriented practice?
- Holistic person-centred approach to empower individuals to lead a fulfilling life
- Collaboration with individuals to find their strengths
- Community-based approach to help individuals find wider aspects of what supports their recovery and integration into society
What are the pros of recovery-oriented practice?
- Holistic and promotes the patient to take an active role in their recovery
- A sustainable approach to mental healthcare
What are the cons of the recovery-oriented practice?
- Can create inconsistency in care
- Does not necessarily fit into traditional pathways of care
What is trauma-informed care?
- Understanding the prevalence and impact of trauma on those accessing mental health services
- Shaping services and interactions that
- Avoiding a one-size-fits all approach to those with specific medical diagnoses
What are the pros of trauma-informed care?
- Another approach that can understand an individual and their individual needs
- Recognising the signs and symptoms of retraumatisation
What are the cons of trauma-informed care?
- There are limitations to how a service can flex to an individual’s history
- Doesn’t always fit the traditional care pathways
What examples are there of specialised services?
- Early intervention psychosis
- Perinatal mental health services
- Forensic mental health services
What is early intervention psychosis?
- Designed to support individuals with first episode psychosis
- Early detection and treatment, improve long-term outcomes
- Holistic support, including:
- Medication
- Therapy
- Systemic support (e.g., family, social, employment support)
What are perinatal mental health services?
- Supporting pregnant individuals and support up to the first year after birth
- Diagnosis and treatment of perinatal mental health challenges
- Individualised treatment plans
- Support which may also include psychoeducational support (e.g., parenting, attachment, social forms of support)
What are forensic mental health services?
- Those with mental health challenges and have or are at risk of committing offences
- Ministry of Justice funded
- Secure hospitals (low, medium, high) and community teams
- Assessment, individualised support, rehabilitation (in some cases)
- Additional considerations:
- Legal considerations (formal routes for leave/discharge)
- Risk management considerations
- Probable complex needs
What are the current challenged to mental health systems?
- Wait lists
- Inequities in mental health
- Recruitment and retention
- Supporting the complexities of mental health
- Social determinants
What is the strong push towards integrated care?
- Psychological Integration Model – Integrating adult mental health teams and psychological therapies
- Community Mental Health Framework – Person-centred and community-based approaches
- Creation of integrated care systems – bringing together health and social care
What are the dimensions of quality in healthcare?
- Safe – Free from unnecessary harm
- Timely – Delivered at the right time
- Effective – Using evidence and best practice
- Efficient – Avoiding unnecessary waste
- Equity – Quality of treatment does not vary depending on a person’s characteristics
- Person-centred – Places the patient at the centre
What are the key features of quality improvement?
- Engagement, engagement, engagement!
- Understanding what is done and how it can be improved
- Good measurement to see if a change is an improvement
- Iterative testing and learning
