Austerity or opportunity? How mental health services can thrive

Mike Smith – Guardian Professional, Wednesday 18 June 2014

On my return to the UK in 2012 to take up a position with the charity Alternative Futures Group (AFG), it struck me how people working in the UK health and social care sector were seeing austerity as a challenge. Having worked all over the world, I know many colleagues would welcome our situation where healthcare has been ringfenced by the government from any real cuts in spending. In fact, the budget has merely been subject to a restriction on growth unlike in other countries, where there have been really savage cuts.

The NHS spends more than £12bn on treating mental health issues, yet we feel so poverty stricken. What is even more concerning is that our outcomes are so poor when compared with those of countries that spend much less.

There is no doubt that the financial challenges ahead will have an impact on future mental health services. Whoever is in government after the 2015 general election will still be taking policy decisions to lower the deficit. Andy Burnham MP, shadow secretary of state for health talks of a whole person approach to care and repeal of the Health and Social Care Act 2012. But is this radical enough for the service and/or workforce re-design which I believe is needed within our sector?

Poverty of thinking, poverty of creativity and a poverty of action seem to colour mental health services in the UK. This absence of new thinking along with tradition mean there is an apparent lack of political will to radically change the way we do things. We have a huge amount of money invested in traditional structures and there is much emotional and personal investment in the status quo which is hampering our approaches.

As mental health services adopt an ethos of recovery, growth and aspiration rather than maintenance and stability alone, they are seeing the changes that are needed to transform expectations, services and people. The good news is that some of the best ways of doing things need not be expensive. Hertfordshire partnership NHS trust support family placements, as one alternative to hospital, supporting crisis resolution services.

Alternative Futures Group has a two-year partnership with Mobee, a charity in West Africa that is developing community mental wellbeing practitioners to support the polyclinics in Gambia. The community workers are trained in self-help and in personal and community capacity building techniques. The self-help tools are based on person-centred counselling and solution-focused therapy but use written questions and small group exercises run within schools and polyclinics, as well as community groups and postnatal classes etc.

Two groups of support workers and senior personnel from our organisation have visited Gambia to share good practice and develop new skills and techniques in an environment where there is little resource, financial or otherwise. We’ve also formed strong links with mental health service professionals in Italy and Denmark to find out how they are dealing with austerity within their countries and communities.

In Trieste, the importance of a whole system response to mental distress rooted in the community not within the patient is highlighted. This approach and the need for strong and effective case management has proved a success.

Another, perhaps even more radical, approach focusing on workforce changes has been adopted at Lyngby Tarbaek Kommune in Copenhagen. Here they have changed the thinking that underpins their provision. They have done away with staff meetings and handover periods in all forms.

In the UK, we should use austerity to look at how we deal with chronicity, avoid creating dependency and a hopeless model of maintenance by learning from other countries and offering alternatives for change.

Mike Smith is vice-chair of the International Mental Health Collaborating Network (IMHCN) and clinical director (mental health) at Alternative Futures Group

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