Future Perfect? Outlining an alternative to the pain of psychiatric in-patient care

Rethink today (December 8) challenged the mental health world to consider a future without psychiatric beds.

Its new research report Future Perfect (847 kb) set out a vision of mental health - as seen by service users and carers.

Service users and carers identified hospital in-patient care as amongst their worst experiences, and called for an alternative built around prevention, telephone helpline support, community-based crisis intervention and short-stay “sanctuary” in high quality non-hospital environments.

Rethink Director of Public Affairs Paul Farmer said: “This research is important in setting out a vision for mental health services and highlights the voices of those people who really matter - service users and carers themselves.

“Future Perfect supports the need to make mental health a mainstream issue and shift care away from compulsion in hospital to care in the community. There are powerful lessons here for the government’s white paper on out-of-hospital care which is due to be published in the New Year.

Mr Farmer said: “We also need an open debate about helping people access preventive services as well as sustain high quality care for people in need of immediate help.”

Future Perfect, builds on the Mental Health in the Mainstream project carried out with the Institute for Public Policy Research earlier this year, which sought an inclusive, community-based solution to mental health care.

Faced with the scenario of a world without inpatient beds:

• Service users and carers articulated retaining a ‘place of sanctuary’ away from home and the need for a secure place for service users during a crisis.
• These ’places of safety’ should be small, purpose built homes to help service users recover from a crisis episode.
• Users talked of a therapeutic environment with open spaces, gardens, complementary therapies and private rooms.
• Services should be person-centred, holistic and included the provision of therapeutic and recreational activities as well as one-on-one time with staff.
• Service users articulated a strong sense that ‘prevention is better than cure’ and access to the right services at the right time was crucial in preventing crisis.
• There was a need to remove cultural barriers enabling people from minority ethnic groups to access mainstream mental health services.
• Service users clearly articulated the need for more community health centres which were accessible at all times for support to avoid hospitalisation.
• Such centres were described as needing to be open and accessible at all times so users can access support during evenings, nights and weekends, able to provide information on ‘self-management’ for users and education in mental health for carers.

When asked how services might better help support people into employment, the focus groups called for:

• Support in adjusting to full time work by means of trying volunteering and part-time options.
• Both service users and carers spoke of the need to have a single designated worker to help the service user gain employment and subsequently support them in the workplace.
• Carers emphasised the need for the government of the future to allow employers the ability to provide flexible working hours for service users with the benefit of financial recompense for employers.
• Crucially however, service users stated their main concern was the ongoing stigma and discrimination faced by employers and a drastic need to significantly change employer attitudes.

When envisioning what would support a better quality of life for carers; the research uncovered that:

• Carers wanted better information, communication, support and inclusion into the care system.
• Carers expressed a need to feel valued and respected by professionals who acknowledged that they held valuable information about the person in their care.
• Carers wanted training in communication and negotiation to allow them to engage with health care professionals on an equal footing.
• Both service users and carers identified the need for respite care.
• Many carers expressed strong views that the mental health system of the future must offer addiction management services in order to help carers deal with the ongoing and increasing challenge of dual diagnosis.

The vision put forward by service users and carers leads Rethink to suggest the following recommendations for the future of mental health:

1. A comprehensive and fully funded national anti-discrimination programme owned by the mental health community.
2. New and accessible routes into care: innovative and comprehensive day or ‘community health’ centres where service users and carers can access information and advice and help in a crisis.
3. Alternatives to inpatient care: new therapeutic environments in the form of crisis houses, retreats or hotels.
4. Modernising day services: A more open, accessible and engaging form of day or resource centre where people can access help, information and support.
5. Support and recognition for carers.
6. Opportunities for employment.

Making a difference: both service users and carers wanted to have more say on the future of mental health services and in the planning and delivery of care. Service users expressed dissatisfaction with the current system for involvement and consultation and felt they were often tokenistic.