Antonia - Rethink, on 25 November 2010 - 02:09 PM, said:
And hello to you, Arj Subanandan
! Thanks for your comments. GP awareness of some of the major issues around mental health is indeed low. We will have to see whether the Consortia are able to have PCT debt wiped, but even so we believe that allocations of resource from the National Commissioning Board should take into account the complexity of mental health as a new area for GPs. We would ideally like to see GP Consortia have a dedicated mental health lead, to be responsible for development and quality commissioning in this area, though we know the government is reluctant to tell Consortia how they should manage themselves.
I think it's important to bear in mind that GP Consortia will have to show they are providing services in accordance to new NICE Standards for different health areas. So as long as these address some of these key national issues, we will be able to see which Consortia are doing a good job and which are not. There will also be local data on new NHS Health Outcomes, will will include data on indicators such as emergency admissions to hospital for people with mental illness, and early mortality rates for this group. We are arguing that this data should be available broken down by age and ethnicity in particular, so we can see if any groups are not receiving quality care.
Thanks Antonia for your response. I'm not sure it's enough for a GP to be simply handed the mental health lead. Think of the inordinate spectrum of disorders. No GPs are educated well in psychosocial stuff. They older ones may not believe in psychological therapies at all.
Breakdown by age and ethnicity makes sense. So does gender. Men are referred to secondary mental health services measureably less than women. It may, perhaps, be because they're less likely to seek help from GPs or because GPs simply aren't recognising symptoms in men. GPs are predominantly male so may treat men different from women.
They also need to drill down to diagnosis level. At the moment there's still real problems with provision of care for the severely mentally ill - as I'm sure you're well aware. IAPT doesn't cater for those with the severest conditions. While funding for IAPT seemed to survive I think psychological therapies for severe mental illness may end up being cut because this wasn't ring-fenced.
The mortality gap is important but it's dangerous. I saw the Baroness who's on the parlimentary mental health group chat about this and go on about how it's all about smoking, so really all they're likely to do is refer people to smoking cessation services without realising that many people smoke as self-medication. Smoking triggers the neurotransmitter that's released by sodium venlaflaxine at high levels. It's guessed that people with sz smoke to help with the negative symptoms. The Baroness didn't seem to know about the 50% reduction in mortality due antipsychotics used in very old people with dementia either.
It's also helping people have a reason to live. I never got any therapy when I tried to get help. They sent me to a drugs and alcohol service which isn't what I wanted then cocked up my referral. I had to get myself better by drinking myself well and something called a paradoxical intervention but I can't really talk about that publicly. Many people with sz aren't getting the sort of support they need to help them want to live long lives. GPs don't understand severe mental illnesses and psychiatrists are barely any better. It's sad to say but perhaps psychiatrists need to have a hand in commissioning because GPs are simply ill-equipped.
There are several GPs in my extended family and network. I do mental health awareness training with them ad hoc and I'm sure they're sick of it but the ones who want to learn are willing to listen. Their qualification barely touches on common mental disorders let alone the complexities of severe psychiatric illness.
As I mentioned somewhere in another post there's a desperate need for a large scale alternative treatment paradigm for first episode psychosis. What I mean is something advanced like the Soteria wards, ones that allow people the choice to be treated without antipsychotic medication and allows them to learn to self-manage. This makes a lot of sense to develop one of these in London. There's a population of something like 7 milion (ONS 2001) and if I remember the details of the AESOP study quoted inthe New Horizons consultation the rate of diagnosis of schizophrenia is twice that of Nottingham and...Bristol I think. This takes capital-wide buy in but the evidence seems to be showing better outcomes in the long term, at least the evidence from countries that seek to have progress in the treatment of severe mental illness.
I have a personal interest in this. When I get psychotic I can't use services. I have to survive alone. The things that happen to me during these periods are horrific. But I refuse to be sectioned again. I refuse to have my right to choice taken away as well as my liberty. UK policy seems focused on more coercion, not less. They're focused on cheap outcomes - this means antipsychotics (which aren't really antipsychotics because they don't really treat the internal experience. They just sedate the person.).
And don't even get me started on dual diagnosis patients. We're fucked. No charity lobbies for us. No one reads the strategy from 2002 and in my experience it's certainly being put into place. We suffer that extraordinarily powerful and untackled stigma: we do it to ourselves. An anorexic with depression is ok but a depressive who becomes an alcohol isn't. Heck - even Time to Change didn't touch dual diagnosis with a barge pole. In fact the stigma is often foisted onto this group of the mentally ill. I very much doubt that the situation will get much better except for the fact that alcohlism is high in GPs. Perhaps that's a sliver of hope that some of them may understand just how hard it is.
Anyway, best of luck. Fight the good fight.