For those that have been in the mental health system what changes would you make?

[Jenisautistic]

Next month is mental health awareness month

Hello everyone a while ago, I made a video about what I believe could be changed in the mental health system, mainly in the hospital, but I would like to hear your thoughts as well and things that should be rights versus privileges or something like that. Also, what was the ideal treatment of a mental health System for you? If you can change anything about the system, what would you change first?

 

[Raggamuffin]

In the UK the NHS has been in crisis for a long time. Shortages both in staff and funding.

In an ideal world we'd have a lot more staff, shorter waiting times (NHS autism assessment wait in my area is over 4 years). Shorter waiting lists for therapy, and a choice in what therapy you get. I was on a 6 month waiting list (over 8 years ago so much longer now) and was railroaded into having CBT, which isn't always as effective with patients who are on the spectrum.

Perhaps less of a reliance on pharmacology, as that tends to just bury problems, rather than solving anything.

It would be nice as well if they could offer alternatives such as yoga, acupuncture, group therapy and such like.

Ed

 

[Neonatal RRT]

The UK and the US are similar. @Raggamuffin hit the nail on the head. A crisis for a long time. Shortage both in staff and funding.

Obviously, the downstream effects of this can range from prolonged mental pain and behavioral issues, to the economic front (job loss, poverty, etc.), to desperate people doing desperate things (crime, sex work, selling drugs), to more self-destructive behaviors (drug abuse, suicide, etc). Frankly, the list is long and tragic. At least in the US, if you are under 18 years old you fall into the "pediatric" category of medicine and insurances will cover at least a portion of the cost, and you at least have some access to the mental health system. Once you turn 18, that "spigot" is turned off, that "kite string" has been cut. This is when tragedies become common.

There is almost no money to be made in mental health, as the majority of the patients tend to be of limited employment and carry little-to-no insurance. The mental health system, in many cases, eats the cost. As a result, people who work within that system, are also paid relatively poorly as compared to their peers in other areas of medicine. At the end of the day, you have to pay people, and if you are one to achieve an advanced degree, spend your time, money, and energy, accumulate a significant amount of education debt, you had better receive the types of salaries that can pay back that debt. It's basic economics from a professional standpoint. A young person going into medicine is going to direct their energies toward something that will not leave him/her decades of debt. The mental health system simply doesn't pay for the typical doctorate degree.

On the other hand, NOT having Federal tax dollars supporting the mental health system may be "shooting ourselves in the foot". Sure, up front, it costs money. However, are we simply swapping an up-front cost with a downstream cost? Do we spend $billions up front, or $billions on the back end dealing with the economic impact, policing crime, drugs, low-income housing, and a long, long, list of other things?

There was a time in the US when we took care of our citizens. Then, in 1981, all that changed with the Omnibus Budget Reconciliation Act, signed in 1981, by President Ronald Reagan. Mental Health Systems Act of 1980 - Wikipedia. The Omnibus Budget Reconciliation Act of 1981 Omnibus Budget Reconciliation Act of 1981 - Wikipedia President Reagan was of the mind that less Federal government and more State and Local government was best. However, most, if not all, states did not have the budgets to support a mental health system.

The primary issue when it comes to governments, is simply political posturing. In summary, the Democrats tend to push for more Federal government oversight and management because the state and local governments typically never do. The Republicans want less Federal government oversight and management, and to push those responsibilities upon the state and local governments. The problem is this back-and-forth with each administration. Both Federal and State governments tend to be corrupt with huge bureaucracies, a lot of waste, fraud, and abuse. Privatization is on a profit-motive (money over people), less waste, but certainly at risk for fraud and abuse, which is never good when it comes to medicine and taking care of people. What can we do when both systems are bad in their own ways?

 

[tazz]

NHS autism assessment wait in my area is over 4 years

I hear this sort of thing a lot, but remember there is "right to choose". Anyone, anywhere in the UK, who has a GP or other medical professional that has agreed an assessment is appropriate, can insist on their assessment being done by any NHS agency that is offering that service. And in the case of adult autism assessments the NHS has commissioned a bunch of private companies to do assessments. So you can get an NHS assessment, performed by a private company, paid for by the NHS, and the wait times are a few weeks or months.

Most of those assessments are done remotely, so a fair amount of form filling and then a video session or two. So this might not be appropriate for someone if they really want a face-to-face assessment. But otherwise it works really well.

I know it's a little off-topic but I mention this because I've encountered so many people who did not know that right-to-choose exists, and didn't have that option explained to them by their GP when the referral was made. So many just get told, you're on the list and the wait time is 2 years (or whatever). But the GP is supposed to explain other assessment options including right-to-choose. I really don't know why they don't do this.

Read more here:

https://www.nhs.uk/using-the-nhs/about-the-nhs/your-choices-in-the-nhs/
And here's a link to a popular company offering NHS adult ASD assessments (I'm not recommending them, just offering them as an example of what I'm referring to). Their current wait time is about 18 weeks. If your GP has already made a referral you can still insist that they switch it over to a company like this instead.

https://psychiatry-uk.com/right-to-choose-asd/
Also, I know from my own experience, that the diagnosis provided using this route is classed as an NHS assessment even though it's performed by a private company. So it shouldn't prevent you obtaining post-diagnostic services from the NHS. If you go to a private company directly, without an NHS referral, and pay for your diagnosis, you may find that you also have to get an NHS assessment in order to access post-diagnostic services. So right to choose also helps in this regard.

Perhaps it's not so off topic at all... one thing that would be really good to change in the mental health system in the UK is that GPs should be aware of what service providers are available and actually inform patients of their legal right to choose, and give them a list of service providers and wait times - like they are supposed to!

 

[Rodafina]

I think this is a great topic, Jen. The points above are both salient and valuable.

I have had experience on both sides of the mental health system in the United States… Receiving services and being employed as a mental healthcare provider.

I completely agree with the problems of underfunding, under staffing, and limited resources. Financial limitations were always a concern in what sort of services we could provide.

I think many mental health services would be better off if they were delegated more to organizations that work at the community level. Finding sustainable supports that are embedded within the community where people who need services are living, is the most effective way to get long-term change. No matter how successful someone’s stay in a hospital can be, the ultimate goal is for them to live on their own.

I also really agree with something that @Jenisautistic said in her video about better organizing inpatient care so that people who have similar needs are grouped together. There are many different reasons to end up needing inpatient care, and it is not always beneficial for this mixed group to be lumped into one.

I would also agree that single rooms would be extremely helpful to those in inpatient care. Although the system is already stressed and it is very difficult for people just to find a bed, the privacy of a room could be crucial to certain patients.

I think the other thing that I would really like to see more of among mental health providers is respect for the idea of culturally competent practice. Not all solutions will work for all clients, and there are very often different ways of understanding mental health challenges and helpful interventions. What may work for one person may be contrary to the culture and lifestyle of another person. Very often there is not a better or a worse way, but a better fit and a more poor fit. Peoples’ mental health struggles are uniquely impacted by their entire lives, and I think interventions need to be equally unique and offered in a way that is very specific to the client’s needs.

 

[Ronald Zeeman]

I had a very good experience. Nurse Nazi probably a personal service worker could have used a bit of customer service training.