Make things happen for mental health
When, at the recent SNP conference, Nicola Sturgeon spoke passionately about changes needed within the care system for looked after children, many of her words could just have easily been referring to the current provision of statutory community mental health care.
The First Minister’s words – ‘a system that stops things happening rather than makes things happen’ – unfortunately very much reflect the experience of Community Links Practitioners and those whom they seek to support in overcoming or mitigating negative impacts from social determinants of health, particularly when it comes to attempting to access relevant support for mental health related issues. Although perhaps the following graphic, doing the rounds on social media recently, encapsulates this experience even more neatly.
The Scottish Government are very much aware of the need for change within the architecture of state mental health support provision, and the need to engender a system that allows the many good people and able professionals working within the system to work to their strengths and take responsibility for their work, rather than being hindered by bureaucracy such as arbitrary inclusion/exclusion criteria and disconnected streams of the system.
The new mental health strategy for Scotland, is due to be published by the end of this year. It is hoped that practical measures implemented on the back of the strategy will help foster a more enabling culture and ensure that available resources are pooled in order to optimise the availability of support as close to the point of need as possible.
Often this point is when individuals present at general practice with symptoms of varying degrees of severity. If people are able to timeously access appropriate support without being presented with often insurmountable barriers then mental health issues can be negated and prevented from deteriorating further.
At present Community Links Practitioners often find themselves having to directly provide much of this support for individuals, which impacts on their availability to others who may benefit from being linked with relevant resources, were these to be readily available. Community and third sector based resources also find themselves under pressure to cope with demand.
The following, from a CLP’s field diary relays a typical example of their experience
“Finally the gentleman was referred to Primary Care Mental Health Team (PCMHT) after suicidal ideation. After waiting five weeks for an assessment he then waited seven weeks to start his Cognitive Behavioural Therapy, which was chosen to be the best option. After feeling slightly more comfortable with them he disclosed he had been sexually abused so they stopped the sessions and referred him to sexual abuse /assault clinic (also comes under PCMHT). He again had to wait for an appointment with them. He was seen twice before he disengaged as it wasn’t for him.
This was a fair few years ago (although the process remains the same) and he has kept presenting at the doctor for support. – depression – suicidal ideation etc. When he was referred his two friends had recently completed suicide . Although he needs support with his Mental Health the doctor has nowhere left to refer him to. In many cases like this it is us who are left for periods of time as the only source of support available to people, which we can provide but it takes up so much of our time.”
More generalist and joined up support rendered accessible through being tailored to the true human nature of mental health, which often means many overlapping and underlying issues that do not fit neatly into boxes, would mean CLPs can ensure individuals are more quickly engaged with these. Their own time would therefore be freed up to reach more and more people and get closer to meeting the obvious demand that exists for the support they can provide, rather than so much of their time being consumed by plugging gaps that exist within the current avoidant systems.
Readily available, well resourced and accessible talking therapies close to, or at the point of need, i.e. Primary Care, is what is clearly needed.
It is a truism of the Inverse Care Law that many people might not know what to ask for upon first presenting at general practice and this is where the skillset and experience of CLPs, as well as the flexible nature of the role, comes into it’s own. There have been many instances of discussions with CLPs helping individuals to get to the root of what is really affecting them, which means people are more likely to identify and then access the most appropriate support, if only this was available.
Learning from this programme and others is clear in that change must be led by those at the front line, both those delivering and those using services. This is where solutions lie, although of course it can be difficult in under pressure systems, to build in time to allow these to be garnered and to feed development.
The National Links Worker Programme will certainly continue to share the experience of those with whom we work and lobby for adequate change through all relevant channels.
Whatever else the new strategy addresses there has to be practical action which changes the culture that has developed in these avoidant systems and implements a new way of doing things that does indeed ‘make things happen’ in terms of support for mental health being provided right at the point in time at which it is needed.