Mental health services: behind the stigma

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Within the last three years, the stigma behind mental health has all but disappeared. More and more, employers and schools are reaching out and encouraging their occupants to seek out support and show their true emotions whenever possible. The understanding of mental health is now widely taught in most schools, and employers often encourage wellbeing tasks and activities in order to maintain a supportive working environment. More than ever, young people are unashamed of their mental health , and feel comfortable in talking to friends or teachers about their problems. Despite being a task that may never be truly ‘finished’, it is of course a drastic improvement. However, I would like to take a closer look at what really happens after this initial stage of reaching out and contact. For instance, the services available for young people after their problems are deemed too much for a school or college to handle, and pose the question: what happens when someone’s mental health goes beyond the realms of counselling to the extent where specialized services are required?

After reading CQC’s report on the state of care in mental health services, 2014-2017, I was left with mixed feelings, both of optimism and fear for the future. The main issue highlighted within their findings was the time taken to get an appointment (both inpatient and in community care) in the first place. The inspection notes ‘Many parents that we talked with in the course of our inspections praised the care that had been provided, but also described the struggle to get taken on by the service and the impact that the long wait had on their children and on them and their families’. Once this initial link was made, they found that 76% of young people’s inpatient wards were rated as ‘good’ and a further 6% as outstanding. Upon dividing inpatient and community services, it is satisfying to discover that both categories are largely similar in ratings, with 66% of the later receiving ‘good’ ratings and 9% receiving outstanding. From this evidence, we can gather that equal effort and investment is being made into each factor; NHS and independent services alike are actively striving for a better patient experience. However, despite these impressive statistics, upon delving deeper some unfortunate truths are discovered, and I start to wonder to what extent our services have really improved.

As previously stated, the largest issue with young people’s mental health services is the time taken to initially receive care, hence why 38% of community services were rated as ‘requires improvement’ in the ‘response’ category. It was discovered that a large number of services are not meeting their own or national requirements and targets for waiting times and responses. There are several issues that come from this. Firstly, the safety of patients. Many young people struggle immensely to communicate their issues with parents, and as a result their condition can dramatically worsen if untreated due to a high wait time. Another is that if a person remains untreated for so long, faith and confidence are often lost in the system before patients even arrive. Typically, high waiting times are particularly prevalent when evaluating services that are typically thought of as being outside the ‘mental health’ bracket. Tests for conditions such as autism were found to be incredibly difficult to obtain. This is largely due to the wide majority of cases being discovered before adolescence. The time taken to get these tests often has a profound impact on a young person’s wellbeing, an uncertain test result can often play a big part on someone’s mental health. This can have further impact if the person in question is applying for university, further education or employment within the next year of their life, as often in order to receive support an individual requires a definite diagnosis from services. The cliché cause pointed to when in regards to high wait times is staffing, however CQC’s inspection actually revealed that generally, staffing levels are ‘sufficient and well managed.’

The issue related to staffing is often not in terms of numbers of staff, but instead is an issue of pressure and dedication. The study found that staff were put under high pressure and consequently sickness and absences were often common compared to other health professions. Despite this, the area where staff excelled in was cooperating with other services involved in a patients care. For example, community services working with inpatient institutions in regards to discharges, or working with schools and GPs in order to determine the best course of care for a patient. However, despite these improvements, the overarching issue of staffing continued to drag some services down in CQC’s assessment. In one practice, it was found that because of shortages, the staff hastily brought in had not completed Disclosure and Barring Service checks. This is a grave threat to both the continuity and nature of a person’s care if unchecked individuals are allowed to practice upon patients. This is of course, troubling to say the least. Knowing this provides any young person and parents alike with doubts before even stepping foot into perhaps their first visit to a mental health service. It cannot be understated the impact parents have on a young person’s recovery, especially if they are not happy with the service their child is receiving. Staff are at the forefront of opinions regarding mental health services, and it is largely because of this that young people’s services are thought of as either outdated or unhelpful by young people. If they are to delve deeper, the care they receive is widely impressive, with a few exceptions. However, first impressions are incredibly important, especially in terms of gaining confidence and building trust in NHS services.

In terms of involving young people in their recovery, I found a real split between community services and inpatient care. In the former, young people and parents often find that their views are not listened to or recorded by staff, creating a sense of powerlessness in their recovery and isolate families or individuals. Furthermore, if the views of patients and parents are not properly recorded, other staff involved in their care will not know some preferences or requirements the young person may have. Speaking from personal experience, it can be incredibly demoralizing if a young person has to recite previously given details or accounts because they have not been properly recorded or passed on. However, when looking at inpatient care, it’s a completely different story. A total of 95% of facilities scored either ‘good’ or ‘outstanding’ in terms or being ‘caring’. Daily activities are often brightly encouraged by staff and patients alike, including trips outside whatever facility they’re staying in, ranging from walks around a local neighborhood to theme park visits. I find the difference between these two categories in this field rather worrying. If young people feel as if they’re views are not being taken on board or they are not being listened to, they are far less likely to feel optimistic for their recovery, a dangerous seed to plant in the mind of someone already struggling.

In this incredibly brief summary of CQC’s mental health report, I hope that I have highlighted both areas of stress but also of optimism. While there are clear areas that require- in some cases drastic- improvement, there are still shining figures, such as the percentage of services rated as ‘good’ or ‘outstanding’. The report concludes with highlighting the strong progress found in the mental health sector: ‘almost three-quarters of NHS mental health trusts that were originally rated as inadequate or requires improvement improved their rating when we re-inspected.’ In short, mental health has never held more importance in the eyes of the government or the public, and despite the advancement needed to quality of care, the sector of health continues to gain and unprecedented amount of support and resources, a clear sign of hope for the future of young people’s care.