Thursday, 13 October 2016

Bridging the gap between (mental) health services and needs: negotiating power and political values

Guest post by Dr Angus Forsyth, Senior Lecturer in Mental Health Nursing, Northumbria University

As Monday was World Mental Health day, there will be familiar messages in the media about the barriers faced by people with mental health problems when seeking appropriate care and treatment. These include (but are not limited to) the difficulties that children and young people face in accessing local services, not to mention specialist services, such as support for young people who may experience eating disorders. For adults the suicide rate has increased, and there are more and more pressures on crisis services and in-patient beds. As overall funding within the NHS is further reduced, mental health services face additional financial cuts as their funding is diverted to other clinical groups whose needs have been identified as more of a priority. 
Steve McDonald (Simon Gregson) battled depression in Coronation Street

As if lack of access to mental health services is not problematic enough, people with mental health problems are also more predisposed to physical health disorders due to the combined effects of certain medications, lifestyle factors, such as smoking and lack of exercise, contributing to obesity and other metabolic disorders. This contributes to early mortality for people with long standing mental health diagnosis such as schizophrenia, having a reduced lifespan of 20 years. Despite these inequalities the Department of Health’s guidance (2011) recommended parity of esteem for people with mental health problems to have the same level of access to services as those with physical illnesses. And even this recommendation has yet to be achieved. 

On the positive side, there has been a relative increase in coverage of mental health related issues within the media and society, either through celebrities disclosing personal issues, storylines in popular TV dramas; magazines, and social media. However, there still persists a stigma associated with the experience of mental ill-health, for example that people with Schizophrenia are unpredictable and predisposed to violence (Houses of Parliament 2015).

Whilst fear and lack of understanding are factors that maintain stigmatising beliefs and attitudes, power inequalities are also evident when exploring the above barriers to meaningful services. These power imbalances can lead to the development of oppressive social systems and organisational practices where the exercise of authority or power can lead to the marginalisation of specific groups. An example of this is the implementation of government policy, for example the reduction of resources and the subsequent allocation of funding by commissioning agencies (as servants of government), can result in further disadvantaging of citizens as in the case of young people attempting to access mental health care. In the majority of these cases, care can only meaningfully be accessed when there is a serious risk to self and others and is provided under the legislative procedures of the mental health act and in locations far from the individual’s home. This example illustrates how healthcare is provided in an oppressive system.

This brief summary of the challenges in accessing comprehensive care and resources that are available to people with mental health issues highlight that as the expression of mental health becomes more dominant, service provision and resource allocation has not kept pace with increasing need and demand for services. This is particularly in light of mental and physical ill-health co-existing and becoming common bedfellows in chronic disease management. Let’s hope that World Mental Health Day not only highlights issues related to the experience of mental health but acts as a catalyst to mobilise meaningful social actions such as:-
  1. Reviewing the public and political structures to include the meaningful involvement of service users at all levels of the decision making process (Rethink 2016). This would further highlight inequalities and disadvantage experienced by individuals and meaningfully influence the development of comprehensive mental health service provision.
  2. Reorganise health and social care structures around the holistic needs of service users rather than in the functional silos that currently operate.
  3. Use World Mental Health Day to evaluate the impact of service delivery for vulnerable groups to identify meaningful changes and clarify further challenges.

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