Yesterday we had Norman Lamb argue for 'parity of esteem' between physical illness and mental illness. Today we have a report that highlights just how far we are to go to achieve that. There is much talk of talking therapies for those with psychosis early intervention, crisis intervention assertive outreach and if you bother to read just a little the lack of pharmacological research in this area
It is now more than 50 years since Enoch Powell made his water tower speech. part of the speech likened what he called the "sheer inertia of mind" (what we would call attitudes) to the
the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside...Do not for a moment underestimate their powers of resistance to our assault.
.
The asylums have gone but Powell's water towers and chimneys have remained. Mental Health has always been the Cinderella of the health service and elderly mental health care and psychosis Cinderella's Cinderella. When the service was part of general hospital services, mental health budgets were often raided (especially elderly budgets) to support physical health services. In the early days of community care community psychiatric nurses (CPN) had small case loads support people resettled and those with the greatest needs, then case load grew and demands to support and to deliver services to those that were demanding in primary care. One CPN described to me as a jungle act of three elements those on the biol those simmering and those on the back burner the trick was to to ensure that you did not discharge those on the back burner too quickly so that you had enough time to focus on and support those on the boil and simmering.
To those that say but the mentally ill are no longer banged up in asylums (and I'm Griffiths report vigilantes) and therefor the mentally ill must have a better life, I would say you can also get banged up in the community and the sad and ethically troubling truth is that banged up in the community is more isolating and more damaging to the individual. It is banged up in full few yet not seen nor wanted to be seen and not supported to be seen by and engaged with the community.
That is not to say that we should see a return of the asylum although there are within the new health service obvious potentual pressures for this. But that not only should there parity of esteem there should also be parity of expentiture, mental illness makes up 23% of the total desease burden on the health service yet only accounts for 13% of the total expediture, and with that disparity comes unnecessary suffering and cost both socially and financially . This does mean in these austerity driven times hard choices are going to have to be made for those that commission services (a respectability that central government has so skillfully side stepped landing it on thelocal) if this financial bigotry is to end. Nor should local agencies get away with counting independent voluntary funding as part of it's wider health economy or for that matter double counting such things as pastoral care in schools or other temptations.
Having said that those that articulate the case for better mental health service also have to show that the service they so fervently want to develop and sustain are going to make the contribution they say they will and within some sort of time and service framework. Yes CBT (and other talking therapies) for psychosis is going to help but it can not be delivered within time frames expected for depression and there may well be argument for and ongoing service of this nature. Yes early intervention when delivering for first onset psychosis (and not trying to identify prodromal cases) is effective in at improving prognoses. But other perhaps less glamorous aspects of mental health services need to be provided with to the same quality and with the same ambition and further not least of these are mental health services for the elderly.
Finally and once again in words from Powell's arcanely worded but non-less true water tower speech
None of these ambitions ... describing can be fulfilled, none of these changes, drastic and difficult, in the pattern of our provision for the mentally ill and afflicted can be brought about, unless the endeavour is sustained by a widespread public understanding and resolve
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helpful tapas asking to permission to have me beaten up
The asylums have gone but Powell's water towers and chimneys have remained. Mental Health has always been the Cinderella of the health service and elderly mental health care and psychosis Cinderella's Cinderella. When the service was part of general hospital services, mental health budgets were often raided (especially elderly budgets) to support physical health services. In the early days of community care community psychiatric nurses (CPN) had small case loads support people resettled and those with the greatest needs, then case load grew and demands to support and to deliver services to those that were demanding in primary care. One CPN described to me as a jungle act of three elements those on the biol those simmering and those on the back burner the trick was to to ensure that you did not discharge those on the back burner too quickly so that you had enough time to focus on and support those on the boil and simmering.
helpful tapas asking to permission to have me beaten up