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About this book

This highly regarded book offers a clear and considered guide to modern mental health policy and practice. Building on the success of previous editions, this third edition provides:

• An up-to-date overview of the changes to mental health policy and practice as they apply to a broad range of mental health services, from primary care and forensic mental health issues

• A focus on mental health specific issues in the context of broader health and social care reforms, including the reform of primary care, the impact of austerity and the personalisation agenda

• A greater exploration of what interagency working means: it goes beyond issues with health and social services and explores the everyday services that are essential to everyone

• A range of case studies, reflection and analyses, followed by engaging exercises and suggestions for further reading.

This book is designed for students of social work, social policy, nursing and health taking courses on mental health policy and practice. It also serves as an important update for practitioners in the field.

Table of Contents

1. Introduction

Abstract
This revised and updated book is designed as an introduction to mental health policy and practice in the United Kingdom (UK) for students as well as for qualified practitioners, their managers and policy makers. That a third edition is needed so rapidly reflects the rate of change in mental health policy and practice across the four countries of the UK, with an increased degree of diversity as devolved administrations have had the opportunity to set their own policy directions. Our focus is on policy and practice relating to a range of mental health difficulties — including both more common difficulties (such as anxiety or depression) and those that may be seen as more serious and disabling (such as to psychosis) — but generally excluding neuro-degenerative conditions such as dementia which have tended to be dealt with somewhat separately in terms of policy and service provision. We will also consider the emphasis on the promotion of mental health and mental well-being that has become more prominent in mental health policy over recent years.
Jon Glasby, Jerry Tew

2. Mental Health Policy

Abstract
In trying to unravel the complexities of mental health policy and practice, the most useful organising principle is probably a chronological (historical) perspective (Porter, 1987). Comparing mental health policy over time enables us to see how successive governments have built on or responded to previous policy and to the social, political and economic climate of the time. Up until the (re)establishment of devolved administrations across the four countries of the UK at the end of the twentieth century, much of this history is shared. However, in the twenty-first century we are now witnessing the unrolling of significantly different policy and legislative responses in each of the countries, reflecting different social, cultural, economic and political concerns.
Jon Glasby, Jerry Tew

3. Primary Care and Mental Health

Abstract
GPs, practice nurses, dentists, pharmacists and opticians form the primary care level of the NHS and, as such, are the ‘front line’ of the health service. On the whole, patients cannot consult a doctor in secondary care such as a hospital consultant or member of a community mental health team unless they are referred by a GP. This filtering process has led to GPs being described as the ‘gatekeepers’ of the NHS. The core group of staff working in a practice is known as the ‘primary health care team’. The actual composition of any primary health care team differs between practices but the Royal College of General Practitioners (RCGP, 2002) has identified a core team as consisting of: GPs, practice nurses, district nurses, health visitors, practice managers and administrative staff. In some surgeries, midwives, physiotherapists, counsellors and community psychiatric nurses are also members of the team.
Jon Glasby, Jerry Tew

4. Community Mental Health Services

Abstract
At the beginning of the twenty-first century, most people in the UK, including those with serious mental illness, are now cared for in the community — either by primary care alone or more commonly by specialist mental health services. This follows a relatively rapid closure of hospital beds in the old Victorian asylums from the 1960s through to the 1990s, and continued declines in both the number of admissions and the duration of average hospital stays over subsequent years. There are multiple complex political and economic reasons underpinning the development of community care (see Chapter 2 for a detailed discussion) and the move towards our current community-based mental health care system has been slow and incremental.
Jon Glasby, Jerry Tew

5. Acute Mental Health Services

Abstract
Despite their apparent popularity with the public and the media, hospitals can be ambiguous places. If you are suddenly or seriously ill, then having immediate access to skilled professionals trained in managing your condition can be, quite literally, a matter of life and death. For people who have become ill over a longer period of time, finally realising that someone is going to take care of you and (it is hoped) make you better can also be a major relief — prompting feelings of extreme gratitude. However, some people probably do not want to end up in hospital in the first place, and for them the same process can be much more distressing and intimidating. Often, they can feel scared, unsure what is happening and desperate to do anything they can to get home. Nationally, there have been debates about the availability of single-sex wards, the nature of the built environment, the quality of hospital food and the cleanliness of wards — all of which can vary significantly and have a significant impact on health and well-being. As people get better, moreover, they can become increasingly frustrated by the institutional nature of many ward routines. For those with ongoing needs, there have also been long-standing debates about how best to organise follow-up support, so that people do not stay in hospital too long, are not discharged too soon and are not sent home before appropriate community support is in place.
Jon Glasby, Jerry Tew

6. Forensic Mental Health Services

Abstract
We know from the wider literature that people with mental health problems face considerable discrimination, poverty and social exclusion (see Chapters 4 and 9), factors known to contribute to criminal activity in the wider population. Moreover, some people with mental health problems probably commit some crimes knowing that what they are doing is illegal — in such situations, the criminal activity may be little different from crimes committed by people without mental health problems and should be punished through the criminal justice system. According to Sayce (2000: 226), therefore, there are a number of key messages which we need to test out on the public and the media:
  • Most crime is committed by people without mental health problems.
  • People with mental health problems often commit crimes for the same reasons as everyone else (poverty, drink and drugs, family/relationship frustrations).
  • It is extremely rare for people with mental health problems to attack someone they don’t know.
  • People with mental health problems are more often victims than perpetrators of crime.
  • People with mental health problems can usually be held responsible for their crimes.
Jon Glasby, Jerry Tew

7. User Involvement

Abstract
One of the most important changes in recent years in mental health services has been an emerging voice for people who have used services — with such people being increasingly seen as ‘experts by experience’ (Beresford, 2003) rather than simply as passive recipients of services designed and delivered by professionals. To quote Peter Campbell, a long-term system survivor and activist:
Living with mental distress is, and is likely to remain, a difficult experience. Nevertheless there are grounds for believing that it is a better time to be a mental health service user in the UK (and numerous other countries) than it was 25 years ago …. One important aspect to these positive changes is the greater involvement of service users in their own care and treatment, in the development of better mental health services and in social change more generally. (Campbell, 2008: 291)
Jon Glasby, Jerry Tew

8. Social Inclusion, Stigma and Anti-discriminatory Practice

Abstract
There is a complex relationship between mental health difficulties and experiences of social exclusion or discrimination. On the one hand, there is substantial evidence that adverse social experiences, including social isolation, abuse or discrimination, can be a contributory factor leading to the onset of mental health difficulties (see Chapter 1). On the other, once people become identified as suffering from mental health difficulties, they may become subject to a range of stigmatising or discriminatory responses, not only from society at large but also within the mental health system. These may, in turn, serve to exacerbate the impact of previous negative experiences, potentially leading to a further worsening of people’s mental health (Tew, 2011).
Jon Glasby, Jerry Tew

9. Families and Carers

Abstract
Over time, there has been an unfortunate tendency within mental health services to focus on the needs and difficulties of the individual without any serious appreciation of the relationships context(s) in which these difficulties may be taking place. This tendency may result from the influence of a number of factors:
  • A biomedical approach tends to foreground physiological processes that are seen as internal to the person.
  • The legislative framework for social care in the community prioritises individual assessment — although subsequent carers’ legislation has sought to redress this to some extent.
  • The training of most mental health professionals does not equip them with the skills to work with family groups.
  • Protecting confidentiality has been widely used as a rationale for assuming that friends and relatives should be excluded from anything more that very general information about the service user — without checking out whether such practices are actually in the service user’s best interests.
Jon Glasby, Jerry Tew

10. Conclusion

Abstract
Although mental health policy and practice across the four countries of the UK has moved forward very significantly over the last 15 years, mental health services still seem some way away from a clear and consistent vision as to the way forward — and a series of long-standing and complex problems remain. Arguably still underfunded compared to other parts of the NHS, mental health too often seems to be seen as a stand-alone and poorly understood area of policy and practice. From a recent period in which there was a stronger political will to improve mental health services, and a commitment of additional resources by which to achieve this, service developments in the coming years will have to be conceived and introduced within a challenging financial climate where total available funding across health and social care sectors may remain static or actually reduce in real terms.
Jon Glasby, Jerry Tew
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