Care in the Community

  spuds 11:04 10 May 2007

The government and various health bodies are implementing schemes were people requiring help and care are being directed to the Community for their needs and requirements.

This idea is based on "there are many added advantages", including freeing up resources like hospital and direct patient care services.One particular service, mental health, seems to have had drastic changes over the last decade, with closures of recognised institutions and out-patient facilities.

There are websites click here and many leaflets plus survey literature that may provide questions and answers. But is the implementation of the schemes really doing enough for the Community and possibly people in desperate needs.

What are your views and comments. Are the analysts, professional experts and think tanks, heading the right way, with their involvements, or are the public being advised wrongly, in the name of progress.

  picklsey 11:42 10 May 2007

in the name of progress my ass it,s more like in the name of selling the land off to private house developers.this one gets me really angry i have a friend who,s brother was disabled since birth (bedridden)when both parents passed away it was arranged he went into a local care hospital the care he received was second to none.(as he gets older his condition worsens) it was decided to close down this hospital and put the patients into houses in the friend fought tooth and nail against the situation is no trained nurses or doctors on call he has carers with very very little medical expierience,when a doctor is needed it has taken up to an hour for them to arrive.there has been a few close calls.i have been with my friend to visit his brother on a number of occassions and other house mates who are there are not able to safely look after there self so you have carers looking after them all.sorry for the rant but to me all they are doing is putting people at risk.

  MichelleC 12:06 10 May 2007

This was the saving-government-money device implimented by Maggie. They closed down, what many described as, 'mental' hospitals. The responsibility then went from the government to local authorities to look after people experiencing mental health problems.

Has it worked? Yes and no.

Yes, people are generally better off in the community amongst 'normal' people, and the CMHT's (Community Mental Health Teams) look after this client-group extremely well. The people can have more choice, more freedom and live a reasonably normal life. A good CMHT will assist their client in all areas in their lives to live as independently as possible, whilst offering support.

No, because the majority of mental health day centres and residential accomodation are charities. And like anything, if it's charity-based, you have to seek out funding and this can prove to be anything but easy. Local authorities contribute some funds, but a lot of funding has to come from other sources.

It costs approximately £30 - 35,000 pp per year to look after someone in this type of care (not including NHS imput and medication costs) for them to have a reasonable standard of life.

Another aspect is a lot of older people now in residential homes had spent many years in the old 'mental' hospitals. The change-over to homes was unnerving to start, and many still miss the old regime of having everything done for them, no responsibilities and living in a hospital.

By and large cic was a good move in many ways. It took away a lot of the 'them' and 'us' syndrome and showed the public they had nothing to worry about from these 'mental' patients.

If you think back at one time people used to hide their 'mental', disabled, downs relatives from the public eye. Now it's perfectly natural to see everyone out and about in public.

  spuds 12:38 10 May 2007

Do you really consider that CMHT are the way forward and proving there worth to the community, especially in dealing with 'establishment' patients, who have been released from rules and regulations, and perhaps constant supervision and observations.

  MichelleC 13:32 10 May 2007

I think so. I believe that encouraging people to look after themselves and gaining confidence to look after themselves and live independently is much better than being waited on hand and foot.

CMHT often consists of a psychiatrist, cpn (community psychiatric nurse), social worker and usually a key-worker. The client will have a care plan which has been taylored to their needs. All agencies are supposed to meet up with the client on a regular basis (usually once a year) depending on the care plan. It's often difficult to get all the agencies together at the same time, so usually the key-worker will go and support the client at the care plan meeting with the psychiatrist.

Clients have been assessed properly to see which of those are able enough to live in supported housing or a residential home.

If they're in housing they should get regular vists from their social worker (who must have extra psychiatric training).

If they're in a home there is always two staff on duty at any given time (by law), included in which is always a senior project worker. The residential homes are properly regulated with stringent criteria (more than older people's homes).

If there's any problems there are approved and proper safety policies in place. Medication in homes is strictly adhered to (by law) and must be administered by two staff (one must be a senior).
Clients in homes have their cpn visit (monthly if medication is administered by injection) once or twice a year.

It's a good and tried and tested system. But like anything you'll get the occasional loophole in the system.

The only problem is that people can't be forced to take their medication. If they don't they could become very ill. We had one client who had been approved to self-administer and it was found she hadn't taken her daily anti-psychotic for two weeks and had to be taken to hospital.

  spuds 17:35 10 May 2007

You have raised some interesting points, especially one in particular 'about self-administer'. I know of three cases were the people did not take the prescribed medication, because no one undertook the actual supervision of making sure the medication had been consumed. The three people involved were later convicted of being involved in fatal acts of other persons. During the individual court proceedings it became very evident, that procedures had not been followed, and back-up was being provided in an unacceptable manner. In each case it was stated "that warning signs were missed or had been ignored".

Regarding the Care-Plan, would you say that this can place a bigger burden onto a GP, and by doing so, release other peoples responsibilities and their budgets and funding!.

  MichelleC 08:38 11 May 2007

Like I said there are loopholes in the system, and these can sometimes have drastic consequences. The case of the man in the church wielding a samuri sword is now in a residential home and being properly supervised.

Some people slip through the net and are only found out when something goes wrong.

Some people are 'dual diagnosis' which means not only do they have mental health problems they also have drink/drug problems too. This client group would be assessed to not self administer.

The three cases you mentioned shows how lax the CPN or social workers were in not checking, but this can be difficult to achieve. Clients have certain rights to privacy and if they lived in housing you do not have an automatic right to search to find out if medication is being taken.

GP's do not play a large part in most care plans, but will liase with the client's psychiatrist if needs be. They will have case records and an up-to-date medication report, but will only intervene if it's not practical for the client to see the psychiatrist.

IMHO the GP's budget is spent on many varied things, including lots of time-wasters whose psychosomatic ailments clog up the NHS. Their budgets would be better spent of providing counselling and alternative therapies instead of dishing out medicines which placate the symptoms and mask the root causes. But that's just my predjudiced view after many years of seeing GP's surgeries on a Monday morning filled up with people who didn't fancy going into work.

Of course I'm not including people with mental health problems in that category or the genuine folk who have real ailments.

  Kate B 09:03 11 May 2007

Bit harsh on psychosomatic illnesses - the symptoms are real, and if anything the people who present with things like that need help too. After a very stressful patch at work (some years ago now) I kept losing my voice, which was baffling and difficult. All sorts of things were suggested, including scary things like growths on my vocal cords.

Eventually after an ENT investigation, all sinister things were ruled out and I went for some speech therapy, which was extremely helpful, as I discovered that the underlying cause seemed to be something to do with how the structures in my throat tensed up along with my shoulders and back when I was stressed. As well as the speech therapy I also had a bit of help on managing stress and *touch wood* I haven't really had the problem again - though my voice still vanishes at the first hint of a cold.

Psychosomatic? Definitely. Symptoms real, distressing and worrying? Certainly. Timewaster at my doctor? Absolutely not. It needed sorting.

  The Brigadier 10:16 11 May 2007

The trouble is that Mental Health is the poor relation in the NHS.
One award winning scheme run as a resource centre for those with mental health problems & run jointly by the South West London & St Georges Mental Health Trust & The London Borough of Sutton, social services was seen as the way forward.

But seems that this flagship service once the envy of other mental health services did not carry on. Instead the centre was closed down & a worse service was offered to those suffering acute mental health problems.

Seems being a pioneer in mental health treatment in the community was not cost effective. Sadly it seems that once again Mental Health is the poor relation in cost cutting.

Which political party will now jump on the mental health wagon next!

  spuds 13:21 11 May 2007

Mental health, still carries a stigma to all intents and purposes, especially within the community. As an example, I wonder how many people are left to their own means, excluding a possible once a month 15/30 minute visit from a social worker or designated person, once the are deemed to be assessed as 'being capable', which in fact was a decision made, because the long term residential was being closed. Neighbours who live possibly right next door to a person who as been a long term patient, may find that any help that they are prepared to offer to 'oversee' on a daily basis, are totally rejected due to 'patient confidentiality'.Not even a contact telephone number is provided, should the person become distressed or aggravated anytime in the day. If the problem becomes terrible, then the neighbours have the only recourse, dial for the police!.

Slightly moving away from mental health. Once again as an example, I witness every day, a scenario of a lady in her late 40's, who is being 'challenged' by the system, and new ideas invented by professionals. Her particular case started about 12 years ago. She lived a normal active life, then over a period of a few months, her whole life style changed. From signs of seemingly being drunk to being wheelchair bound. Initially, most of the caring was left to her two 12/14 year old children. Eventually the children left home, and a result of that was daily carers (early morning/late afternoons) were engaged.Modification at great expense were made to her home. It was then decided that a full time live-in carer would be employed, with part payment coming from benefit funding. This experiment lasted for about six months. She is now back to early morning and late afternoon carers, which provides the services of 2/3 people on each visit. Also, she is now attending hospital appointments 2/3 times a week. With this new arrangement, she as had to have a more substantial motorised wheelchair, because the previous wheelchairs were not capable of doing their intended tasks. All this independence and care in the community is perhaps achieving something for someone, but at what cost!.

  MichelleC 13:59 11 May 2007

It was clear from what I said I meant the monday morning malingerers, and those that think the dr's surgery is their 2nd home. You may be interested in the Alexander Technique. It retrains one to use the whole body without stress.

The Brigadier
Mental health issues have always been a low priority with all governments. I recall my parents lobbying MP's in the 60's to get the archaic mental health laws changed. In those days patients had absolutely no rights, but thankfully things have improved over the years.
Feltham and Hounslow local authorites have day centre facilities and free counselling. I wish other councils would provide this type of support.

All services are stretched to their limits now. You'll always get cases like the disabled woman, which shouldn't happen. And unfortunately not all professionals, however well trained, have the nouse or common-sense we would want them to have.

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