Authors: The South-West Community Mental Health Knowledge Mobilization Network. Collated and approved by network members.
Previous blogs:
Part 1: Roles needed to implement the Framework
Part 2: How to work together across different sectors
Part 3: The use of language when working together to support people with mental health problems
Part 4: Positive risk-taking in the context of the Community Mental Health Framework for Adults and Older Adults 2019
Introduction
The South-West Community Mental Health Knowledge Mobilization Network is a safe space to share experiences of implementing the Community Mental Health Framework for Adults and Older Adults 2019. This blog discusses the reality of an increase in demand for mental health services and the challenges that come from not having extra resources to meet that demand.
Increased demand
Without any hesitancy or the need to think too deeply, members were able to share both stories and data that reflect a significant increase in demand. Importantly, a lot of the increase in need seen by members has been with individuals experiencing acute symptoms and complex struggles. Developmental trauma, suicidality, and complex emotional needs have seen an exponential rise in demand.
Response of services
Using the model that our mental health systems operate in, these needs would traditionally be met by secondary care services like community mental health teams. This increase in demand has led core mental health teams to increase their waiting lists and shift thresholds to manage those waiting lists. These essential, but often reactive, responses are not only undoing much of the implementation of the Framework, but also leaving more people with moderate to severe mental health needs unable to access statutory mental health support when they need it. Because this is a space traditionally served by NHS services, the VCSE sector doesn’t have a well-established provision that meets the needs of this complex cohort; but are now relied on to hold these individuals, as secondary care support isn’t accessible.
Members shared that there are attempts to find alternative ways to meet this rise in need, but there are often unintended consequences to those innovations. One example that was shared was a provider’s 24/7 mental health helpline being accessible via 111. This has meant more people have been able to access support, but this increase in use hasn’t been able to be matched by new resources, so it has also meant that some people haven’t been able to get through on the phone line when they needed urgent support.
There was a realism amongst members that the financial status of statutory services and VCSE organisations is unlikely to positively change in the near future to help meet need. Some felt that statutory services cannot be responsible for meeting low-level mental health needs, even when there is no appropriate alternative. Our communities need to have intentional and proactive support in rebuilding their social infrastructures, so they are better able to create the healthy environments people need to thrive. This will bring financial challenges as any investment will require a reduction in investment somewhere else.
Empowering individuals, and their friends and family
Some of the members also acknowledged that individuals should be empowered to have more responsibility over their own emotional state.
One of the areas members thought needed further exploration was engaging with the family members of people needing mental health services and enabling them to be a better source of support. It was mentioned that the “next of kin” part of people’s notes is often blank, and their support was underutilised.
Members discussed whether the way we communicate mental health struggles is part of why family or friends find it so difficult to provide support. “Does medicalising mental health needs shoot ourselves in the foot by creating a culture where only licensed professionals feel able to offer anything meaningful? Is a diagnosis of a mental illness an empowering thing or a debilitating thing?
Both perspectives were held by the members in the room. For some, a diagnosis was their only means of accessing mental health support, benefits, social care, educational support, etc. The medical model is weaved in and out of all of our public services to the point that it is near impossible to see a complete separation of them. For others the diagnosis led to stigma, inappropriate treatment, refusal of care, and an ignoring of the wider historic and environmental context that has led to the lack of wellbeing.
These challenges seem to be particularly relevant when it comes to our young people. Having spent a large chunk of developmental years in lockdown and social isolation, we shouldn’t expect them to be fully emotionally developed. However, rather than working on that development, it is believed some young people are given a list of diagnoses that are often experienced as something that boxes them in for life and makes them feel “lesser” than everyone else.
Conclusion
In conclusion, implementing change is a difficult task that often requires more time and resource than we can imagine at the beginning of the process. Therefore, innovative change becomes more and more difficult the more resources are stretched or reduced. However, the current experiences of local authorities across the country teaches us that innovative change seems to be one of the only paths that takes us away from financial bankruptcy and closer to making sure people are able to access the help they need when they need it. If we don’t take the risk and try new ways of meeting needs, we might not be able to dig ourselves out of where we end up.
Interested in joining the South-West Community Mental Health Knowledge Mobilisation Network? Please email charley.hobson-merrett@plymouth.ac.uk
This blog post is supported by the Peninsula Clinical Trials Unit (PenCTU) and the NIHR ARC South West Peninsula (PenARC)