By Andy Acquaye, Deputy Hospital Director, Huntercombe Hospital Roehampton
Managing mental-health issues is enormously complex, for health professionals, social services, carers, families, friends and patients alike.
This reflects not only the range of conditions that fall under the banner of mental health, but also the difficulty of diagnosing many of those conditions, of planning and implementing optimal treatment programmes, and of maintaining a stable regime in conditions subject to abrupt change.
These challenges are further complicated by the continuing stigmatisation and lack of understanding of many mental-health problems, by overlaps with drug and alcohol abuse, homelessness or criminal activity, and inadequate healthcare resources to give mental-health patients the care and attention they really need.
Although an estimated one in four people in the UK will experience a mental-health problem in any given year, surveys in England and Wales suggest that only around one in eight adults with a mental-health issue actually receive treatment .
Where patients do have access to services, these must be focused on early intervention and long-term follow-up, so that people with severe mental-health problems can avoid protracted stays in acute and secure settings.
Around 90% of people with these problems will at some point relapse. While first episodes in mental health are relatively easy to treat, second, third and fourth episodes tend to be more complex, resulting in longer spells of institutionalisation.
This calls for more co-ordinated efforts to ensure that when patients are reintegrated back into the community, they have an effective and sympathetic framework in place that will maintain stability of treatment and pick up any warning signs that a relapse may be imminent.
The right support networks are invaluable to this transition. They include services offered within intensive-care facilities, as well as relationships with family, carers, community health and social workers, care co-ordinators, crisis teams and other stakeholders such as police and ambulance services. They are critical both to successful reintegration and to prompt intervention in the event of relapse.
Keeping stakeholders in the picture is one vital component. When patients with mental-health issues are admitted to an intensive care facility, known as a PICU (Psychiatric Intensive Care Unit) they are typically referrals from NHS acute-care services. Referring organisations need timely information on the patient’s status, treatment plan and progress, as well as guidance on relapse prevention once the patient is re-established in the community.
PICUs can also provide practical support mechanisms to help patients acclimatise, maintain their relationship with the outside world, optimise treatment, and prepare for a smooth transition back into the community.
Patients will see many of their liberties withdrawn on admission to a PICU. Replicating basic community amenities, such as banking services, within the facility will help to mitigate any sense of isolation or powerlessness.
Some patients with religious convictions may want access to a rabbi, imam or priest. Others may need advocacy or interpretative support. If a patient wants to visit their home to pick up clothing, for example, then issues of cost and supervision need to be addressed onsite.
Patients may seek practical assistance from an on-site social worker on issues such as claiming housing or disability benefits, registering for an Oyster travel card, or joining a gym or library. Escorted leave in the community under Section 17 of the Mental Health Act also does much to facilitate reintegration and recovery.
Helping carers and family members come to terms with an intensive-care admission is another crucial element of building and sustaining support networks for people with mental-health issues. Family members may be grappling with feelings of confusion, frustration, guilt, anger or blame, along with fear of aggression or concerns about stigmatisation.
They need education, information and reassurance around issues such as understanding and managing the patient’s condition, medication and side effects, visiting hours, and access to key personnel. These people will be closely involved in the patient’s journey towards recovery and reintegration, often putting enormous pressure on the carers’ own lives.
Regular open days at intensive-care facilities can address these issues through one-to-one interactions with facility directors, doctors, psychiatrists or psychologists, as well as through open fora.
For patients with mental-health issues, and the people who care for them, the prospect of recovery or reintegration as an able member of the community may often seem distant.
A carefully tailored treatment programme will set patients on the right path. Complementing that treatment with the right support networks will give them the best possible chance of completing their journey.
Andy Acquaye, Deputy Hospital Director, Huntercombe Hospital Roehampton
 McManus, S., Meltzer, H., Brugha, T. S., Bebbington, P. E., & Jenkins, R. (2009). Adult psychiatric morbidity in England, 2007: results of a household survey. The NHS Information Centre for health and social care.
 McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Leeds: NHS digital.
 Welsh Health Survey 2015: Health status, illness, and other conditions.
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