The Masked AMHP was recently featured on guerillapolicy.org's site in the Frontline series. Banging on about clustering and Payment by Results again. Here is the post in full. It can also be found here
I am a mental health social worker and Approved Mental Health Professional working in a community mental health team. My AMHP role means that I have the power to apply for the compulsory detention under the Mental Health Act of people with mental disorder. However, this is a power I do not take lightly, and indeed, most of the time I am advocating for people with mental health problems and attempting to keep them out of hospital.
I’ve been writing the Masked AMHP blog for the last 4 years. Having been involved in the training of social workers for many years, I thought that writing about the reality of the job of social work in mental health was a good way of giving an insight for those interested in the nature of my job. I wanted to be both informative and entertaining. I hope I have achieved that.
The knowledge that mental health practitioners, and the service users with whom they work, have of the day to day experience of having a mental health problem could and should be used to inform policy in this area. We know the effect that mental illness has on people’s life opportunities; we see and experience on a daily basis the positive and negative effects of social policy. Imaginative and joined up social policy initiatives can have a profound effect on the ability of people with chronic mental disorder to live full and productive lives and to contribute to their communities.
The move away from hospital based mental health provision to community services in the 1980’s and 1990’s was immensely important. It placed a wide range of mental health professionals, including doctors, social workers, nurses, psychologists and occupational therapists together in teams which were focused on providing efficient and cost effective services within the communities in which service users lived. And when it was adequately funded, it worked very well.
However, in recent years, policy changes focused on reducing expenditure at whatever social cost, and based on the ideology of the Private Sector being best, threatens to destroy the best aspects of community based mental health services.
The radical refocusing of the NHS, which fully comes into effect this April, has already had a disastrous effect on service provision, with Mental Health Trusts being forced to redesign their services according to year on year swingeing cuts in funding. Not only are many hospital beds being closed, but frontline clinical staff are also being cut to an alarming extent: typically, 20% of frontline staff, the people who actually work face to face with people with mental health problems, are being axed.
An integral part of this redesign is the concept of Payment by Results. Although this was apparently designed and approved by the Royal College of Psychiatrists, it does not obviously bear the signs of having been constructed by people with first hand experience of mental illness. Rather than focusing on how mental illness affects people in their daily lives, it concentrates on identifying their symptoms and then designating them to “clusters” of symptoms. These then define the treatment package that they should receive.
Although that sounds superficially patient centred, in fact the true reason for clustering service users is so that these clusters can be used as a “currency” for the allocation of financial resources. This is an explicit intention of the policy.
And once you have defined individuals in terms of their “clusters”, then it becomes possible for agencies and organisations outside of the NHS to bid to provide the treatment packages defined by these clusters. This lays the NHS open to piecemeal privatisation of services, leaving only the most difficult patients to be treated by an impoverished rump of the NHS. This is exactly what is currently being proposed in changes to the Probation Service.
At the same time that these finance led, rather than needs led, changes in mental health service provision are being made, the reductions in welfare benefits will be implemented.
In an article published in the Guardian on 09.01.13. Aydin Djemal, the chief executive of the Disability Law Service, which provides legal advice to disabled people, says "Austerity is already hurting the most vulnerable, but in truth the greatest impact is yet to be felt." The article goes on to say “Local authority cuts will start to kick in after April, hitting social care services and charities which support disabled people. Legal aid funding will be drastically cut back, and more benefit reforms will kick in. ‘We expect to hear more and more cases of disabled people having their basic dignity taken away from them,’ says Djemal.”
It is a depressing prospect for both mental health services users and those professionals still trying to help them.