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.
It astounds me that our trust have been simultaneously promoting a 'big recovery' at the same time as PBR in a doublethink exercise of trying to pretend that these two things aren't almost diametrically opposite. We've had s couple of years of it and it is infuriating......
ReplyDeleteClusters' are causing a watering down of quality with tick box tokenism taking over,thus having a detrimental affect on the individual's who have already been marginalized within our societies'.
ReplyDelete