Hello List,

Cameron Stark of Highland Health Board writes the following paper on Mental
Health for Think Net. To join the discussion please go to
http://www.think-net.org/

Developments in Mental Health Services

Short-term

The movement towards increased user and carer involvement in mental health
services is unstoppable. As well as closer working in clinical settings, it
seems likely that mental health service users will be involved to a greater
extent than at present in both planning and monitoring of services. NHS
Trusts, Health Boards and Local Authorities will have to work with user
movements to develop good ways of doing this. Carers will be involved in
providing views on the parts of services with which they come in contact.

Treatment options will expand. Drug treatments are an essential option in
the treatment of many mental health problems, but psychological treatments
offer important benefits, either in combination with drug treatments, as in
the treatment of some symptoms of schizophrenia, or as standalone therapies,
as in some types of depressive illness. Services will have to respond to
this by exploring ways of increasing availability of these treatments.

Medium Term

Stigma is a substantial problem with mental illness. Reluctance to talk
about mental health problems leads to delays in acknowledging difficulties
and seeking support where necessary; problems when trying to re-enter the
workplace after an episode of severe illness, and lack of public knowledge
about mental illness and the treatments available for it. The problem of
lack of discussion has contributed to unhelpful dichotomies between physical
and psychological therapies, between complementary and mainstream therapies,
and between health and social care. The WHO predict that mental health
problems will become increasingly important causes of suffering and
disability in western countries. If this is not to be compounded by stigma,
we need a societal reconsideration of the profile to be given to mental
ill-health. An open, reasoned debate can only be sustained if people are
able to discuss these problems, and obtain information to inform the
discussion.

The prevention of mental illness, and the promotion of mental health, will
become more important. Prevention is important, but we also need to consider
how to increase general mental well-being. Prevention requires joint working
between agencies, and between service users and agencies, to decrease the
chance of relapse, and to reduce the chance of illness in people in
vulnerable groups. Promotion needs more than this, however, and needs broad
efforts across agencies and communities to improve general mental health.
The evidence-base on this is patchy at present, although the importance of
early childhood experience is already clear.

Barriers between services should reduce, either by merging services or by
developing the current interest in treatment pathways and the users’ journey
through the services. 

Long Term

Investment in basic science research in mental illness offers both potential
advantages and challenges. Increased understanding of the bodily mechanisms
underlying the experience of illness offer the possibility of advances in
drug treatments. Drug treatments for mental illness have changed little in
decades, other than to offer drugs with fewer unintended side effects. The
drugs have altered little in terms of effectiveness, with the exception of
the availability of a treatment for some people whose schizophrenia has
proved difficult to treat. Most of the treatment advantages in recent years
have flowed from better ways of organising services, improved understanding
of treatment alternatives and treatment combinations, and advances in
psychological treatments. We may see substantial advances in drug
treatments, as underlying mechanisms are better understood.

The downside of basic science research, at least while ability to recognise
illness potential develops in advance of improved treatments, may lie in
genetic research. Genetics offers great potential in its contribution to
recognising underlying physical problems and their origin, but brings the
spectre of genetic screening for some diseases. This may be a more potential
than real problem, as many mental health problems may prove to have various
different causes producing similar symptoms. In some families, however,
recognisable genetic vulnerabilities may be identified with the risk of
disadvantaging individuals who remain well.

Cameron Stark

To join the discussion please go to http://www.think-net.org/

Regards

John

John Gray
Chief Executive's Office
The Highland Council
Glenurquhart Road, Inverness,
Highland, IV3 5NX
SCOTLAND, EU

Tel No: 01463 702706, E-mail: [log in to unmask]

(http://www.highland.gov.uk) (http://www.hi-ways.org)
(http://www.think-net.org)