Hi SarahI'm not sure if your first point about struggling to find any critical thinking about time limited interventions is specifically in relation to young people with learning disabilities, or if you're asking this more generally. If more generally, then whilst I agree with you that its actually economics/politics driving this, there is the body of 'dose-response effects' literature, where they deal with how many sessions of various therapies are needed to make significant changes. I think this is the sort of stuff NICE draws on when figures like 16 sessions are bandied around.
With regards cmhts doing more harm than good, I think I hold a both/and position. There is plenty of evidence about iatrogenic effects of medication of course, and some evidence about psychological interventions sometimes being unhelpful, and of course things like sometimes diagnosis is helpful (e.g. to access resources) and sometimes unhelpful (e.g. stigma, responses to the label, etc). But on the other hand, I think one problem with all of this is that the arguments of people who might be critical of what happens in mental health services can get joined up with the arguments of people who commission and manage mental health services, which leads to the oppressive recovery discourses and talk about how people are too dependent and need to take responsibility and need to move on out of services, etc...in other words, as an excuse to withdraw access to support. So to some extent, the idea that any of the populations we serve (including people in adult mental health, not just LD) having team contact for as long as they want is valid. There is a lot of heartache and time spent with people simply because they are so concerned about being discharged.
In short, I don't think there is a simple, either/or answer, but perhaps returning to that question 'In whose interests is it that we do this/say this/believe this?' also shed light on it. In whose interests is it to discharge people from services when they are not ready?
Best wishesPenny
From: Gillian Proctor <[log in to unmask]>
To: [log in to unmask]
Sent: Friday, 25 May 2018, 12:43
Subject: Re: Episodic/time limited service design
Hi sarah, I completely agree with you. I think its another example of the idea of ‘recovery’ being coopted for economic reasons. Sorry can’t help with any literature though.
Gillian
> On 25 May 2018, at 10:34, Sarah Bradley <[log in to unmask]> wrote:
>
> Hi everyone,
>
> I've been asked to provide some continuing professional development input to the team I work with within an NHS service for child and young people with a learning disability and/or autism. I am new to this population, having had the last two years off and the first 8 years of my nhs career working with adults.
>
> I am struggling to find any critical thinking around the idea that it is "best practice" to work with people for a specific amount of time around a specific reason. NICE guidelines talk about "short-term assessment and intervention" and "intervention" guidelines recommend "a specified timescale to meet intervention goals". However I can't find any written literature about why this is seen as most helpful for people and my current conclusion is that the driver is purely economic.
>
>
> In my work with adults I felt it was important to support the population to get out of, and away from, psychiatric services as quickly as possible. I saw the community mental health teams as replacements for natural community and I saw the medical model as doing more harm than good. However, in the children and young people with learning disability and/or autism team, I think the staff are doing ethical non-pathologising systemic work and I am left wondering whether it wouldn't be better for this population to have a team contact for as long as they want one. I can think of a few arguments against this myself and I am happy to have a genuine debate within the continuing professional development session, however does anyone in this group have anything to say about this topic? or is anyone aware of anything written in any context that they could direct me to?
>
> Yours in anticipation,
> Sarah B
>
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