The medical model is very much focused on treating the symptoms, rather than addressing the causes. Prevention is better than the cure, but not enough time nor money is spent on prevention. The NHS, whether it's hospitals or GP surgeries, has outdated computer infrastructure. They have some good systems, like GP Connect, but the various arms of the health service don't always communicate effectively. I work in a care home and I will sometimes have to inform a resident's GP that the hospital or the mental health team has prescribed them a new medication, because it depends on the prescriber and how on-the-ball they are. Having good computers, that have the latest version of Windows, and having a joined-up approach to healthcare, would solve so many issues.
As has been mentioned already, the drain on the NHS from social care is the elephant in the room. The elderly use up so many resources - time, money, expertise - and aren't contributing to the nation's coffers any more. Mental health services, stretched beyond belief, end up affecting the hospitals, because people in crisis end up in A&E. They also affect the police, who have to spend so much time and resources on managing situations with people in crisis.
I used to work in mental health, and service users used to have their own social worker. However, the short-sightedness of central government decided that it would be best to do away with nominated social workers and just have a duty social worker system instead.
So, if one of my service users was in crisis, I'd ring the mental health team and be put through to someone who didn't know my service user. I'd have to explain the person's history, the situation they were in right now, and have to wait for a call back, as the duty social worker had to either research this individual some more or go and ask others for advice.
So much time was wasted explaining things to a new person every time, something which was replicated millions of times up and down the country. So inefficient and so ineffective. And that's if you were lucky and someone answered the phone in the first place. Ring the mental health crisis team at 3am on a Saturday morning? Good luck!
So much of a good mental health service is about prevention. We don't want people in crisis to begin with. I'll give you a genuine example and how much more it costs to deal with a problem that is easily preventable.
'Joe' was a guy with Schizophrenia that I supported. He was a very unpleasant individual, incredibly selfish, believing other people always had alterior motives. As such, he was miserable and friendless. He had 3 blocks of 5 hour 1-2-1 time, paid for by the local authority, which enabled him to access the community with support. In simple terms, he and a support worker like me, would visit museums, galleries, cinemas, have lunch out, enjoy a coffee, etc. It was so that he didn't just sit in his room 24/7 (which is what he did for the rest of the time).
A great new initiative began at the local mental health centre, called 'the men's group'. Three times a week, people like Joe met up at 10am and did arts and crafts, had discussions about local or national issues, and enjoyed coffee and a chat with their peers for a couple of hours. Joe really enjoyed these sessions and now had a reason to get up in the morning 6 days a week. He completely changed. He went from a horrible, selfish, nasty individual into a friendly, upbeat, considerate person. It was remarkable. I'd never seen anything like it. 'New' Joe lasted 9 months.
Enter the coalition government and austerity. First thing to go was the 1-2-1 funding. This didn't have a great impact at first because the new friendly, confident Joe had begun accessing the community himself. He wasn't a danger to society or anything, but before the 1-2-1 support was put in place, he'd literally go to the nearest shop, spend his personal allowance, then come back and sit in his room. Having learned good habits, he now stayed out longer, going to coffee shops, visiting places, being a part of his community.
However, the body blow was when the men's group funding was cut. At first it was reduced to twice a week. Then to once a week. Then to once a month. Joe had gone from having a fulfilling life, accessing the community 6 days a week, chatting to people, and literally changing as a person, to now having no 1-2-1 support and no men's group. He had no reason to get up in the morning. His mental health didn't just decline, it fell off a cliff. He made allegations left, right and centre. His paranoia went through the roof. Imagine being a support worker sitting in the living room, reading a book, minding your own business, and someone storming down the stairs every 5 minutes, screaming at you, claiming that they've heard you on the phone (when it hadn't rang), threatening to report you to the police, solicitors, the newspapers, etc. And you work 24 hour shifts. This was the new normal.
Joe, having developed schizophrenia after contracting meningitis as a child, and now in his late 50s, had tried every medication going. The medical model, as I mentioned at the start, focuses on the symptoms. The psychiatrists wanted him to try a new antipsychotic called Clozapine (or Clozaril). This medication is banned in a lot of countries, can severely shorten life expectancy, and can cause serious side effects. One of which is greatly reducing blood pressure. As such, he had to stay in a secure unit, so that he could be monitored around the clock.
He was in there for 28 days. It was a train and two buses away from his home, so us staff could only visit a few times a week. I would attend MDT (multidisciplinary team) meetings about Joe, where psychiatrists, advanced nurse practitioners, social workers and the like, along with little old me, would discuss what to do. He was at the last chance saloon, taking a very dangerous medication, and I tried so hard to get everyone to understand how he'd ended up here. His mental health hadn't deteriorated because of a chemical imbalance in his brain; it was because he didn't have anything to do and nobody to do it with. So fixated were the others around the table on this new medication, that my pleas fell on deaf ears. They were trying to provide a chemical solution to a social problem. It was maddening.
Money was the root cause of the problem. A short term saving of a few quid on a couple of support staff 6 hours a week, that gave around 20 people like Joe something to look forward to, had now cost untold thousands and put his long-term health in jeopardy. And there will be tens, if not hundreds, of thousands of people like him up and down the country, where a small investment would make such a huge difference to their quality of life. Instead, they take that pittance away and society pays a much bigger cost in the long run. This is the part that needs reform. There's no need for private enterprise. Just spend more on giving people a reason to live and you won't need to spend so much on medications or doctors.
