.... a web site for family carers of serious mental illnesses, who give voice and help to those who can't, or don't, voice for themselves
"think clearly, and do not ( just ) hope" Camus ......
August 2008
... The site is edited by a retired consultant psychiatrist who has looked after a family member at home, affected by schizophrenia, for the last fifteen years
For beginners - This Home page links to other pages by a click on the underlined linking like this ...e.g. ... click on CPA for the Care Programme Approach ... and then to return, you click on the back button - at top left usually on the internet page of your computer when connected to the Internet, and this page, or, at the bottom of every page there is generally a link to click that goes back to the starting Home Page
How the Government ... 'New Ways of Working' [ NWW ] ... ... wll affect carers Anybody know what the creepy appendix D is supposed to be about - it can't be real ? it reads like '1984' and a love in for Big brother. If it's a made up - then that's it; the whole thing is a phony !!!
The list of those on the Committee does not include one working front-line psychiatrist in an ordinary mental health Trust service. The spokesperson is a specialist in rehabilitation, some one arriving long after the diagnostic formulation has been made. A User giving his benefaction does not describe what kind of a 'user' he is. The carer giving their benefaction does not describe the kind of mental illness they are caring for.The other psychiatrists stopped w and became spokespersons.
Oh dear
orking
What NWW does is to put, at a remove, the Authority in psychiatric services. The most intelligent, the most qualified, and the most experienced in practice, psychiatric opinion; the consultamt psychiatrist is to be removed from the lead position for first opinion, and the patient is to be attended to, by a first assesment that is carried out by a less qualified, less experienced opinion. It will rest with them, the gatekeepers - the first contact in the mental Health Trust community team, as to whether they know their limitations, and pass the patient onto a more qualified view. After seeing the patient they will report to a multidisciplinary team , and on what they have discovered at first assessment will be presented there. The lead clinical opinion - deciding the working diagnosis - will have to come to that decision at secondhand, depending upon the description, to be able to declare their view on what is best for the patient.
The system will only work if that first interview reveals enough information , and the first interviewer, knows what is relevant. The most likely next step will be to get back to the contact patient to be, to find out more information, and to open a door for further observation. The whole process is an ideal. In ordinary practice the team is inconsistent, and changing in experince all the time. Contrast this dictat, for that is what it will be with this, the previous working arrangement.
" Until the late nineteen eighties each Consultant had attached to the team a Community psychiatric nurse and a Social worker . These three professionals worked closely together ; for example, in the out-patient clinic they occupied adjacent rooms, and would be in constant contact with each other about both new and established patients "
... CLICK on ...UNMET NEEDS... what to do !!! ... this is a vital, crucial, urgently important topic ... for carers ... particularly for family carers ...
If it is not in the Needs ssessment stage of the Care Programme Approach you will not get it !!!!
Family and Community Carers absolutely must start to know what was - and still will be for some on the enhanced category - the Care Programme Approach - ( usually spoken of as the CPA ) this process is the basis system for community care, and can therefore be brought up, referred to , when seeking proper service for the family sufferer.
Now - after a year taking 'evidence' there is new guidance that the NHS Trusts will follow.
The following link is the less patronising guidance to the NHS Trusts about the change second line is best But better still click on the link "refocussing the care programme approach" in the right-hand column
Even more important that you, the family carer, are recognised and intervene at the Needs Assessment stage of the NEW CPA ... that is at the first stage after first contact.
surprise ... surprise -the first line link on the new CPA page ( see above ) gives this within it ... needs ssessments that find some needs unmet ...will, occasionally !!! lead to service improvement ... occasionally ??? !!!!
it is both patronising and misleading. It talks about Partnership in Care - they believe in it - without adding that you will Care all the time and we will visit occasionally. ...and - oh - some people used the CPA to claim access to services !!!! ???? so we will abolish it except for those the Team decides are serious and complicated - [ and not too greedy ]
? Who decides about who continues on new CPA - the local Mental Health Trust service deliverers - the Mental Health teams - the DOH new CPA guidance says p 12 para 5 .. " Services should continue to use
current local eligibility criteria to make initial
decisions on an individual's need for secondary
mental health services ". local thresholds are what decides .... if they have nothing further to offer serious illness aftercare is let down - no commissioning - because their resource access is limited, then - off you go. And don't think the Local Authority Social Services can help with aftercare - they have their own cut off point
click on FACS = Fair ? access to social care - below that - they decide that - you are off their books, as well.
An audit of homicides in London over the last five years finds 26 cases should have had a mandatory external Inquiry and did not.
Avoidable Deaths - the new 5 year review of suicides and homicides.
Your observations and experience are ignored or worse declined.
British Journal of Psychiatry(1990),157-671 - 674
The Assessment of Psychiatric Disability in the Community
A Comparison of Clinical, Staff, and Family Interviews
C. R. BREWIN, F. VELTRO, J. K. WING, B. MAcCARTHY and T. S. BRUGHA
.... "Assessments of some of the symptoms and behaviour problems of long-term psychiatric
patients living in the community were obtained independently from clinical interviews with
such patients, and from interviews with day staff, residential staff and families caring for
them.
In general, interviews with residential staff and family members revealed much higher
levels of symptoms and behaviour problems than either of the other two interviews. "
These
findings have implications for research and clinical practice including the fact that adequate
assessments should include the testimony of family or residential staff "
What they can do if people who have been ill apprehend a future breakdown
and want to put in their wishes about that in case they are too ill at that time
patients make an advanced declaration - what they want to happen if they are ill again and can't say it. Here is one example
Sainsbury Centre Inquiry and Reports about mental health services ... I can't see the morality in this. Why can't those who overspent be discovered, and be made to make up for it themselves?
King's Fund .. some do, some do not e.g. "At the extremes, on mental health, Islington PCT is spending four times the amount spent in Bracknell Forest PCT after accounting for needs and other factors. Leaving aside the most extreme contrasts, there are still large variations with a two-fold difference in mental health spending per head across 90 per cent of PCTs
"
" Public bodies are given their duties under statute. Their first duty is to discharge the statute, defending themselves for any perceived shortcomings in performance is wholly subsidiary to that end. Health Trusts accordingly should first strive to give care to the best of their ability, and where problems arise their duty is to investigate, acknowledge and improve in order to fulfil their statutory duty to attend to other patients. Defensive conduct that minimises or evades the full examination of such incidents in whatever forum through a desire to protect the Trust is likely to be in open conflict with that primary duty of continuing care.
This is the distinguishing factor between the public and private sector, which justifies the continuation of public trust. It is the foundation of public accountability."