Burstow’s vision

Community Care have an exclusive interview with Paul Burstow this week where he discusses his approach to mental health care. Useful, as he is the Department of Health minister responsible for care services.

In the article he makes a link between poverty and mental health – nothing particularly ground-breaking there except a vague indication that the government acknowledges this and their responsibility to approaching this issue as he says

But, in facing up to poverty, we must acknowledge another truth: that poor mental health is often a key link in that miserable chain.

Of course there is a side swipe which is not altogether unmerited, at the previous government and their lack of action on tackling both poverty and mental health. Interestingly, he picks up on the New Horizons document as big on principles but short on detail.

Believe me, I’m no great defender of the last government but I am not sure that’s entirely fair criticism seeing as the point of the New Horizons document, which, after all was only published in December 2009 – was to set a vision of the agenda for mental health care in the coming decade rather than to detail some of the plans of delivery which was always going to take place after the document was published – or at least, that was my understanding of the process. Indeed, New Horizons is subtitled ‘A shared vision for Mental Health’.

Fair criticism would be on the actual actions of the previous government and he does get stuck in there as well although not necessarily in the ways that I would have expected him to.

He praises the IAPT programme – for example (Improving Access to Psychological Therapies). I have to say I’m not wholly au fait with the nature of the roll out of IAPT – one of the difficulties highlighted is the ways that the roll-out has depended considerably on local services and issues. I do know that a part of the problems with the roll-out have been cuts in spending which took place prior to the general election.

Burstow commits to an increased funding in this area. I hope there is a consideration to the access to referrals across the board and across all age groups and the funding isn’t clustered around adults of working age, I don’t remain particularly hopeful however.

This little sentence made my heart droop a little bit

Our NHS White Paper – with its plans to replace process targets with a new focus on patient outcomes – will help to achieve this.

Over this summer, we are discussing with patients and clinicians which “outcome” measures should be used to judge the health service in the future.

Targets or outcomes – perhaps because I’m not involved in the ways and means of measurements  but I don’t see the benefits of one over the other as both can be massaged in any way chosen. Measured outcomes sounds good. We absolutely want people to ‘get better’. But who is judging how ‘better’ someone is and what is the baseline? It is still a bit too ‘tidy’ when ‘better’ means many different things. It might mean someone getting back to work if they have been off for a long period of time – it might mean being able to do things previously they weren’t able to but it is often as not a snapshot judgement and while I know it is the way we are going – we are being measured currently on outcome delivery, it doesn’t seem to guarantee a quality service is being delivered.

I can’t think of a way around quantifying the work we do – which is what is demanded. The only measure I can get my head around is actually asking the people we work with and their family members if our input has been more positive and useful but that isn’t ‘measureable’. Maybe it is due to the ways the outcome measures work that I feel a little cynical about them and the ease with which they can be manipulated – not necessarily maliciously but judging someone who has a fluctuating mental state between one week and the next may deliver different outcomes as might completely unrelated external factors – a recent bereavement, a new relationship – things over which the role of the professional would not make a difference.

Back to Burstow though and he does seem to be saying the ‘right’ things about tackling mental health through pubilc health initiatives and it shows that at least there is a sensitivity to the needs of mental health services in the country.

I do both wonder and worry where the next steps of this government will take us. As long as there is an agenda to stigmatise those who are dependent on state benefits and to cut preventative services across the board, there is not likely to be a whole person approach to mental health across different departments. Maybe if the Department of Health spoke to the Department of Work and Pensions a little more openly there would actually be some government money being saved in terms of prevention.

As a front-line practitioner, it’s easy for me to say that money should be pumped in here, there and everywhere and I’m aware of that. I know it won’t be. I am no macro-economist.

What I do see though is false savings in chronic care which lead to more expensive acute needs.

What I see is financial responsibilities for individuals between pushed between health and social services because neither want to take up the budgets and where the only person to suffer is the one for whom we should be caring.

As long as issues are dealt with within siloed budget streams of one department or another, it’s unlikely that the more global savings despite earlier outlays will be accounted for.

As for Burstow, he has the right honeyed words but he will be judged purely on what he and his government deliver.

9 thoughts on “Burstow’s vision

  1. Hello British Social Worker.

    Two comments: 1. One of the major concerns around IAPT is the initiative’s obsession with Cognitive Behavioural Therapy. This core therapy in IAPT is contradictory to personalisation – it is squeezing people into service which may not be of use to them.
    2. Beware the Big Society and its vision of massed public involvement with scads of volunteers all over the place. If we follow the continuum of social work assistants replacing trained and qualified professional social workers, an insidiously increasing process since the 1980s, and follow that continuum into the future we can see a volunteer replacing you. See my recent posting on PPlog above.

  2. Pingback: This Week in Mentalists – Thermonuclear Hypocrisy Edition (By Proxy) « Mental Nurse

  3. Hi Mike
    Thanks for your points. To be honest, I don’t know too much about IAPT as it has been focussed on adults of working age but I know there is a definite push towards CBT because it is seen as more cost-effective. You are right though, pushing people into one model is counter to the ‘personalisation’ agenda although I have my own feelings about that – namely that it is something of a smokescreen of saying the right things but without necessarily backing it up in practice.
    You are right about social work assistants replacing social workers in some areas. It is happening now and it is happening in the borough in which I work. That’s why it’s important to highlight what is happening and one of the reasons I want to continue writing.

  4. How ARE you supposed to measure target achievement and outcomes in mental health; a service area that is usually longterm and persistant – part of the diagnosis process and in Canada, a criteria that must be met in order to receiving ongoing and intensive service from our major mental health service providers. Serious depression doesn’t go away; nor does bipolar disorder or schizophrenia, as you know. Changes can be made to improve quality of life, but I hope that a reduction in service users is not a target that is established.

  5. Hi Jen – the outcome measures at the moment (that we use – from what I understand, different areas use different kinds of measures) would ‘take a snapshot’ of how someone’s mental health is on a basis of a number of factors and compare it with a similar snapshot after 6 weeks of working with our team to see if anything is ‘better’. Its a bit complicated and I have a lot of scepticism about the veracity of these types of measures as there are so many complex aspects of people’s lives who come into contact with our services.
    But – the government demands value for money and so we are being judged on these outcomes and funding will be linked to them.

    • Ah, it’s all about stats in the end. But stats are so difficult to gather on such a qualitative subject! And really – SIX WEEKS!? That’s not even enough time for most meds to kick in.

      • It might not always be done after 6 weeks – that is somewhat situational – it could also be 6 months but it depends on what has been happening. To be honest, I have put some of the details to the back of my mind at the moment because at the moment, it isn’t mandatory…

  6. I tend to share your concerns CB. This sounds like nice words with little substance but we’ll wait and see.

    One thing I do like (and this contradicts Jen, sorry ?Jen) is that the emphassis on outcome allows for acknowledgement of recovery. We’re finaslly moving away from the biomedical self-fulfilling prophecy about permanence and toward a more reasonable awareness that people do regularly erecover from disorders like schizophrenia (a ‘dodgy’ diagnosis anyway when you look at the evidence base).

    It will be interesting to see if political perspectives on recovery are catching up with modern research or whether we’re still going to be stuck in the old biomedical assumptions of the past.

    We’ll have to wait and see ….

  7. Emphasising outcomes is different to actually using the rather rudimentary tick-box outcome measures that we have in place at the moment. I accept that measuring outcomes is probably better than measuring targets but, and this is the big but, I’ve used some of these outcome measures and they are very very clumsy. You ‘score’ if someone is ‘better’ according to ticks at a particular snapshot period and sometimes it is over quite short periods. I don’t know how else they will or could work but for me in my fluffy social work world, I like the idea of involving patients and carers in the ‘outcome measures’. Currently they are wholly based on my (or whichever professional is involved) opinion.
    I went to a recent seminar about these outcome measures and how they will work and on leaving the room, I said to a colleague, that it felt that we were taking leaps backwards as regards ‘medicalisation’ of mental health conditions as none of the outcomes related to any social outcomes at all.
    But – on the other hand, I think generally there is a move towards more recovery model based thinking. It seemed to have been a part of the New Horizons approach and is definitely gaining traction.
    Nothing wrong with measuring outcomes but the outcomes that are measured and the way of doing so, could be a whole lot better.
    I am happy to communicate privately about the particular models and outcome measurements because these ones are very medicalised.

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