Wednesday, 4 December 2013

Clustering and Slipping Through the Net

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Care clustering in mental health is something that I've been wanting to write about for some time and today my anger at the system has finally reached a level which warrants me ranting it out on here.For those of you who don't know clustering is a method of coordinating care in a way that mental health service users are compartmentalised into different groups in accordance with the characteristics they display. Basically, in order to receive treatment from certain areas you have to tick the relevant criteria, so what happens if you don't tick those boxes? You can't get treatment and slip through the net.

What we have here is a health system that raves on about early intervention at the same time as running criteria-led services; surely I can't be the only one thinking these are totally incompatible concepts? Two areas in which I think criteria-led services are particularly destructive are: eating disorders and addictions where a service user is also suffering with another mental health need.

There is tons of literature which support the need for early intervention in anorexia in order to increase recovery chances however, here lies a problem. Criteria-led services make this almost impossible, I wish it was enough for people who feel like they both need and want help to be able to access it and if I'm honest I think it needs to be that way. The state services are in at the moment you have to be almost at deaths door in order to be taken seriously. It has to be one thing or another: you either go for early intervention or you have people needing to tick boxes to fit criteria. Well you know what, funnily enough, people don't work that way. Not every illness is textbook but should that mean that they aren't offered the treatment and support they need? I think not. Imagine if you walked into A&E with a broken arm and were met with a Doctor who told you it wasn't quite broken enough because it hadn't broken the skin so they can't treat it until it's at that state? It's hard to imagine isn't it? That's because it wouldn't happen. So why is it okay to tell someone with anorexia their BMI isn't low enough to meet treatment requirements? It shouldn't be.

Which came first: the chicken or the egg; the substance misuse or the mental health problem? Does it really matter? Well, according to services at the moment, yes, it matters. Then BAM you end up with inter-service politics of mental health services not wanting to treat someone until they have dealt with their substance misuse problems; I don't understand why the "system" won't allow for both to happen efficiently side-by-side. If substance misuse and mental health are in fact synonymous with the chicken and the egg scenario surely to achieve ultimate recovery in both areas they both require addressing at the same time to avoid one constantly causing a relapse of the other? Instead however you get people trying to self medicate with illicit substances in order to cope with their mental health problems in a bid of self-help because lets be honest, this sort of treatment system lets people down.

Clustering and criteria-led services cannot possibly be a sustainable future for mental health care services; surely sometime soon people are going to start and realise that by trying to fit people into neat little categories they are letting the people who most want and need treatment down. This makes me genuinely sad because once someone gets into services there are some fabulously dedicated professionals working hard to support those in need; it's getting to that help that's the problem.

Hannah x


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