Care in and out of the community
What is mental illness and what causes it?
Feelings of sadness, anxiety and confusion are perfectly normal responses to the stresses and strains of life. They only become mental health problems when they significantly interfere with everyday life.The causes of mental illness are complex and the subject of much debate, differing between illnesses and each individual. Often illness can be triggered by traumatic, stressful events such as bereavement and physical illness and by work, relationship or financial problems. Drug misuse can precipitate illness in vulnerable individuals, as can pregnancy and childbirth. Other times there is no obvious environmental cause. It is generally recognised that illness is the result of the interplay of genetic vulnerability and life experience. Scientists are seeking to establish what genes confer vulnerability to severe mental illnesses like schizophrenia, bipolar disorder and major depression. These conditions sometimes run in families, evidence of a genetic predisposition.
Treatment
A visit to the GP is normally the first step to getting treatment. For most common mental health problems, such as anxiety or depression, a family doctor may provide lifestyle advice, such as reducing stress and taking more exercise, a prescription for anti-depressants or a referral to counselling or talking therapies.A GP is likely to refer someone with more severe or chronic mental health problems to a specialist mental health services such as the Community Mental Health Team or a consultant psychiatrist. Specialist services exist for children and young people (Child and Adolescent Mental Health Services) and for older people.
The vast majority of people receiving help for their mental health problems live in their own homes or with their families. Some, with extra support needs, may live in residential care homes, hostels, supported housing or therapeutic communities.
Hospital admissions are mostly voluntary with only around one in ten patients being detained or ‘sectioned’ under powers under the appropriate section of the Mental Health Act. A small minority of those admitted to hospital need to receive care in secure settings for the safety of the patient or other people. Secure care services are provided in a number of hospitals around the UK.
Drug treatments are widely used for a range of illnesses, and are considered essential for treating more severe illnesses like bipolar disorder, schizophrenia and severe depression, although they sometimes have very unpleasant side effects.
Talking therapies include counselling, psychotherapy and Cognitive Behavioural Therapy (CBT), the most evidence-based talking therapy which involves challenging negative thinking patterns. Many patients benefit from a combination of medicines and talking therapies.
The changing face of services
Over the last decade, emergency admissions to in-patient wards have fallen because of a move towards community-based treatment. Patients increasingly treated in their own homes by ‘crisis resolution’ and ‘home treatment’ teams, which are available 24-hours a day. Every year almost 100,000 people are treated safely and successfully at home instead of at hospital.The Government has also pledged to invest £170m by 2010 in talking therapies in England. This is expected to reduce average waiting times to see a therapist from 18 months to a fortnight. Most people with anxiety and depression want talking therapies, rather than anti-depressants. It is expected that this will enable 900,000 more people, who would otherwise mostly have only had the option of anti-depressant treatment, to receive talking therapies.
The NHS is also making Computerised CBT, therapy delivered by computer online and through a CD-Rom, available after the National Institute for Clinical Excellence and Health recommended it as a treatment for mild depression or anxiety.
The Mental Health Act 2007, applicable in England and Wales from October 2008, introduced supervised community treatment, a new way of managing the care of patients in the community rather than in hospital. Patients can be asked to keep to conditions, such as attending out-patient clinics to take medication under supervision, to help ensure they receive the treatment they need. They may be recalled to hospital for treatment if necessary.
