Some fascinating insights into the mental health sector emerged from a survey of participants at The Mental Health Services conference in Perth last week.
The importance of prioritising the needs of youth and children, the unhelpful impact of the dominance of the medical model in mental health, and the potential to expand the role of consumers in service planning and provision – these were some of the issues raised. The results also sound something of a wake-up call for the psychiatry profession.
Professor Gavin Mooney, who conducted the survey, reports:
“The Mental Health Services conference is unusual in that it brings together a wide array of players on the mental health stage – mental health service consumers, carers, health care professionals, administrators, academics, government bureaucrats – the whole spectrum of interests in mental health.
This year the organisers arranged through me to conduct a survey of participants entitled ‘what do you want from the mental health services?’
The survey looked at two things, first the sort of principles or values that participants want to underpin mental health services and second what they see as priorities on a number of levels.
One thing sticks out above all else in the responses. I had assumed that consumers would have very different views from health care professionals and again that academics would see things so differently from carers. Yet the pattern of responses across the groups was quite remarkably similar.
These people – diverse in terms of their roles in mental health services – know what is wrong and what needs to be done and are united in that!
On values and principles they argued for the idea that priorities should reflect the fact that even for people with the same problems, some have greater difficulties in accessing care than others.
The prime goal of the mental health services they see as looking after as well as possible the interests (both health and other) of those with mental illness and their carers and families.
Most interesting perhaps – certainly most radical – is that they want the values of consumers and people with mental illness to drive priorities. Now wouldn’t that be something!
At the same time, of the total of 164 responses not one person wanted the values of politicians or government or administrators to set priorities.
On priorities regarding extending services, there was strong support for more community services, none for general practice and very little for inpatient hospital services.
The top priority on age groups was youth with children second.
The participants were asked what type of staff they would most want if more staff could be attracted into the service. There was a big majority for more consumer advocates and peer workers. Nurses and social workers were second but a long way behind. Psychiatrists came last.
They were also asked about stumbling blocks to reform – both who and what. These open ended questions provided some fascinating but also sad comments.
Regarding who are stumbling blocks, government, the bureaucracy and clinicians came out of this very badly indeed. The participants suggest there is government neglect, no political will for reform, bureaucratic indifference and clinical elitism. Several respondents mentioned the inappropriateness of the medical model and the conservatism of clinicians in the mental health field.
On what is blocking reform the answers are again clear but sad – lack of resources, community attitudes, stigma and again the medical model. Lack of coordination was also highlighted and the issue of power not resting more in the hands of the clients and their carers.
My reading of these results is that there are very real frustrations involved for many of the participants in their dealings with mental health services. There appears from these answers to be a very real need for the service to look at itself in a very critical way and especially for psychiatrists to be looking at what their role is, what it might be and what it should be.
What is most striking is that the participants believe that there is much that needs to be reformed in mental health services, they are remarkably agreed on what that is and they have some pretty good ideas about what needs to change. They know what is wrong and they know what needs to be done to fix it.
That knowledge needs to be heard – but will the current decision makers listen?”