We understand that service users have different expectations of recovery. How can we help a patient achieve recovery if we do not know what the service user expects to gain from an intervention?
Mental Health services use a wide variety of interventions. These include IAPT style talking therapies, medication, community based psychological therapies, community recovery teams, occupational therapies, hospital admissions, tertiary care in specialist settings, and so on. Some of these interventions, even though they are used by a very small number of people, require a lot of time and effort to set up. Some of these interventions require considerable effort from the patient and their carers. For example, patients with a diagnosis of borderline personality disorder may be sent to an out-of-county in-patient “democratic community” unit specialising in behavioural therapies. This tertiary care could last for six months. It needs a lot of paperwork and requires applications for special funding.
We need to improve services for people with borderline personality disorder. While the numbers of people with this diagnosis, and who need to go to places like Cassel or Main House, is small the costs involved are large and the effects the illness has on the person and the people around them are large. I believe some simple changes could improve the quality of life for those people, and possibly find some efficiency savings
We should ask a few simple questions when a service user is about to start some treatment. Questions like:
What do you expect from the intervention?
What do you want to concentrate on? Are there things about your MH problem that don't bother you?
What challenges do you think you'll face during this intervention?
What are you going to do about those challenges? How can we help you best during those challenging times?
We know from patient satisfaction surveys that some people do not feel involved in their care. A simple method to get people involved with their care, and to understand their expectations of care, would be to ask them before care starts. Discussion with the patient could uncover misconceptions they have, and help to correct their expectations. Or it could help relieve their fears of treatment, and increase compliance. Greater understanding of the desires of the service user is always good; and probably required by law.
We should also ask questions of service users when they have finished an intervention. Strictly when a patient leaves county they stop being a 2gether patient, but really 2gether sent them there so 2gether should take some responsibility for them.
I am surprised that we do not ask people what their experiences of a hospital were like. We should be actively seeking cases of abuse - even if those are very rare. But we should also be seeing how useful the patient feels the intervention was. Are we wasting money if we keep sending people to a hospital and they never find any benefit from that stay? So we should be asking some questions of the patient immediately after stopping an intervention; a fortnight after; and six months after.
2014/06/26 DRAFT v1