{"id":44726,"date":"2019-05-30T10:52:25","date_gmt":"2019-05-30T09:52:25","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44726"},"modified":"2019-06-07T12:19:23","modified_gmt":"2019-06-07T11:19:23","slug":"ben-collins-outcomes-for-mental-health-services-what-matters-most-for-patients","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/05\/30\/ben-collins-outcomes-for-mental-health-services-what-matters-most-for-patients\/","title":{"rendered":"Ben Collins: Outcomes for mental health services\u2014what matters most for patients?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">For at least a decade, health policymakers across developed countries have worshipped at the altar of \u201cvalue.\u201d Rather than paying for activity, purchasers should define the desired outcomes for particular health services\u2014rehabilitation after a hip operation or effective management of a chronic condition\u2014and reward providers for delivering these outcomes as efficiently as possible. <\/span><\/p>\n<p><span style=\"font-weight: 400\">But what do we do if there is no broad agreement on the outcomes a particular group of services should deliver? Under these circumstances, will the definition and pursuit of specific health outcomes provide valuable professional discipline? Or will it cause mistrust and division?<\/span><\/p>\n<p><span style=\"font-weight: 400\">Mental health is one area where consensus is hard to find. There is fierce disagreement on the benefits of established forms of treatment. Service users describe themselves as survivors\u2014not of illness\u2014but the institutions supposed to help them. Many turn to organisations that operate as an alternative to traditional health services. There is a perception that, despite the best efforts of many staff, traditional services are failing on matters of fundamental importance.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The King\u2019s Fund\u2019s recent <\/span><a href=\"https:\/\/www.kingsfund.org.uk\/publications\/outcomes-mental-health-services\"><span style=\"font-weight: 400\">paper on outcomes in mental health<\/span><\/a><span style=\"font-weight: 400\">, commissioned by Janssen, considers the outcomes currently prioritised by mental health services. In clinical services, the focus is on managing the signs and symptoms of mental health conditions such as anxiety or depression and people\u2019s ability to cope with daily life. In social services, the focus is on developing the resources and capabilities people need to recover and live independent lives. For example, do people have a job or other form of meaningful activity, safe and secure housing, and a strong support network? These are all vitally important things. And yet this narrow focus seems profoundly problematic.<\/span><\/p>\n<p><span style=\"font-weight: 400\">At NAVIGO, a social enterprise in Grimsby, we were shown around by a service user, Maria, who is now a volunteer. Maria had &#8220;selective mutism&#8221;\u2014she didn\u2019t talk\u2014during her childhood and a large part of her adult life. She told us about her childhood with a mother with post-natal depression who was unable to show warmth or talk to her, the sexual abuse she suffered at school, and terrifying experiences in locked mental health services. She also explained how, in NAVIGO\u2019s therapeutic community, she was able to make sense of what had happened to her, recognise the cycles of her illness, and reconnect with her family. When she stopped talking, we were all in tears. <\/span><\/p>\n<p><span style=\"font-weight: 400\">If I am rushed to hospital with trauma after a car accident, I am, and those caring for me are, likely to have a clear set of shared objectives. The order of priorities is self-evident. \u00a0In the care of people with mental health problems, and perhaps people with other chronic conditions, things feel very different. Even a brief discussion with Maria reminds us of the profoundly personal nature of mental illness. While she might share a diagnosis with others, Maria\u2019s experience of mental illness, her understanding of her condition, her healing journey and her aspirations for the future are unique.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The roles of public services in supporting people with mental health problems are also surely equally complex. In moments of crisis, people turn to services not just for a diagnosis, medical treatment or social support, but for sanctuary, to alleviate symptoms of illness, to help make sense of what has happened to them. They look for support in grieving, in recovering their voice, in rekindling hope. They look to services to address the stigma that comes with a mental health diagnosis, to let them know that just because they have reached rock bottom, they are still fully human, and perhaps for many other important things besides.<\/span><\/p>\n<p><span style=\"font-weight: 400\">If service users are angry, it is surely in part because traditional services\u2014incited by commissioners and trapped within a narrow definition of the outcomes that matter\u2014are prioritising the technical and clinical aspects of care to the detriment of these &#8220;humanitarian&#8221; aspects of care.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Ben Collins<\/strong> is projects director at The King&#8217;s Fund and author of Outcomes for mental health services: what really matters?: <\/span><\/i><a href=\"https:\/\/www.kingsfund.org.uk\/publications\/outcomes-mental-health-services\"><i><span style=\"font-weight: 400\">https:\/\/www.kingsfund.org.uk\/publications\/outcomes-mental-health-services<\/span><\/i><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>For at least a decade, health policymakers across developed countries have worshipped at the altar of \u201cvalue.\u201d Rather than paying for activity, purchasers should define the desired outcomes for particular [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/05\/30\/ben-collins-outcomes-for-mental-health-services-what-matters-most-for-patients\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":42636,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2148],"tags":[],"class_list":["post-44726","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kings-fund"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ben Collins: Outcomes for mental health services\u2014what matters most for patients? 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