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‘Hospital is not always the answer’ - Mental health crisis team manager speaks about role

By Burton Mail  |  Posted: May 14, 2014

  • 01/05/14 Crisis team visit Paul Bowers - Crisis team member from South Staff NHS FT

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WITH a quarter of adults suffering a mental health problem during their life it isn’t surprising that the topic is rarely out of the headlines.

Here in Burton, psychiatric provision is rarely out of the spotlight, especially since the closure of services at the Margaret Stanhope Centre in 2012.

While occasional ‘horror stories’ may make the papers, the vast majority of patients will recover from their illness, said mental health worker Paul Bowers.

For the last two years Paul has managed the crisis resolution and home treatment teams for Burton’s mental health provider, the South Staffordshire and Shropshire NHS Foundation Trust.

From talking with Paul it became clear how the trust operates and why the crisis team make the decisions they do.

He explained that their role is that of a ‘gatekeeper’ for the trust’s mental health beds.

“This is so nobody is admitted into care unless the team has agreed that there is no alternative,” he said.

“At every point we want to do what is least restrictive, so people are not being taken into hospital.

“It has been recognised that while hospitals have a place for some people with mental health problems, this is not the route for everybody.

“We have to accept that a large proportion will go on to recover, so we want to work with this group to prevent them going into hospital, and if they do, to make their transition out all the smoother.”

The trust’s team of 25 nurses and psychiatrists work to the principle of ‘least restriction’, that is to prevent patients becoming institutionalised after spending long periods in psychiatric care.

“Each situation is unique,” said Paul

“If we feel that a level of risk is too high to be managed safely in the community then we might consider hospital admission.

“But each person has a real life, roles and responsibilities.

“The longer they are removed then the potential for them not to recover as fully grows exponentially.

“So when we admit someone in hospital we will work to support discharge at the earliest opportunity, and we will never use the Mental Health Act to get someone in hospital unless we absolutely have to.”

But public perceptions are hard to alter. For decades, hospitals have been seen as not only the first port of call for people in crisis, but a place for treatment and even long-term care.

But the winds of change are blowing, with more emphasis now placed on caring for mental health patients with community and charitable services.

For Burton this is through charities such as Mind and Changes, while ‘talking therapies’ have also emerged as tools to combat depression and anxiety.

Services like these are far more beneficial for patients than being treated in the confines of a hospital, said Paul.

He said: “If we can manage people in the lower-level environment without dragging them of into the hospital and removing them from their family and into recovery then they can get help them get back on with their lives.”

Paul uses the analogy that it’s better to get smokers to quit, than to have to treat them for lung cancer to emphasise his point.

But old habits die hard, and he acknowledges there is much work to do in changing the public’s perception of mental health.

“Some people will question the community-based support because they have come to believe that hospital is the only solution to keep them safe,” he said.

“What we have is spectrum of responses, but the more options we have got to help people then the better it is for all.

“People will ask if we use straightjackets and padded cells, we have to try and combat some of this.

“Yes there are horror stories, but people will never know the overwhelming majority of good work we do.”

So what does the future hold the trust’s crisis team? Paul said discussions are always taking place on how to improve care, with street triage teams and working groups set up to see how patients’ needs are being met in times of austerity.

He said: “I think we will be working far more closely with emergency services in the next two years.

“We all have competing demands and we have to find ways to make more effective targets, so unless we work together we won’t achieve that.

“The economic situation is driving us to work more effectively and that’s going to work better for people than it ever has done before.

“I have never had a sense that it is as collaborative as it is at the moment, so the will is definitely there.”

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