Monday, 31 December 2012

the postcode lottery of mental health care in Scotland

I've had cause recently to consider again the postcode lottery of mental health care in Scotland.  Where some areas seem to have a variety of choices for people in mental distress and requiring psychiatric treatment.  And others of us are at the bottom of the barrel.  Very little choice, lack of resources and mental health services that struggle to be either person-centred or recovery focused.

Edinburgh, for example, has a crisis centre for service users and carers who can self refer and stay for up to a week in a calm environment.  Lothian also has IHTT, intensive home treatment teams where a person can be supported through a mental health crisis at home.  A few other Scottish areas also have this.  Fife doesn't and isn't planning to.  

Glasgow has the Esteem service "a dedicated service for people aged 16 to 35 years old who are experiencing a first episode of psychosis. The team offers advice, support, treatment and various interventions. The team is multi-disciplinary, comprising consultant psychiatrists, psychologists, occupational therapists, nurses, support workers and administration staff.".  

The only other similar service is in Edinburgh, for young people, the "NHS Lothian Early Psychosis Support Service (EPSS) is a unique CAMHS based early intervention service for psychosis".  However both of these services, I believe, are based on a biopsychosocial model of mental health.  And it's the 'bio' bit that gives me cause for concern.  For I have never believed that mental distress was bio anything and is about life's traumas and problems.  

The bio bit opens the door to ECT/shock treatment and brain surgery for mental illness.  It also can mean lifelong mental illness and psychiatric drugs, being consigned to the severe and enduring mental illness label and cul de sac.  Where recovery is not mentioned and maintenance is the name of the game.  That's not to say that some people might require maintenance and support through life.  However hounding folk off welfare benefits is not the answer.

It seems to be that Scotland's mental health services in different areas are autonomous.  They get to 'do their own thing'.  Which means a postcode lottery for those of us at the receiving end.  And survival of the fittest.  We can't all move to the capital so as to be best served, mental health wise.  Neither should we have to.  So what is the government going to do about these inequalities in mental health care?

Taking away the user voice isn't the answer, as in doing away with independent advocacy and user led groups.  Neither is trying to silence the critical voices in psychiatry.  These are what bring about balance and expose human rights issues and abuses.  There has to be room for dissenting voices in a free and democratic country.  In my opinion.  Otherwise we will all be constrained, restrained and forced to conform.

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