Better Mental Health Care

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Foreword......Page 9
Acknowledgements......Page 12
Aim of the book: how to improve mental health care......Page 13
Drawing the map: the ‘matrix model’......Page 14
How to use the resources and ideas in this book......Page 15
References......Page 16
Defining ‘community care’ and ‘community mental health’......Page 17
The public health approach to mental health......Page 18
The public health impact of mental disorders......Page 20
Prevention as a component of the public health approach......Page 24
The aims of the mental health service......Page 26
References......Page 27
Period 1. The rise of the asylum (1880–1950)......Page 31
Period 2. The decline of the asylum (1950–1980)......Page 36
Period 3. Developing community care (since 1980)......Page 38
References......Page 40
Guiding principles at the national level......Page 43
Guiding principles at the local level......Page 45
Accessibility......Page 46
Comprehensiveness......Page 52
Continuity......Page 53
Co-ordination......Page 54
Guiding principles at the individual level......Page 55
Putting principles into practice......Page 56
References......Page 58
Epidemiologically based measures of local prevalence rates......Page 61
Actual service provision data as information for planning......Page 62
Using service utilisation data......Page 63
Evidence for a balance of hospital and community care......Page 64
(1) Out-patient/ambulatory clinics......Page 67
(3) Acute in-patient care......Page 68
(4) Long-term community-based residential care......Page 69
(2) Community mental health teams......Page 70
(3) Alternatives to acute in-patient care......Page 71
(5) Alternative forms of rehabilitation, occupation and work......Page 73
References......Page 75
Distilling experience......Page 83
A framework from experience......Page 84
General adult mental health care......Page 85
Stakeholders......Page 86
Challenge 1. Anxiety and uncertainty......Page 88
Challenge 2. Lack of structure in community services......Page 89
Challenge 3. How to initiate new developments?......Page 90
Challenge 4. How to manage opposition within the mental health system......Page 92
Challenge 5. Opposition from neighbours......Page 93
Challenge 6. Financial obstacles......Page 95
Challenge 7. System rigidity......Page 97
Challenge 8. Boundaries and barriers......Page 99
Challenge 9. Maintain morale......Page 100
Challenge 10. What is the right answer?......Page 102
Lessons learned......Page 104
Key points in this chapter......Page 107
References......Page 108
Social and political domains......Page 109
The economic domain......Page 111
Implications......Page 112
References......Page 113
Service functions at the local level......Page 117
Engagement with local stakeholders......Page 119
Implications of focusing on the local level......Page 120
References......Page 121
The significance of the individual level......Page 123
Seeing the individual as a partner in care......Page 124
Using the individual’s family members and carers as a resource......Page 125
Not too much and not too little care......Page 127
References......Page 129
Defining the input phase......Page 133
Inputs at the country/regional level......Page 134
Inputs at the local level......Page 137
Inputs at the individual level......Page 138
References......Page 139
Process at the country/regional level......Page 141
Process at the local level......Page 143
Key points in this chapter......Page 149
References......Page 150
Outcomes at the country/regional level......Page 153
Outcomes at the individual level......Page 156
Psychometric properties of outcome measures......Page 157
Methods for assessing outcomes......Page 158
Using outcome measures in routine clinical practice......Page 159
References......Page 161
Changing from an institutional to a community perspective......Page 165
Basic and continuing professional education......Page 167
Training guided by evidence: treatment guidelines......Page 168
Implementing guidelines in routine practice......Page 171
Building and maintaining clinical teams......Page 172
Key points in this chapter......Page 174
References......Page 175
An ambitiously realistic vision for mental health care......Page 177
Unifying the mental health sector and advocating for resources......Page 178
Better mental health care informed by ethics, evidence and experience......Page 182
Key points in this chapter......Page 185
References......Page 186
Index......Page 190