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	TX: 02.12.04 - Mental Health PRESENTER: SHEILA MCCLENNON

	THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT.혻 BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 91훑괵 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. MCCLENNON Christmas is one of the most difficult times for patients with mental health problems, the Samaritans say they receive up to 20% more calls during the festive period. The change to mental health services could help. Three years ago the government promised that by the end of this year there'd be 335 mental health crisis resolution teams in place around the country. The teams offer intensive support and treatment to a patient at home, thus avoiding admission to hospital but four months ago just over half the target numbers of teams were in place. It's one of the bigger shake ups to the mental health services since the NHS was created and it promises to have a radical impact on the way that mental illness is dealt with. Stephen Niemiec is a nurse consultant with the crisis assessment and treatment service in Newcastle, part of the North Tyneside and Northumberland Mental Health Trust, which is often referred to as a gold standard. He told me how it works. NIEMIEC Fundamentally what we do is we would see people very, very quickly following referral from a GP or from an A&E department or from the police. Primarily what we do is we provide alternatives to in-patient admission, that is people can be treated at home and they can be treated intensively for quite extended periods of time from anywhere from two weeks up to about three months. MCCLENNON And what are the advantages and what have you seen to be the advantages of actually treating people, keeping them at home, in their own home? NIEMIEC They experience more autonomy - they can get up when they want to, they can watch whatever TV programme they want to and they don't have to worry about being surrounded by other people who might also be ill. And so fundamentally people feel much safer being at home. But there is also good clinical evidence to suggest that treatment at home is actually more successful. For example, we have a decreased suicide rate within Newcastle and North Tyneside of about 19%, we can also reduce Mental Health Act detention rates to hospital - that's been reduced by 25%, which is a reversal of the national trend. We've reduced the burden on in-patients services to be all things to all people, which means that those people who are being admitted are the ones that really do need to be admitted. But for people who are on home-based treatment they also go back to work earlier and they go back to their educational studies earlier. MCCLENNON Now you travel the country Stephen, giving advice to some of the healthcare trusts who are trying to set up these teams, from your experience how are they doing - are there enough suitably qualified professionals to staff these teams across the country? NIEMIEC Well I think that we're living in times where we're constantly short of psychiatric nurses and social workers and psychiatrists, so what's happening is that these teams are taking staff from other areas. The sad thing is, is that poor investment inevitably leads to poor results, both for patients but also for the mental health services as a whole. MCCLENNON So do you not think the criteria's being met? NIEMIEC That's a very difficult question to answer because there are some teams who are being very successful around the country but there are many other teams who I don't think will be able to deliver the full benefits, both to the local area or to the local mental health service. MCCLENNON Now this is a concern that has also been expressed by the mental health charities Rethink and the Sainsbury Centre for Mental Health, they've said about the quality of some of the teams set up in order to meet the target. But does it matter if these teams are not yet quite fully functioning - at least if they're there they can be built on, is that not a good starting point? NIEMIEC Yes, I mean I think it's always better to be able to begin new services but the risk that you run if you have a small team servicing a large area is that those staff will become exhausted and they will want to move on to other areas of the mental health service where it isn't so busy or so stressful for them. And so I think that it makes good sense to be able to set these teams up working with model fidelity, which is much more likely to lead to success. MCCLENNON This is a big shake up to mental health services in this country, the NHS is now saying that it's moved its target to the end of 2005 for 24 hour crisis resolution to be available to every patient that demands it. Do you think that's achievable? NIEMIEC I think with the extension of time and I think that with good resourcing there would be good reasons to be optimistic. Most of these services would be operating with what we would call fidelity principles, and those fidelity principles are that you work 24 hours a day, that you keep the admission beds, that the teams are multidisciplinary, that the team stays involved with people until the crisis is resolved and that's the difference between a crisis resolution service and a crisis intervention service. But also you've got multidisciplinary team, you've got medicine, you've got nursing, you've got social work, you've got occupational therapy if you can and you've got some psychology time. But also the team are mobile and that they engage with carers. And if you get all of those principles involved, the team will be successful as long as you've got sufficient numbers to cover your population. I keep calling it a chocolate cake - if you want a chocolate cake you've got to put in the right ingredients. MCCLENNON Stephen Niemiec. Well we asked the Department of Health how many crisis resolution teams are now in place. The latest figures they could provide only went up to March this year and showed 179 out of their target of 335 teams were in place then. As for 24 hour provision they said round the clock provision is managed differently in every area and its services may include crisis resolution teams, on-call doctors and duty psychiatric and A&E liaison teams and in some areas emergency drop-in clinics. Back to the Transcripts homepage Back to the You and Yours homepage The 91훑괵 is not responsible for external websites

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