Outcomes for mental health services: what really matters?

“For service users, it can be deeply disempowering when clinicians discount their understanding of their own illness, stripping their experience back to a set of symptoms and converting individual suffering into a 1–10 score in the search for a diagnosis.”

This independent report has been written by Ben Collins, commissioned by Janssen and published by the King’s Fund. It includes the following conclusion:

“… we cannot usefully direct mental health services to the dogged pursuit of particular outcomes until there is a broader consensus on which outcomes really matter. Where service users, professionals and different professions already appear to be pulling in different directions – each blaming the other for their dissatisfaction with the current system – that kind of approach would simply create further antagonism. It is also clear that some sort of reconciliation is urgently needed. Unfortunately, any serious reflection on desired outcomes from mental health services quickly leads us away from unthreatening technical discussions to much bigger questions about the purposes of health and care services.”

It also contains the following:

“… Michael Smith told us that staff in his depression clinic in Glasgow had started to talk about ‘the thing with no name, this strange ingredient X, which I think really reflected engagement and connection between clinician and patient’. They concluded that at least one component of this ingredient was simply curiosity: profound and sincere curiosity about the person on the other side of the table based on a sense of human connection and engagement. For Michael, ‘It’s one of the reasons why I have become more suspicious of traditional outcomes frameworks – they just can’t capture these two critical therapeutic factors of curiosity and connection’ …”

And:

“… Some professionals might argue that, in addressing the symptoms of mental disorder, they will address the suffering that comes with it. However, there is extensive research on the distinctions between being afflicted with a physical or mental disorder and suffering …”

And:

“… The professionals in health and care services have tended to frame mental illness as generalised problems amenable to generalised solutions – a medical diagnosis and a set of social factors, much the same from one patient to the next, amenable to a common set of off-the-shelf solutions: medical treatment for the disorder, support for housing, a training course to get back to work, for example. Service users do the opposite, seeing mental illness not as a diagnosis – one that they share with other people – but a unique personal experience, and one that is inextricably wrapped up in every feature of themselves and every aspect of their lives …”

And:

“… For the most part, NHS mental health services are not the sort of places people reading this paper would want to visit in a moment of profound personal crisis. Many are noisy, frightening places. There is linoleum on the floor. The windows are glued shut. There are few quiet spaces where you can take refuge. Few people working in mental health services would argue against trying to alleviate suffering or rekindle hope; indeed, many are attempting to do precisely that. Yet the priorities of the day are visible in the environments we have created: ensuring hygiene, avoiding infections and minimising risks, rather than providing sanctuary, alleviating suffering, recovering voice or rekindling hope …”

You can read the entire report from here.