Breaking Down Barriers - (Prof. Lewis Appleby Interview (Transcript))

willwade — Wed, 16 May 2007 12:23:02 +0100

Well I'm not entirely sure what to make of the following - here are some musings and the the transcript for yourselves to ponder.

Last Friday I awoke to the Today programme on Radio 4 and hazily heard a fascinating interview with The National Clinical Director for Mental Health, Professor Louis Applepy. He spoke to the Today programme discussing the "Breaking down barriers - the clinical case for change" Document (although it was stated as "some ideas"). Above everything else what I find fascinating is the strong hinting of the word "occupational therapy" without actually saying it. Or, did I have my "wishful thinking" hat on and they are infact thinking of using doctors & nurses... hmmm. The document doesn't really state anything new in my opinion - its what OT's (and on occasion some other AHP's and to some extent nursing) have been saying for a while. I also agree that many Mental Health units - particularly those involved outreach work are doing what is outlined. So who is this for? I'm not entirely sure. What's nice is the strong undertones that we need to move towards a more social model of healthcare - but it will take more than a couple of documents from the mental health sector of healthcare to get us there.

For the record I am posting it here. You have until this Friday to listen again on the BBC's site.

Friday 11th May 2007, 0714: Edward Stoughton (ES): The National Director for Mental Health , Professor Lewis Appleby is putting forward some ideas into for the next steps into reforming Mental Health Care. As I understand it you want the NHS to become more involved in peoples ordinary lives - that is patients being treated in the community.

Professor Lewis Appleby (LA): Yes the report is about the next phase of reform of mental health care. We have had several years of strengthening what community services do and the report is about breaking down barriers in the next stage of reform, so I'm talking about barriers that that get in the way of better patients experience of care. At the moment there is a barrier between what health services traditionally do, which is clinical care, improving peoples illness', abolishing their symptoms - but what patients often tell us they want is help with quality of life. They want opportunities for training, for jobs and decent housing and we have to take on that responsibility.

ES: so the sought of thing we would call more social work than health work?

LA: Well its rooted in social care certainly. The quality of life approach to healthcare has its origins there and I suppose traditionally we in clinical services have seen that as a secondary benefit so our main aim is to make sure people no longer have symptoms and we hope of course that there will be broader benefits to that, but now we are saying really those broader benefits should be the primary aim of what services are about.

ES: And do you think that's an argument that will fly, as its conceptually quite a big leap isn't it

LA: Well the good services are already doing it I think its fair to say. Erm, its certainly a step forward from what we have done in the past but you know if a young person has a first episode of psychotic illness and previously we would help them get well and then we would return them to their families and hope that they would prosper. Its much better to be saying we will now help you get back to college, find a training place and a job - we will support you and support any potential employer so that they are prepared to offer you a job

ES: It sounds expensive

LA: I don't think it is expensive - its one of these things that is more about changing aims and professional roles. Its really about how we as clinical staff see our main responsibility

ES: Its also about staff doing things that they haven't done before? That's bound to require more resources isnt it?

LA: Well not necessarily. We have had large increases in investment and very big increases in all the staff groups. And its our job now that to make best use of that money. And that means focusing on the things patients they want and in particular they tell us that they want to return to mainstream society. They don't want simply to turn up to outpatient clinics and get their regular treatment

ES: this whole area is something giving the government problems isn't it. I'm thinking of the mental health bill which is still trying to get through parliament. Do you think its the right moment to be talking about anther leap forward rather than consolidating what you have been trying to do already?

LA: Well the connection with the Mental Health Bill is that the aim of the bill is to keep people well and the main measure in the bill is community treatment border that will require some people to take their treatment

ES: But my point is that its politically proved very difficult indeed because not everyone agrees with the way the bill has been put forward

LA: Well lots of people are in support of the community treatment order although they may differ on the exactly what the criteria ought to be. But remember , if your life is one of repeated admissions to hospital and untreated mental illness you cant get a job you cant take advantage of decent housing, you cant form friendships and relationships in the way that other people can. And the bill is there to make sure that some high risk and vulnerable people get the treatment they need. "