Early Days


For beginners, clicking with the mouse on a highlit item e.g Care Programme Approach [CPA } will take you to the appropriate page.

You absolutely must understand the Care programme Approach and how to deal with it; read the above link and pursue it's links.

You must also be familiar, at the start - later will be too late - with the caring journey, from the beginning to the outcomes.

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I say at the start .

Until you know what the family is getting itself into, until you are told in detail what it will be that you will have to do for a lifetime, until you are told what services the professional mental health service in your locality will have to offer, you should not take on the care of your family member suffering from schizophrenia, in your own home.

Learn the Language, the different Teams.
Admission services - beds - may well be uncertainly connected with Community Teams. These are Assertive Outreach Teams, Home treatment teams , Crisis Resolution Teams [ not evenings and weekends ?? ] - if you are lucky - a Rehabilitaion and Recovery team

Part of the requirement for a community care service is a variety of domestic alternatives
- supported homes, day centres, sheltered flats, hostels with associated routine and aactivities -- where the professional team is in contact, in charge, and accountable.
Unless you are clear that there is some outside interest that your family member will take up on a regular committed engagement during the week, that the supporting professional team will see as part of their commitment to arrange and support that, and if not successful, that they will intervene with alternative domestic placement and an outside routine
don't allow the decision that they will be living with you to be made in the first days.
When you are told everything - be hard about this - then , up to you.

You must get a working diagnosis as early as possible, so that you can prepare yourself for the range of prospects in store for any possibity of your commitment to family care at home.

There will be a Carer Support Worker service in your Mental Health Trust [ ask the Community Mental Health Team at once for their contact number ] area and you should invite them to give you advice immediately, about what aftercare support there is in your area.
They will know the reality in local aftercare delivery - day centre based occupational and educational activities, supported housing, supported flats - from their conversations with other carers before you.
They will put you in touch with carer groups and/or other carers who have been longer in your position, to enlighten you on what to expect from the aftercare NHS services in your area.
If you wait , options will already be closed off for you.

If you are stuck and frustrated try PALS the mental health team has the tel, no. Ask for - the team will know how you get this - and get a Carer Assessment - make sure it is read by your local mental health team - so that you can be sure your views and the reality of your caring circumstance are recorded by them

This how one letter writer described Home Treatment in care in the community " throwing people back on their own resources regardless of whether they have any, or not. "

That is also my personal experience of 'Home Treatment'. It is offered because 'they' have removed 'beds' so that there is no way back.

*** New !!! (2010) 34: 522-524. The Psychiatrist 2010 The Royal College of Psychiatrists
Correspondence to Naida F. Forbes [ abstract ]

Aims and method:-
We examined the local impact of introducing a home treatment team
on the use of in-patient psychiatric resources and rates of detention under the Mental Health (Care and Treatment) (Scotland) Act 2003.

Results Rates of admission to hospital and duration of hospital stay were unchanged.
However, there was an increase in episodes of detention in the year following the team's introduction.

Clinical implications Offering home treatment as an alternative to in-patient care may be associated with an increase in compulsory treatment.
If true, this is incompatible with the 'least restrictive alternative' principle of the recently revised mental health legislation.

P. R. I read with interest the paper by Forbes et al, which investigated the impact of a crisis resolution service. I am intrigued by their finding that the introduction of the crisis service was followed by an unexpected increase in the absolute numbers of patients detained under the Mental Health Act. In their discussion a number of possible explanations are explored. However, I believe there is one possible explanation, which is not fully discussed, although it is perhaps hinted at in the clinical implications section of their abstract. This is that the intervention might have a negative impact on some patients.

This is now the third study to find this association, with only one group failing to replicate it. Tyrer et al explicitly and at some length discuss the notion that negative effects on some patients of this type of service are one of the most plausible explanations for the increase in compulsory admissions. Furthermore, they suggest that any benefit from crisis services through reducing informal admissions may be cancelled out by the increase in compulsory admissions.

There does not yet seem to be a consensus around this important issue. Further research to explore the association is therefore warranted. Also of importance is research to clarify any risk factors that predict compulsory admission to hospital following a period of treatment by crisis services. Identification of such factors could potentially be used to improve services to patients.

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