*** !!! NEW Latest July 2009 National Confidential Enquiry[ on their front page - go to 'latest news' top right ] unsettling and alarming news It's not to be buried or disguised, but to be taken very seriously, now. The families and friends of the victim and the perpetrator are all affected by this, their neighbourhood, all other families with members who have schizophrenia; secure Units and prisons that have the long-term custody of them.
If it's accurate, it demands a better service that can intervene early, and as important keep people with schizophrenia, in care and in touch The Inquiry found that there had been an increase in the number of homicides committed by people with mental illness at the time of the offence from 50 to over 70.
There was also a a rise in the number by people with schizophrenia - from 25 in 1997 to 46 in 2004 and an estimated 40 in 2005. 1997 ... all 54 ..... 2004 all 70 plus - say 74
1997 .. SZ 25 ..... 2004 SZ 54
1997 = ano 29 .... 2004 ano 20 i.e other serious mental illness has gone down. [ This is what I can't follow: general rise 54 -70+ = 16 rise - schizophrenia 25 -46 = 21 rise - i.e. from schizophrenia, sufficient in itself to account for all the increase ?? yet one query is answered like this - in those cases of homicides outside continuing care ,
.... ' depressive
illness was more common, The diagnoses were extracted from the
psychiatric reports [ are these public documents - open in Court ? ]
which were written pre-trial,
to determine the mental state of the perpetrator
at the time of the offence. ] Any previous contacts with the NHS Services is likely to be in those Reports, and maybe information within those Reports about GP contacts and the observations form there, should have led to more information being brought out by this Inquiry. It looks as though it received little ongoing ruminative reflection from monitors or this information would be available now. Patients staying in continuing care show no such increase in these tragedies - but no reduction, which must be the aim.
Professor Louis Appleby, Director of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, said:
There has been an unexplained rise in the number of homicides by people with mental illness and we now have to try to understand why this has happened.
It is important to emphasise that the increase has not occurred in mental health patients..... It is also important to keep these findings in perspective. The risk of being a victim of homicide in England and Wales is around 1 in 1,000
[ what's the base line ?? ... around 1 homicide per 100,000 population makes 1 victim per 100,000 !!!?? .....!!! and the risk of being killed by someone with schizophrenia is around 1 in 20,000. [ Ed. I can't follow this. The following figures are very rough but in the right order ]
Take generally the rate by adult people - say 500 adult homicides out of 40,000,000 adults - I make it 1- 80,000
But the population of people suffering from adult schizophrenia is approx 200,000 . Maybe one third of these are unstable, 70,000
If 40 annually is from this population the figure for Homicide, then it seems the proportion is 1/1700 . please can someone with a sense of statistics sort me out !
Professor Appleby is right to point out that the increase in homicides, where schizophrenia was the illness, came from those outside the NHS service.
But when the perpetrator was in the NHS service, the Reports after Care and Treatment Inquiries
are that the service was not up to the standards required to maintain them within the service.
Not a question of blame. In all but a very few, at the time, the service failed to get involved,
or was only part involved, or only able to be part involved, with the resources available.
Medication was often inadequate or not maintained. What should be done about this ? ? The current talk is for early intervention - meaning before the illness takes hold and wrecks the life - can this be done is doubtful still - but rather neglects those who have 'dropped out' or never been known to service - or have been discharged 'we have nothing further to offer'.
1, ...
The Confidential Inquiry should gather data on how many of those with schizophrenia, committing homicide, have been under psychiatric care, how and why they ceased to be so, and in how many cases others had been trying to involve psychiatric services prior to the homicide. There may be a lesson from this that long term follow up of patients with schizophrenia is justified, even if the patient appears well. " From a letter in the British Journal of Psychiatry: the home journal of the Royal College of Psychiatrists
2." However, the key question is, what happens once the patient is engaged? [ by Assertive Outreach Teams ]
I believe the focus of the team should then swiftly move towards recovery and social inclusion.
The most important characteristics of this would include a strengths-based approach and a focus on helping patients back to employment,
whether voluntary or paid.
Other characteristics would include a clear relapse prevention plan made in collaboration with the patient and a strong network of supported accommodation.
Occupational therapists (OTs) are invaluable in promoting such approaches in psychiatric care,
both in terms of social inclusion and potentially in leading on return to work initiatives.
Similarly, strong links with the local authority are important in ensuring a good network of supported accommodation.
This is facilitated by the presence of social workers with such links within the team.
However, it is interesting that in surveys done of AO team composition, it is the nursing profession that predominates.
OT and social work input remains limited, while psychology input is concerningly rare.
AO as an intervention has worked well abroad but needs to be modified to suit the needs of the UK population.
The modification required, in my opinion, is a stronger focus on recovery and rehabilitation.
This can be facilitated by ensuring that Occupational Therapists and Social Workers are an integral part of AO teams.
It intuitively makes sense that a strong recovery approach, clear relapse prevention plans
and good supported accommodation that is available for the patient who needs it,
should together reduce admissions and bed usage. This is the AO model that needs to be evaluated in well-designed randomized controlled trials." ... from a consultant psychiatrist [ Shetty ] in an Assertive Outreach and Rehabilitation Team and this in response ... A consistent finding in studies of ACT is that it is more acceptable to “difficult to engage” clients than standard care, but although UK ACT services are engaging clients, as Shetty rightly states, they are not building on this to deliver the evidence based interventions likely to improve clinical outcomes. In some cases this is due to inadequate specialist staffing, though this was not an issue in the REACT study. A survey of 222 English ACT teams in 2003 found that only half had a psychiatrist, one fifth had a psychologist and very few had a substance misuse or vocational rehabilitation specialist. In addition, only 12% were operating with high model fidelity and many did not operate outside office hours (Wright, personal communication). A comparison of ACT in London and Melbourne, Australia, found that London teams had around one quarter of the input from a psychiatrist, only half operated outside office hours (vs most Melbourne teams), only one third made the bulk of their contacts away from the office (vs. the majority of Melbourne teams) and they scored lower for caseload sharing (Harvey, personal communication).
Inadequate implementation of the ACT model, inadequate delivery of evidence based interventions, and similarities between key elements of ACT and standard care therefore appear to explain the variation in its effectiveness reported in the international literature. In the UK, ACT teams need to be staffed appropriately and operate with the critical components likely to result in improved outcomes. Otherwise, their lack of cost-effectiveness (McCrone et al, 2009) will make them vulnerable to closure. Killaly from Camden services, in letter in response to Shetty
How to discover and retake these into the help needed. For those in a system of living which provides for a regular attention and connection to activities in the week - a programme for their living, sustained and reliable, open to observation for early intervebntion, if necessary; here, the light touch is reasonable.
For the others, erratic and excluding themselves, it increasingly looks as though some kind of 'wardship' should be developed - CTO's but with clear reciprocal benefit in funding, appropriate residential support and occupational activities; guardianship with extra powers? There is a difference from those in some residual illness , but who have a directed life that they are in charge of, that is one connected to some meaningful regular activity, a routine for themselves, maintained by them, observed by other people :
from those who do not have this, and are consequently open to times when the illness is in charge, not open to observation; there is no such programme onto which to re-engage and restore the commitment.
It is the latter who have to be kept in contact, sufficient to carry some form od surveillance and with the contact to a significant person in their lives, often a family member, able to do reporting in.
back to Home Page
*** !!! NEW New Horizons - the guidance given in 1999 by the National Standards Framework NSF for mental health is to be made to disappear in autumn this year to be replaced by New Horizons.
The information about the intention in this is meagre, but the move by local area PCT managers is to say that
those left with serious and enduring mental illnesses - schizophrenia - are far less numerous than those in the primary GP led service with worried well and milder mental health conditions
- so guess where their funding priorities - devolved to local PCT decision makers to commission will now be - not with those in the aftercare of schizophrenia and their families - silent [ as this website knows ] and suffering.
Come on, make a noise send in your views to New Horizon on the aftercare experience not made available in your area for schizophrenia. This is around what I have sent. Formal consultation begins in July. Get ready !
New Horizons
Sir Louis Appleby has trotted round the country, to eight meetings. I doubt many family carers affected by schizophrenia will have got near him.
back to Home Page *** !!!
carers week survey the website is well worth a visit.
carer week survey people [ thank you, Sushila ] pulled out mental health for me ... 11.5% = around 270 were adult mental illness carers 76% said they had been near beakdown. Surveys of this kind combined with the National Institute for Clinical Excellence NICE recommendations below give the way forward for campaigning on facts .... a survey of what 'breaks within the week from caring' you have .. .. from which will/would come out, what sufferers are doing during their day and week
back to Home Page Carers Strategy One Year On - More Help For Carers
Carers Strategy
A one-stop
information and advice service for carers
who look after ill, frail
or disabled friends and relatives has been launched by the Care Services
Minister Phil Hope.
The Carers Direct hotline should make England's five million
carers' lives easier and reduce the time and stress of searching out essential
advice, including:-
Details of support available, including assessments,
benefits, direct payments, individual budgets and time off.
Help to maintain, leave or return to employment.
Help in education or training.
Advice on how carers maintain or improve their social and
emotional well-being, and their physical and mental health.
Access to health and social care for the person being
cared for.
How to access information about, and support from, health
and social care services for the person being cared for.
back to Home Page National Institute of Clinical Excellence on schizophrenia .... NICE .... says nothing of much volume on aftercare - but Nice is very valuable as providing standards of reference to be quoted, to apply pressure for aftercare service provision - and it is buried in the three hundred pages
But - and to be accepted by Primary Care Trust commissioners - NICE is authoritative - quote it for aftercare resource in your area. National Institute of Clinical Excellence [ NICE ] on Schizophrenia; updated 2009 - in continuing care - the most important aspect of schizophrenia: - this is what it says ( out of 335 pages ! ). 4.6.8.1 All teams providing services for people with schizophrenia should offer [ ? and if they decline ? ] social, group and physical activities to people with schizophrenia
(including in inpatient settings) and record arrangements in their care plan.
4.6.9 Employment, education and occupational activities
4.6.9.1 Mental health services should work in partnership with local stakeholders, including those representing BME groups,
to enable people with mental health problems, including schizophrenia, to access local employment and educational opportunities.
This should be sensitive to the person's needs and skill level and is likely
to involve working with agencies
such as Jobcentre Plus, disability employment advisers and non-statutory providers. [ oh, and their family carers maybe ??? ] The following is important - and how often does it happen ?
4.6.9.2 Routinely record the daytime activities of people with schizophrenia in their care plans, including occupational outcomes The limitation in this, is who is to be responsible, so as to discover the absence of aftercare activities - and who is to provide for such activities - how to apply it to those - discharged from the secondary service supervision - 'we have nothing else to offer them' left to their families or various forms of assisted housing, - those who have not met with the secondary service at all, or who have broken off for one reason or another Who is going to monitor the figures. Patients with continuing schizophrenia of some degree, who have activities, get a stabilisibng routine into their weekly lives, and at the same time their families get 'breaks in the week' from caring. But it's a start If those continuing in some lasting effect of schizophrenia are not in a routine, a certain programme of involvement with a regular activity of some sort - education, interest, hobbies, sheltered occupation, that engages them on days in the week - say monday, wednesday, friday - they drift - there is no 'internal' anchoring back into a reality outside , thinking wanders into illness, medication is forgotten, and they relapse. *** !!! ook at an 'official' review of rehabilitation and a link to those who have a service - does your area have one - please let me know ?!! Carers must use their intervention at the Needs A
If you don't get into the CPA, then ask for a Carer Assessment and put it in there as a NEED UNMET -three sessions per week when the long-term are doing something outsid the home.ssesment - the first stage of the Care Programme Approach - professional service must follow this system, but ask and get it clear that they are following this process, so that you can insist - to have put into the Care Plan, provision for aftercare engagement in an activity outside the care base, on a regular basis,that will give you 'breaks in the week', to yourself - the Carer.
If no such plan is delivered, have it registered as an UNMET need in the Care Plan, and raise the deficiency at every Review, and quoting NICE, to every pressure point you can access in your area: GP, MP, repeated letters to the Primary Care Trust in your area, especially where you can be a group representing all carers of schizophrenia, like yourself
*** !!! ... One comment from the latest Inquiry after Homicide
The Primary Care Trusts - the funders - knowing the inability of these sufferers to reach for power,
or to sustain any ability to challenge through legal redress for this neglect,
avoid examination of the failure by blaming the other - in section 117 for NHS and LASS,
They wait [ we thought it was up to them ] for the other lead to take the leadership in providing rehabilitation pathways. Cochrane reviews are two years into reviewing ... *** !!! ... rehabilitation in schizophrenia Consultant leads no longer put rehabilitation Needs as unmet in the Core Assessment stage of the Care Programme Approach. *** .. two present pleas from experience for specialist Rehabilitation teams as essential to support the lomg term ill who otherwise disappear ***
The neglected Need Primary Care Trust funding feel no requirement, nor demand, for them to commission rehabilitation services. Many of the initial support programmes accessible to the longterm sufferers from schizophrenia have disappeared. The old leaders - the consultants have their heads down, unable to declare the authority that belongs to them from their qualification, their training, their experience, their intelligence, and by being the most likely to stay long enough in post, and acquire the knowledge of how to practice the service in the locality, and to assess the capability of the other staffing.
They are often now uncertain as to how far they can call upon the response from, and support of, the other members, within the secondary mental health specialist teams, who each have their own line managers., whose interests are to their careers.
back to Home Page There is a new NHS inspectorate, part of the Care Quality Commission [ CQC ] replacing the old Mental Health Commission. *** !!!NEW !!! .. This is what the MHC used to ask providers to reply to ...
MHC Note the absence of any indication that provider Trusts should tell what they are delivering as service to aftercare - rehablitation, supported housing ,sheltered lodging etc . The government is now sold on local provider NHS Trusts, in their decision making, obtaining, and following, the views and experience of those receiving in the front-line So, tell the new body that you carers are not to be left out in any review of local mental health service; go to the CQC tell them in the next 'inspection' in your area , you want your carer after-care experience to be sampled *** !!!NEW !!! ...The worst has happened: what can you do
back to Home Page Comparitive mental spend per person: English Primary Care Trusts
can we find 'the best buy area' to live in for after-care? *** !!! e.g.
If you are internet and table literate with linking
try this service mapping website to find for your geographical area ... compare them to other areas [ e.g. supported housing has wide variation: Dorset lots, Cornwall none.
Or for your local Mental Health Trust
{ go to LIT - provider Trust area , under service group, tick 'allservices' then, at bottom, click RUN REPORT
and ; or in particular service type ... try continuing care ...type ... Rehabilitation and Recovery services - the after-care service ] back to Home Page
Items marked red are new or retain importance !!! *** !!!
Care Programme ApproachBut now - after a year taking 'evidence' this is the guidance that all the Mental Health NHS Trusts will follow. There is now a New CPA ... the same four stages . This is the less patronising guidance to the NHS Trusts that follows second line is best But better still click on the link "refocussing the care programme approach" in the right-hand column Even more important that you, the family carer, intervene at the Needs Assessment stage ... that is at the first stage in the CPA after first contact. That's the time when you ask about after-care service - what's available, and in particular what arrangements there will be, to give you and family patient "regular " breaks during the week " so that you and patient can have a life of their own.
If no arrangments are provided for you family future care situation - then get that registered at once as an UNMET need. and about your entitlement at the needs assessment stage of the CPA for you to have a Carer Assessments are for you to say what you want from the service - especially you want a life for your family member outside the home - an interest of their own. surprise ... surprise -the first line link on the new CPA page ( see above ) gives this within it ... needs assessments that find some needs unmet ...will, occasionally !!! lead to service improvement ... occasionally ??? !!!! ? Who decides about who continues on new CPA - the local Mental Health Trust service deliverers - the Mental Health teams - the DOH new CPA guidance says p 12 para 5 .. " " Services should continue to use
current local eligibility criteria to make initial
decisions on an individual's need for secondary
mental health services " and if they are the wrong decisions ?".
And don't think the Local Authority Social Services can help with aftercare - they have their own cut off point click on FACS = Fair ?access to social care - below that - they decide that - you are off their books, as well.
back to Home Page
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| Schizophrenia, homicide and long-term follow up letter B J Psych 30 September 2009
From a current Mental Health Tribunal Review member - a psychiatrist, now retired from being a consultant in Rehabilitation
The increase in the number of homicides committed by persons suffering from schizophrenia, revealed in the 2009 Annual Report of the NationalConfidential Inquiry into Suicide and Homicide by People with Mental Illness, is a cause for concern.
The report suggests that the increase is accounted for by individuals not classified as 'patients', i.e. those who have not been in contact with services in the last twelve months.
If the total of the data is represented in the report, then one should be able to derive the number of 'non-patients' by simply subtracting the 'patients' from the total of the schizophrenia homicide group. That resulting figure not does appear to support the hypothesis.
It appears to show that all of the increase is due to 'patients'. That increase may be due to follow-up failings.
Assessing patients for Mental Health Review Tribunals, I have noted that many teams often simply discharge patients when they do not co-operate with follow up.
The 'positive attitude of hope and recovery', adopted by some community teams and encouraged in New Ways of Working (2009), (NWW), fails to acknowledge the typically chronic or relapsing course of schizophrenia.
NWW also appears to discourage consultant psychiatrists from engaging in long term follow up by talking of a 'shrinking and more focused role for senior professionals, shedding repetitive activities or doing them more smartly'.
These approaches and the fragmentation of services into myriad teams risk losing opportunities to form and maintain therapeutic relationships with patients and their families and to gain understanding of the long term course of patients' illnesses.
It can subsequently become a bewildering task for families of discharged patients, or for concerned others, to get help.
When they do make contact, this will often be with professionals unknown to the patient and to whom the patient is unknown.
Given increased investment and increased numbers of psychiatrists, documented in NWW, it is difficult to see why psychiatrists and other professionals should have less time to allocate to the important task of maintaining links with this high priority group.
The 2007 Progress Report on New Ways of Working says: 'The aim is to achieve a cultural shift in services that enables those with the most experience and skills to work face to face with those with the most complex needs'. Schizophrenia is a severe and usually chronic or recurrent illness associated with a high suicide risk and relatively high homicide risk.
It is commonly associated with substance misuse.
Long term prophylactic medication and psychological and psychosocial interventions can reduce relapse rates.
Long term medical treatment carries risks of adverse effects.
Consultant psychiatrists are commonly among the longest serving members of their teams. The complex elements of schizophrenia and the advantages of long term follow-up provide an important and valid role for psychiatrists. Judicial Review perhaps this way
Forms Judicial Review Forms page
Judicial Review Guidance
Schizophreniago to About Schizophrenia back to Home Page
Rethink [ the old National Schizophrenia Fellowship - it seems to be getting back to that basic support ] gives good advice about mental illness issues. 0208 974 6814 open between 10.00am - 3.00pm Monday - FridayMay be you will join ?
they have a carer diary
Schizophrenia
Two necessities for 'some kind of recovery' Without these, in place, or as a written down commitment from professional aftercare, in definite preparation, my advice is not to have a family sufferer at home immediately.
Of course when there is a Care plan: that is to say, the professional service is going to express it's authorititative advice to the future 'cared for', about what is necessary, for them not to be ill again. So that you can say 'this is what we were told was 'best for you' by the experts who know this from experience.
Professional service will continue to maintain a connection, and help put in place the resource needed.
You are convinced that the family patient will have a regular programme of outside occupational activity for the aftercare , that means you will have regular breaks from caring - then Ok. Too early an acceptance and your leverage has gone for good !!!
You will have more influence - more clout to insist on what has to be put in place for you to continue caring - if this is going to be the outcome - by raising the question of breaks from caring during the week whilst your family member is in the hands of the professional team. They will then feel obliged - where otherwise they will not - to put their authority with some persuasive coercion, into telling sufferer with continuing illness - that there is an aftercare imperative which they must join in with, to stay better and to get better. A 'must' but one for which the team will deliver the resource and the personal support, to find for the sufferer . With that relief in the form of breaks within the week, comes the break for the family carers. If they discharge before any of this is raised you will find that the team will take thier priorities elsewhere. Why not - you will be carrying the can . This is not cynical, it is often the reality. out of sight IS out of mind NEW !!!
basic management1. Acceptable medication, maintained.
This has to be addressed seriously. Taking medication insures against future relapse, perhaps by being there when anxieties in a situation might otherwise lead to flurries of illness, taking over. That relapse follows stopping medication is well established overall. { not enough use is made of blood level tests of medication compliance, especially when surveillance is compulsory and compliance doubtful.
There is no general standard of the range for an efficacious blood level, although there is agreement that below a certain blood level medication will be ineffective.
But there is a personal level that can be taken as a baseline - it is the level found when compliance and observation of successful effect are assured, usually during a long enough period of hospital stay.
That level should be found to be at that level in the community care situation. A depot delivery regime should be tested just before or on the day of injection - that is when the level from the previous injection is at it's lowest. It is also the time when observers may note deterioration. Ask them ! ] A few can manage without medication - with limited lives
There is little success with acceptable medication if the people better [ not well ] after it, do not have some kind of future in life for themselves.
That leads to disappointment, emotional upsets on the way, and relapses. 'I take medication and where does it get me' ?! 2. A life outside the person; supporting a personal interest, a personal hope, giving an anchoring safe structure onto which to reconnect from wandering in thought, , a steadying and dependable routine that can be reliably there, onto which to fall back ; there in place for a settled future engagement.
A programme that rebuilds and prepares, the internal associations that will go to support the routine. When this is not in place, You have UNMET NEED This is what carers and charities that want services to be better, need to campaign about. Government Strategy recognises the need. It has committed itself ... see page 13 on [ The Journey to Recovery [ = a gloss on the National Standards Framework ]
[ quoted in Unmet Needs ] Many will relapse without this structure to 'lean on', as most ordinary people flounder without a job, or a domestic work habit; and without contact with company.
The acute stage and the care crisis, the first signs of florid illness, are quickly and are presently adequately addressed with what is needed straight away. What is an NHS service neglect, and left unanswered in a deliberate way, has been to postpone and deny funding and service development for the after-care the best source of facts about schizophrenia.. to manage properly you have to measure ...The best source of a full range of trials in schizophrenia management *** !!! *** !!! new MH Act people definitions.... the Act comes into effect today Nov 3 ... Supervised Community Treatment Orders [ SCT's ] , with limited compulsion the most significant change - challenge legally unless in a rehabilitation programme. Letter in the Royal College of Psychiatrists Journal about Community Treatment Orders [ SCT's ] ,
aftercare for those under Mental Health Act Orders, [ Supervised Community Treatment SCT's ] and the situation of carers.the original 'debate'..... transcribed *** !!!Stage 1. of the CPA, the Needs Assessment is the tool for getting public accountability of funding and spending and for blaming and shaming by using the Review stage to expose what becomes the continuing neglect.
Otherwise the unmet need is ignored in the game - 'not us to do ... for you to do' - between LASS and NHS.
Unmet needs in the CPA is a clinical deficiency for the clinicians to register, and then for the responsible managers to be named and called into account about it.
An unmet need that goes un-addressed can be challenged. It is something- when registered - that can be counted. Counting is the basis of management and accountability of management. What can be counted is there as a figure, there to be made public, as a neglect, to be the responsibilty of management to adress. Stigma
...How should one behave towards a person with schizophrenia or allied disorder? Keep to the point
family treatment; a caution original article third world better third world better ? comments on original article Leff comments on 'third world better' figures another comment gross domestic product and duration before treatment Risk assessment ..... violence in schizophrenia
...
a family voice ....
Pentreath Industries dies.A sorry tale - how to walk away and nobody cares. In the old mental hospital there was a prompted daily domestic routine for those without their own initiative; a sheltered workshop, clerical printing section, horticultural activities, messenger and observational duties ; an Occupational Therapy activity unit open each day. The point is that they were held within a culture in which there was accepted authority of direction and that cultural expectation provided sufficient coercion.
It meant many took part in activities off the wards - they had a routine to their daily lives, and a scaffolding framework programme of activities during the week.
It was this regular engagement in activity outside themselves that kept the internal associations from wandering into illness guided behaviour.
There was something to come back into, to bring 'outside' into focus, against a background of unchanging routine. That certainly brought 'institutionalism'. There were an insufficient number of normal people around which to dilute those with illness, an insufficient degree of the demands of 'normality'. The funding was never there for anything better, and certainly not one to recreate a supporting structure like this, 'outside' Now, outside in the community there is no activity of a sheltered kind, no system of access, no lead into participation by mentoring companions - there is nothing avalable for them to participate in: and no expression of authority from those whose expertise, cultural standing, and legal backing, give them that power to demand funding, but leave them with a pharasaical outlet and an exculpatory defence, against being involved or made responsible 'It is their choice; they are not ill enough as we see them' I prefer the overheard more honest words of a councillor in lead of Local Authority Welfare ... they should never have let the 'buggers' out Preparing for community care in the County catchment of Cornwall during 1995, the activities available to in-patients were moved out dispersed into the 'Community' - occupational health activities: printing, sheltered workshop, horticulture, , 'night club' - to a Charity - Pentreath Industries - nationally proclaimed as exemplar - under a manager, a senior Sister from the hospital She held it in order, innovated, but could not get funding to develop from the local NHS commissioning body - the one that was £30,000,000 pounds overspent on general health - turning instead to european money, given but linked to preparing people back to competitive work. The initial funding out of a total adult mental health budget in 1996 of £13,000,000 was £340,000 annually [ 3.5 % ]. After three years, the European funding lapsed. Ten years later, in 2006, out of the overall adult mental health Budget of £40,000,000+ the Budget for Pentreath Industry was £370,000 [1% ] .
So much for the longterm ill - seemingly less a burden [ on the NHS ! ] and in need of longterm intervention, than the acutely ill ??!!! A later attempt at a three year plan to invoke a 'Recovery 'programme based upon nodes throughout the County, failed when funding was withheld, to pay off the debts run up by the general illness hospital service, and 5-10% was taken out of secondary mental health budget, to help out the GP's who did not know what to do with those finding themselves inadequate in their community lives, deserving help, but not at the expense of those whose serious illness meant they could make little claim for themselves, and whose illness is disorganising one, and means they cannot organise an outside social framework by themselves
*** !!! NEW CBT
CreditFor the Article Below Goes To PSYORG.COM
Evidence That Cognitive Therapy Is Of No Value In Schitzophrenia
June 26th, 2009
"News-Research co-led by an academic at the University of Hertfordshire,
concludes that Cognitive Behavioural Therapy (CBT) is of no value in schizophrenia and has limited effect on depression. Professor Keith Laws, at the University's School of Psychology, is one of the lead authors on a paper entitled
: Cognitive behavioural therapy for major psychiatric disorder: does it really work?
A meta-analytical review of well-controlled trials, which has just been published online in the journal Psychological Medicine.
The paper reviews the use of CBT in schizophrenia , bipolar disorder and major depression .
The results of the review suggest that not only is CBT ineffective in treating schizophrenia
and in preventing relapse, it is also ineffective in preventing relapses in bipolar disorder.
The review also suggests that CBT has only a weak effect in treating depression,
but it has a greater effect in preventing relapses in this disorder.
The authors focused particularly on methodologically rigorous trials
that compared CBT to a ‘psychological placebo' and also investigated the impact of ‘blinding',
i.e. whether or not the people who assessed the patients knew
if they were receiving active treatment or not
. Both factors are considered essential before a drug treatment is approved
for use in psychiatric disorders .
The authors noted that not a single trial employing both blinding and psychological placebo
has found CBT to be effective in schizophrenia and surprisingly few well-controlled studies of CBT in depression.
"The results of this review are important because in March NICE re-approved CBT for use in all people with schizophrenia. The Government is also investing millions of pounds to provide CBT for depression and anxiety
in 250 dedicated therapy centres across England," said Professor Laws.
"Yet the evidence here is that the effectiveness of this form of therapy
may be less than previously thought, to the point of being non-existent in schizophrenia."
The other authors of the paper are Professor Peter McKenna, Benito Menni Complex Assistencial en Salut Mental, Barcelona and Dr Damian Lynch, University of Glasgow.
Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials, Psychological Medicine, Cambridge University Press, doi:10.1017/S003329170900590X
Source: University of Hertfordshire cp.
Eysenck
Eysenck: Psychotherapy
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