Guardian - Mental health services in crisis are abandoning patients to meet targets May 2019

[Sly Saint]

Off-rolling has recently become a buzzword in the world of education. It refers to the removal, by various means, of students from schools’ records who are deemed too complicated or who don’t make the statistics look good. However, it’s not just education. Off-rolling is common in mental health services and disproportionally affects those most vulnerable and marginalised.

Off-rolling takes three main forms. The first is prematurely discharging patients from secondary mental health services such as community mental health teams. Traditionally, one could expect better care if one had moderate to severe mental health difficulties, as opposed to mild problems, as funding was based on clinical need. However the relentless obsession with targets and outcome privileges services that give good optics.

To manage these expectations, secondary care has re-oriented to a new value – that of recovery, which, as the pioneering mental health survivor-led campaigning group Recovery in the Bin demonstrate, has become decoupled from its founding principles to discriminate against people who remain disturbed or unwell.

From Recovery in the Bin

The Recovery approach started with noble principles but has been co-opted by Neoliberal ideology and now mostly operates as cover for coercion, victim blaming, disability denial and removal of services.

full article here
https://www.theguardian.com/comment...-vulnerable-off-rolled?CMP=Share_iOSApp_Other

 

[rvallee]

Ah, I see that IAPT is going splendidly well. The one trick to meet that absurd 50% "recovery" target: redefine "recovery" as "whatever" and kick off people who won't meet it. Genius!

Who could have predicted that overloading mental health services with people whose primary needs are medical care would be a bad idea? Surely no one. Well, no one who was listened to anyway. Good job, Simon. You truly are "too smart" to be a psychiatrist.

Other controversial predictions include: hot stoves are hot and unpleasant to touch, having sick people yelling at their symptoms is ridiculously unprofessional, depriving sick people of basic medical and social care is bad. Best of all: my predictions are free and come with significant long-term savings and economic success.

 

[Peter T]

Hopefully this will encourage the MUS empire builders to think again about trying to hijack ME, given we are a patient group where their preferred treatment methods have demonstrably failed.

However I guess this just means the empire builders will keep trying to force us into an inappropriate service which in turn will desperately be trying to discharge us as quickly as possible, leaving even more people lost in a service limbo.

 

[alktipping]

tick box exercises have always been about been counting and have in my experience led to far worse customer/client satisfaction. It is always politically motivated because of the soundbite effect in mass media . It is possible in an alternative universe that this method actually produces value for money ?

 

[Snow Leopard]

The lesson is those delivering the assessments need to be independent from those delivering the services.

Redefining "recovery" or whatever post-hoc and then claiming you met the pre-defined target is fraud.

 

[Mithriel]

Having a family member involved in this it is a worry. His support has been passed onto a community group which is very good but it is reliant on grants. Too many community groups have had their grants removed and closed.

So the NHS justifies moving patients on because community support is available but when that support is removed, they don't care.

 

[Trish]

I have a friend who is struggling emotionally with caring for a spouse with a very difficult and long term illness (not ME). The GP's response was referral to a CBT 'group' of 20 people lectured to in a classroom with a white board. The group include, for example, a youngster who gets anxious about driving lessons, and others with who knows what other random anxieties or depressions.

My friend is now paying privately for counselling.

 

[Arnie Pye]

@dave30th This thread may be of interest to you if you plan on writing any articles on IAPT.

 

[rvallee]

I have a friend who is struggling emotionally with caring for a spouse with a very difficult and long term illness (not ME). The GP's response was referral to a CBT 'group' of 20 people lectured to in a classroom with a white board. The group include, for example, a youngster who gets anxious about driving lessons, and others with who knows what other random anxieties or depressions.

My friend is now paying privately for counselling.

I have no idea what people were expecting. None of this can scale up in a meaningful way. Even in the most perfectly controlled circumstances it barely produces a weak, self-reported and thus non-standardized, questionnaire effect and those would be many times more expensive than what it aims to replace. It makes exactly as much sense as deploying an electric grid on direct current, with repeater stations every km, massive power leakage and constant risk of fire. Absurdly naive and promoted by people who clearly have no idea what they're doing.

And yet there is no mental health crisis, the vast majority of those are casual misdiagnoses where perfectly normal behavior in difficult circumstances is pathologized. It's a worthless solution to a made-up problem that carries a huge opportunity cost, as hundreds of millions are wasted rather than being put to good use.