The approach in mental health services, known as ‘stepping down’, has been criticised by service users in a new report published by charity Manchester MIND.
Historically, people with ‘severe and enduring’ mental health needs, including those with conditions such as schizophrenia, have been treated in the long-term by mental health professionals.
But the report says that an increasing number of such patients are being handed over to the care of their GP.
“It has become apparent that this change in service provision is not working either for the individuals who need to access it or the professionals who deliver it,” the MIND report states.
“The perception was that people with complex and chronic disabilities are ‘dumped’ on GPs, many of whom ‘lack the capacity and willingness to understand’ how to manage their care.”
Researchers spoke to around 30 mental health service users about their experience of being discharged, as well as the voluntary and community group workers supporting those who have been ‘stepped down’.
Many people said they were not involved with the decision to be discharged, while some were completely unaware they’d been stepped down.
Researchers said there was ‘obvious confusion’ among patients being discharged, sometimes with a ‘harshness in the delivery’ and a ‘lack of concern’ for the person’s expressed fears.
The report said: “The majority, however, were shocked, puzzled and angry at their treatment, they were not listened to, got little or no information, were not involved in the decision, felt let down and abandoned.”
Many felt they were discharged for non-medical reasons, including missed appointments, using the service for too long and insufficient resources.
Some said a shift in treatment has had a detrimental impact on their lives.
One person said: “There is a rolling back of adult mental health services for those of us with severe enduring diagnoses who need ongoing support.
“The medical model has been superseded by the recovery model which is all about how we live best with our illnesses, but the recovery model is being used in a way that is destroying quality of life for most service users.
“We can’t live full lives because we are terrified of becoming ill as we don’t know what we will do on our own.”
Many complained of losing benefits, housing and community support as a result of being stepped-down.
The report said when people are discharged, there can be an assumption they are ‘recovered’ and are therefore no longer entitled to benfits.
This can be further exacerbated because they no longer have access to supporting medical evidence from a psychiatrist or care co-ordinator.
Paul Reed, mental health campaigner and chair of the Manchester User’s Network, described the report as ‘damning’.
“I’ve never seen so many patients upset,” he said.
“It’s a damning report which shows that something needs to be done.
“These poor people are being stepped down and losing their benefits.
“They are doing it dangerously when they know patients are at risk.
“Nurses are fed up at not being able to do their job.”
The Greater Manchester Mental Health Trust did not wish to respond to the findings of the report.
It described stepping down as a ‘vital part of recovery’.
A spokesperson for the trust said: “Stepping down – the process by which an individual is discharged from specialist mental health services and returns to primary care – is a vital part of recovery.
“Specialist mental health teams are there to offer care for people who are suffering from a range of mental illness and when they respond to the team’s interventions, it is a positive step for them to step-down from our services and return to the care of their GP and primary care services.
“Step-down decisions are based in evidence and what is of most clinical benefit to the individual.”
The trust was recently rated as ‘good’ by the Care Quality Commission (CQC) but told it must make safety improvements.
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Source: Manchester Evening News, 18th February 2020