Page 58

and confused. In 1998 a report by the Sainsbury Centre for Mental Health found that ‘hospital care is a non therapeutic environment’ and recommended an overhaul of the care and amenities on acute wards (Sainsbury Centre, 1998). Despite some improvements, many people still find acute psychiatric wards frightening and unhelpful (RCP, 2008). Talking treatments should be available in hospital, and the importance of ‘ordinary human interaction’ between staff and service users cannot be overemphasised (Rose, 1998). The increasing administrative burden on staff in psychiatric wards can also make it difficult for them to find time to talk to service users. Many nurses find this frustrating and demoralising, and since people often find interaction with nurses the most helpful aspect of their stay in hospital, it also represents a considerable waste of resources (Rose, 1998). A range of alternatives to acute psychiatric hospital admission have recently been developed. These include non-hospital crisis houses such as the women’s crisis house run by Camden and Islington NHS Trust (http://www.candi.nhs.uk/our_services/services/ drayton_park_womens_crisis_service.asp). There are also examples of crisis services run by service users and ex-users, for example the Wokingham Crisis House (http://www.wokinghammentalhealth.org.uk). Workers should help every service user who wants it to draw up an ‘advance directive’ stating what he or she wants to happen should a crisis occur in which he or she is considered temporarily unable to exercise appropriate judgment. ‘Crisis cards’ which summarise these wishes should also be available to all users of mental health services. All service users should also have access to independent advocacy (BPS, 1999). 14.3.1.6 Information and choice: Practical help Many people find medication, talking treatments or both helpful. However, this is not the case for everyone and even for those who do find them helpful, help with things like housing, income, work and maintaining social roles can often be equally important in their recovery. Services should be flexible enough to offer each individual what he or she finds most helpful and, as outlined above, sometimes this will be practical help (for example with accommodation or employment) rather than ‘treatment’ or ‘therapy’. Work and/or education are often particularly important. People who are under-occupied are much more likely than others to experience recurring problems with extreme mood and work can bring about clinical improvement, particularly when this work is paid (Seebohm et al., 2002). Indeed, there is evidence that getting back to work has a greater positive impact than any other single factor (Warner, 1994). Helping people to find meaningful employment (or places on educational or training courses), and supporting them whilst they are in it, should therefore be a core task for mental health workers (Meddings & Perkins, 1999; Perkins et al., 1999). 14.3.1.7 Information and choice: Making rights and expectations explicit The principle of informed consent is paramount, as any treatment has the potential to do harm as well as good. It should be standard practice for service users to have access to the same information that is available to workers and should have the right to refuse treatments, from ECT and psychological therapies to medication. It is the recommendation of the British Psychological Society’s Division of Clinical Psychology that every service should publish a statement explicitly setting out what users

56

Understanding Bipolar Disorder

Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...

Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...