The first thing that would make the mental health system better is a whole lot of funding and enough staff. But that’s probably not going to happen. Neither is anything I suggest, in all likelihood, but I have some ideas.
1) We need long-term inpatient facilities. They went out of favour sometime before my time – I think they were mostly closed down in the 80s in favour of community-based treatment. They were not perfect, and there was a lot of unethical behaviour associated with them, but I still think they need to come back.
Why? Because the current acute units are forced to deal with long-term patients, who spend months in them, taking up space that was supposed to be for emergency acute care. Allocating resources to facilities designed for long-term care will take the burden off acute care units and allow them to deal with acute patients. Additionally, long-term care facilities can target their treatment, and institute therapeutic programmes to help their residents prepare for the outside world.
What could go wrong? The biggest worry (apart from the dire lack of funding) that I see is the risk of institutionalisation. People can become so used to their sheltered facility that they never reintegrate into society. However, I would argue that it’s already happening in acute facilities. Additionally, there is the sad truth that some mentally ill people will never do well in the community, and many end up on the streets or in prison. Many families cannot cope with their mentally ill relatives, especially in the long term, and the mentally ill are left with very little to fall back on. Long term care must be looked at as a viable option ofr both individual and community health and safety.
2) The range of therapeutic programmes needs to be broadened and made more accessible. Community programmes are overburdened and under-funded, and inpatient programmes are often non-existent.
Why? Being well needs a combination of drug therapies and talking/skill-building therapies – and both should be readily available and accessible, both in inpatient and outpatient scenarios.
What could go wrong? Well, bot a lot that I can see. More availability of services can’t be a bad thing, except maybe for budgets.
3) Sub-acute facilities need to be more readily available.
Why? Sometimes mental health patients need time away from their own lives in order to sort their mind out a little. Short-term sub-acute facilities are ideal for this, and early intervention could take pressure off acute care wards. But sub-acute ‘respite’ care is not readily available. Some areas have none at all, and others have very little.
What could go wrong? If people needing acute care are sent to sub-acute facilities due to poor needs assessment or lack of space in acute wards, neither the others in the facility nor the patient are safe.
These are just the things churning around in my mind at this point. There’s probably more that I will think up at a later date.