Outpatient and community services for mental health problems

Experiences of outpatient and community services

The majority of mental health care is provided by services in the community. People described using day centres, day hospitals, rehabilitation centres and being a hospital outpatient. Various professionals were involved in their care including support workers, GPs, CPNs (community psychiatric nurses), psychiatrists and social workers. Some people referred to the combination of different professionals as their ‘mental health team’.

As with hospital inpatient services, various activities were available through these community services, including leisure activities, therapies, and work training. A few people found going to day centres helpful, but one woman said the day centre was only a ‘reason to get out of bed’ and the only thing she got out of it was the opportunity to write poetry in their creative writing class. A few people mentioned that day centres were no longer available in their area.

Many people talked about professionals who had been helpful. This was usually because they had felt able to talk to them, and they had listened and seemed to understand.

Mae says she hasn’t had much help, but didn’t really want any because she didn’t trust…

Age at interview 62

Gender Female

Age at diagnosis 45

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Tariq set out his own care plan and says the mental health system is different from how it’s…

Age at interview 21

Gender Male

Age at diagnosis 18

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She felt her GP didn’t try to understand what was wrong with her, whereas another doctor gave her…

Age at interview 60

Gender Female

Age at diagnosis 40

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Edward says he has a good GP who arranged for him to have an assessment when he told him his…

Age at interview 59

Gender Male

Age at diagnosis 20

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People also mentioned receiving practical help and support from mental health services in the community, including noticing when they are becoming unwell, and from their GP – ‘without her, I don’t know what I’d do’. One man felt that community mental health should also have responsibility for people’s physical, as well as mental health problems. Many people went to day centres or saw a mental health professional for their medication (see ‘Prescribed medication & side effects‘).

Professionals who didn’t listen or give support were seen as unhelpful and even intrusive. One woman mentioned that although her GP was good, she didn’t have the opportunity to discuss at length the things she felt were making her unwell. Another woman felt neglected because she’d been waiting for months for a referral to a psychiatrist. Some people valued the choices they had over their community based care and felt they had been really involved. Others, however, described feeling under pressure from mental health professionals.

Sara says her mental health team were patronising and didn’t listen; she didn’t feel like a “free…

Age at interview 31

Gender Female

Age at diagnosis 17

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Class, gender and ethnicity of professionals

Many felt it was important that the professional in question was able to understand their experiences and listened carefully to them, whatever their background. Some people felt it could be especially helpful if the professional had similar experiences, for example, of racism or mental health issues.

For some, it was essential that professionals shared the same background (whether gender, class or ethnicity), while for others it didn’t matter at all. For one man, the professional didn’t have to be the same ethnicity, but from any ethnic minority background. Another felt it would be helpful to have more Black psychiatrists in the system, but that sharing the same belief system as the patient was more important.

Her white, male psychiatrist is supportive, but she says it’s important that the rest of her…

Age at interview 36

Gender Female

Age at diagnosis 21

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Tariq says the ethnicity of his mental health team doesn’t matter, because they’ve all given him…

Age at interview 21

Gender Male

Age at diagnosis 18

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Lorenz believes it’s important for a doctor to be open minded and to have the same belief system…

Age at interview 50

Gender Male

Age at diagnosis 20

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One Asian woman found it difficult to talk to her White, middle class therapist (see Sara’s story), although another Asian man felt that ethnicity didn’t affect his care because he was middle class. Several people felt that professionals ‘don’t seem to understand Black culture’, including one woman of mixed heritage who felt that her white CPN couldn’t identify with her.

Sara believes that white middle class people can’t always understand Asian culture. (Played by an…

Age at interview 31

Gender Female

Age at diagnosis 17

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Another woman noticed that she had expectations for professionals based on their ethnicity and gender which were not met: for example, she was initially disappointed when she couldn’t talk openly with a Black female GP, and pleasantly surprised when a White male GP was very helpful. The same GPs, however, acted quite differently in later appointments.

Imani saw GPs from different backgrounds and reflects on her expectations and experiences of the…

Age at interview 48

Gender Female

Age at diagnosis 47

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Not wanting to use services

Some people mentioned being reluctant to get help from services because they didn’t trust professionals [see Mae above]. One woman didn’t want to see an Educational Psychologist because she felt angry that she was perceived to be ‘the problem’ and in need of treatment, not her family. She was also concerned about having a psychiatric diagnosis and whether that would make it difficult to get a job in the future.

A few people felt that the services they received didn’t take their culture into account. They felt that more should be done to make services more attractive to people from Black and minority ethnic backgrounds, ‘I really do think that a lot has to be done to draw the Black people in who really do need help and aren’t getting any’.

Jay says there was nothing for Black people at the day centre she attended.

Age at interview 49

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Devon reflects on why Black people don’t want to use services and says the system needs to be…

Age at interview 49

Gender Male

Age at diagnosis 22

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Ali says he didn’t want to seek help because mental health is a taboo and because he was worried…

Age at interview 27

Gender Male

Age at diagnosis 26

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It is hoped that new government programmes for mental health will improve access to services for minority ethnic communities, but the approach is questioned by many BME mental health campaigners and it is too early to tell whether it will be effective.

Recovery

Ways of describing mental health recovery Traditionally, people with mental health problems - especially severe mental health problems such as schizophrenia - were not expected...