Mental health problems

The concept of care has attracted considerable interest and there has been growing attention both to the needs of carers and how they may sometimes conflict with those of service users. Draws on initial research findings to examine experiences of care in mental health for men and women and for carers and users.

Background: NHS Direct is a new service that offers 24-hour advice from trained nurses. The National Service Framework for Mental Health and the National Strategy for Carers both mention NHS Direct as an important source of support for people with mental health problems. Aims: This paper reports findings from an evaluation of the Department of Health's NHS Direct mental health initiative.

Objective. Treatment decisions in life threatening situations (TD) are poorly studied in people with dementia.

Method. The carers of people with dementia were asked four TD questions, pertaining to cardiac resuscitation, intravenous fluids, oral antibiotics and intravenous antibiotics. The impact of key variables (age, dementia severity, psychiatric co-morbidity, physical illness, family relationship of carer) on TD were evaluated.

Specialist mental health services for older people have grown rapidly and successfully over the past two decades, aiming to offer services that are comprehensive, accessible, responsive, individualised, multidisciplinary, accountable, and systematic. As with all mental health problems, the burden falls on primary care (where minor morbidity often goes undetected) and specialist services tend to be reserved for those conditions and patients where diagnosis and management is problematic.

This article describes how Thurrock Council Social Services Department and South Essex Mental Health and Community Care NHS Trust launched a joint initiative to develop an integrated service strategy and implementation plan for older people's mental health services in Thurrock. The main principles of the approach were: service user and carer involvement, the active participation of mental health professionals working directly with service users and carers, representatives from all key agencies involved in the planning process.

Argues why the nearest relative role has important lessons for the roles of the nominated person and carer which will replace it in the next Mental Health Act.

User or carer involvement is often seen as intrinsically worth while; but if such involvement is a good thing in itself, it would not matter whether changes resulted from it. However, most people argue for user or carer involvement because they think some useful change will follow as a consequence. Being involved can benefit users or carers both personally (for example, by empowering them or increasing their social contacts) and practically (for example, by enabling them to earn money or learn new skills).

In June 2005 it became mandatory for psychiatric trainees to receive training directly from people who experience mental health problems and their carers. This will be checked on approval visits to all training schemes, and accreditation may be withheld until this aspect of training is in place.