Psychiatrists should have less influence over psychiatric inpatients, says report

Psychiatrists should have less power when making decisions on mental health patients in acute care, according to a new report.

Instead, psychiatric inpatients should have more support from peers who have experienced mental health problems, concluded a report by mental health charity Mind into acute and crisis mental health care in England and Wales.

Reducing the overall medical emphasis in patient care and treatment was one of four key recommendations in the report, produced after Mind held an investigation into mental health inpatient care.

Mind met mental health groups, services and individual experts, including service users, from January 2010 to August 2011. It also received 350 responses from a Mind website questionnaire.

“The needs people described – care, safety, someone to listen, something to do – did not require a medically dominant response,” read the report.

“People told us about the value of different people who have supported them from across the range of mental health professions as well as non-professional help.

“While some emphasized ‘trained professionals’, many people would prefer more peer support from people who have themselves experienced mental health problems.”

The report, entitled “Listening to Experience”, argued that psychiatrists would be more effective if they contributed as part of a team or were available for consultancy “rather than always ‘in charge’ or wholly ‘responsible’ for care.”

“We accept that doctors play a valuable role but this does not mean that they should head a hierarchy of professions,” read the report.

In 2010 more than 100,000 people were inpatients in a psychiatric units, such as emergency departments, crisis resolution, home treatment teams and community services.

The report’s other key recommendations were that inpatients should have more choice and control, be treated with more humanity, and that commissioning be improved.

Mind said while its inquiry found examples of good care with courteous and helpful staff and well-designed environments, there were also examples of poor and traumatic experiences in care.

The report, which included numerous accounts of patient experiences in crisis care, also made a number of recommendations for inpatient staff.

These included that they “share something” of themselves with patients.

“Not all your problems, but enough of your life to engage on an ordinary human level,” stated the report.

Also recommended was a commitment to working in non-violent ways and use de-escalation techniques first.

Paul Burstow, care services minister in England, said the report shone “a light on the good, the bad and the unacceptable”.

He said he wanted to work with Mind to take forward work on the report’s recommendations.

Leeds Survivor-Led Crisis Service, whose staff had experience of mental health crisis,  and London’s Maytree Sanctuary, which recruited people for their listening skills, and not qualifications, were mentioned as “most valued” services.

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