Abstract
This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency). Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans). We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment) need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.
Highlights
In most high income countries there has been a profound transformation in mental health care over the last 30 years
We aim to identify which lessons learned from the evidence and the experiences accruing from this transformation in mental health services may have relevance for the future development of healthcare for people with long-term physical conditions
Principles which we first identified to guide mental health service organisation, all nine of which can be potentially applied to long term care as well
Summary
In most high income countries there has been a profound transformation in mental health care over the last 30 years. In designing community-based mental health services, we have proposed a series of 9 principles to guide planning decisions [4] These principles were initially considered as orthogonal, or mutually independent, but experience has demonstrated to us that some of these principles may be either positively or negatively correlated with each other. Historical and current levels of funding mean that the level or coverage (meaning the proportion of people with a particular diagnosis who receive treatment) shows an ‘inverse care law’ in that in many high income countries about 75% of people with long term conditions are treated, whereas only 25% of people with mental disorders receive care [5,6]. Demand for mental health care may be substantially impeded by stigma-related factors, including lack of knowledge of locally available services, as well as expectations of low quality treatment, and of stigmatising reactions to a person who has received psychiatric treatment [7,8]
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