Abstract
Despite developments in mental healthcare over recent decades, there remains a group of people with very complex needs who require lengthy admissions and high levels of support in the community on discharge. This is the group that mental health rehabilitation services focus on. In the context of contemporary mental health services that minimise in-patient lengths of stay, the needs of this group must not be overlooked. Providing a local, ‘whole system, integrated rehabilitation care pathway’ requires intelligent commissioning in order to avoid the social exclusion of this group to the ‘virtual asylum’ of out-of-area placements.
Highlights
IntroductionDespite the many developments in mental health treatments and investment in community-based services over the past few decades, some people continue to present with complex problems that require longer-term care
As a consequence of these multiple issues, everyday functioning tends to be severely impaired and challenging behaviours and poor engagement are common.[1]. This group represent a relatively small proportion of people in receipt of mental healthcare; it is estimated that around 14% of people newly diagnosed with psychosis will develop the kinds of complex problems that will require rehabilitation services.[2]
Over half the NHS mental health trusts in England have a community rehabilitation team[4] that provides clinical input to local supported accommodation services to enable patients in their ongoing recovery and progress through the care pathway.[6]. For those without a community rehabilitation team, clinical input is provided by other community mental health services such as community mental health teams, recovery teams or assertive outreach teams
Summary
Despite the many developments in mental health treatments and investment in community-based services over the past few decades, some people continue to present with complex problems that require longer-term care. As a consequence of these multiple issues, everyday functioning tends to be severely impaired and challenging behaviours and poor engagement are common.[1]. This group represent a relatively small proportion of people in receipt of mental healthcare; it is estimated that around 14% of people newly diagnosed with psychosis will develop the kinds of complex problems that will require rehabilitation services.[2] they usually require lengthy in-patient admissions and more intensively supported accommodation on discharge, which results in them absorbing 25-50% of the mental health and social care budget.[3] They can be considered a ‘low volume, high needs’ group. The remaining 20% of referrals come from forensic/secure services,[4] illustrating the importance of local rehabilitation services in the pathway out of secure services
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