Question to those in UK re: mental illness

[Loves Vintage]

Hi All,

I traveled to the UK last year and spent just a short amount of time in London. In that time, I managed to encounter only one man who appeared to suffer from some degree of serious mental illness (extreme paranoia), though he was working and appeared functional. I've been curious how laws in the UK may differ from those in the US with respect to serious mental illness. Here, as far as I understand it, people can be admitted to the hospital for treatment (against their wishes) for only a very limited period of time and only if there is sufficient evidence that they are a danger to themselves or to others. They are "stabilized" with medication, and then sent back home or just out, if there is no home. It appears, though I will admit I've never researched this, that many homeless people are stuck in this cycle, unable or unwilling to receive adequate treatment, and left to function on their own.

So, I've been curious. Where are all of the mentally ill people in London? In hospitals, long term treatment, forced treatment? Or, did I simply not spend enough time there, and I am off-base in thinking that the rules are different there?

 

[momhappy]

There's an interesting article (on mental illness in London/Jan. 2014) that can be found in the PDF here:
http://www.london.gov.uk/priorities/health/publications/london-mental-health-the-invisible-costs-of-mental-ill-health

 

[Loves Vintage]

Thanks, Momhappy, for posting that link. I will read through the report and will post back here. I'm not sure if I articulated this clearly in my first post, but I am curious to find out whether there is a higher rate of homelessness in the US due to untreated mental illness. Often when people are severely ill, they will refuse treatment. It seems like a growing problem, or maybe I am just more aware of it now.

 

[Rhea]

I work in London with the homeless population, and more specifically with those who have substance use and mental health issues. I work in second stage housing so people are housed with us, normally through the council, which pays for their housing and other services which are in place.

I don't think there's a blanket answer. When I moved to London I was surprised at the high number of homeless but I'm from a very small, rural town in the US so any city would have had much higher than I was accustomed to seeing. People come to us through the council, usually because they are sleeping rough and have been through hostels and are moving onto more independent living. I work with the last stage before the finding your own place step. That's a bit of a laugh though because our service is supposed to be 2 years but has a ton of people with on-going issues which mean they may never be out of supported housing. The work I do is both comprehensive and severally lacking.

People with mental health problems are truly everywhere - some of our clients end up back on the streets (revolving door), many are in supported housing with stays in hospital and have high invention from mental health services when they need it, many are struggling to cope with much less support than they feel is necessary, and some are in work with minimal support and ready to move on. And that's just one small part of a not so small London based charity!

We do have the same problem as the US I think. Homelessness is a hugely complex issue as is mental health. Last year I had several clients who were sectioned (forced treatment as you worded it - a person is detained under a particular section of the Mental Health Act, basic points here - http://www.nhs.uk/NHSEngland/AboutNHSservices/mentalhealthservices/Documents/Detention%20_Under%20_The%20_Mental%20_Health%20_Act%20_Factsheet.pdf), quite a few who couldn't cope and left supported housing for the streets where they will live seeking what they need as they go (rolling night shelters, day centres, GPs, and street outreach often but not always have contact with this population) with the potential for further assistance if they deteriorate, and a quite a few who were stable and simply in supported housing.

It's a bit (ok, huge!) problem in that the government and funders always want people moving forward. I understand the need to push and not let someone keep doing something just because it suits them at the moment, but there's been a big change away from supported shared living (one large house, several people, each has own room or bed-sit) for an extended period. Now it's max 2 years hostel, max 2 years supported housing, and then on to own housing - and that's if hundreds of other things are in place such as the council taking responsibility for you. We see a lot of people "graduate" (for lack of a better term) through the stages just to slip back down to the streets and start all over. It's an incredibly flawed system, but the NHS and welfare system at least provide that bit of protection for a descent percentage. I won't pretend that it's all people by any stretch.

I think if you asked lots of people who work in services you'd get a huge range of answers about where the homeless are in London and if services work. Street outreach, hostel workers, NHS A&E, mental health services, statutory services, and charities will all think very differently about how mental health treatments work and if they are succeeding in their goals. I vote no, too high of a street population with little assess to services and time limits on those services with too much pushing to move on, get stable and integrate into society - whatever that means!

There's also the problem of "hidden homelessness". You may not have seen the homeless population because they do actually have a place to rest their head (albeit not their own place and it's temporary) or they spend the day looking like everyone else - reading in the library, hanging out with people they know, walking about (one of my clients spends his days walking around Hyde Park up to Selfridge's and looks quite like everyone else), riding around on public transport, or in day centres or coffee shops. A lot of homeless people are very smart and know where and when to bed down so that they won't be disturbed by police or drunk revilers. My couple of times out with street outreach shocked me at how many homeless there actually are about if you know where to look.

 

[House Cat]

Here in the states, there is the thought that they refuse treatment, but we should look at why. When I look at the homeless population, I see many people who should probably be put on some pretty heavy duty medications. Many people know that these meds have serious side effects and sort of brush off the homeless population by thinking that they don't want to persevere through these side effects in order to improve their lives, but I see something different. Let's think for a moment about the very mentally ill or delusional/psychotic individual who needs an antipsychotic medication. It really isn't a matter of living with the side effects, which can be terrible for SOME. It is a matter of adjusting to the medication in the first place. These meds usually require at minimum, two weeks for an individual to adjust. During this two weeks, the person is in complete zombie mode. They will sleep most of the time, shuffle into the kitchen for food, use the restroom, and go back to sleep. Little by little, they will wake up and become themselves with fewer symptoms (hopefully.) People within the general population, with good insurance, sometimes make this adjustment in the hospital. I don't see a homeless person able to make this adjustment at all. For one, a county hospital won't hold a bed for two weeks for a med adjustment. For two, a homeless person won't be able to keep themselves safe for two weeks in a zombie-like state. For three, they won't be able to provide for themselves in the way of food or other incidentals while they are in such a state. So, although these meds might lead to a healthier frame of mind and ultimately a better life, logistically, I don't see how it would work for them.

I was also told about five years ago that county medication services were cut for all people except those in crisis. I don't exactly know what that means. I don't know if that means that county psychiatrists won't be prescribing or if they won't be providing the actual medications.

It seems that whenever I turn around, mental health care is being cut in some way or another.

With "Obamacare" the homeless population has access to healthcare, but someone would have to sign them up. This might actually help them a LOT in the way of finding the care that they need. If they get connected to an actual HMO, they might find a hospital bed and have the "luxury" of being able to adjust to their meds.

I always say that mental illness is a group of disorders that make your brain lie to itself. The challenge is to get just a small window of lucidity, where you can get the person feeling well. If you can get that period of time, it can be life changing. Unfortunately mental illness is still being treated as an after thought by HMO's and by State run entities. I have no idea what it will take to turn things around for those who have the power to impart change.

 

[Tacori E-ring]

Here in the states, there is the thought that they refuse treatment, but we should look at why. When I look at the homeless population, I see many people who should probably be put on some pretty heavy duty medications. Many people know that these meds have serious side effects and sort of brush off the homeless population by thinking that they don't want to persevere through these side effects in order to improve their lives, but I see something different. Let's think for a moment about the very mentally ill or delusional/psychotic individual who needs an antipsychotic medication. It really isn't a matter of living with the side effects, which can be terrible for SOME. It is a matter of adjusting to the medication in the first place. These meds usually require at minimum, two weeks for an individual to adjust. During this two weeks, the person is in complete zombie mode. They will sleep most of the time, shuffle into the kitchen for food, use the restroom, and go back to sleep. Little by little, they will wake up and become themselves with fewer symptoms (hopefully.) People within the general population, with good insurance, sometimes make this adjustment in the hospital. I don't see a homeless person able to make this adjustment at all. For one, a county hospital won't hold a bed for two weeks for a med adjustment. For two, a homeless person won't be able to keep themselves safe for two weeks in a zombie-like state. For three, they won't be able to provide for themselves in the way of food or other incidentals while they are in such a state. So, although these meds might lead to a healthier frame of mind and ultimately a better life, logistically, I don't see how it would work for them.

I was also told about five years ago that county medication services were cut for all people except those in crisis. I don't exactly know what that means. I don't know if that means that county psychiatrists won't be prescribing or if they won't be providing the actual medications.

It seems that whenever I turn around, mental health care is being cut in some way or another.

With "Obamacare" the homeless population has access to healthcare, but someone would have to sign them up. This might actually help them a LOT in the way of finding the care that they need. If they get connected to an actual HMO, they might find a hospital bed and have the "luxury" of being able to adjust to their meds.

I always say that mental illness is a group of disorders that make your brain lie to itself. The challenge is to get just a small window of lucidity, where you can get the person feeling well. If you can get that period of time, it can be life changing. Unfortunately mental illness is still being treated as an after thought by HMO's and by State run entities. I have no idea what it will take to turn things around for those who have the power to impart change.

I work in the mental health and substance abuse field. County psychiatrists DO prescribe medications. At least in my state. Some counties have better resources (more providers) than others. I know exactly what county in my area is best and worse and if I had a family member needing services I would move fast.

Many if not a majority of my patients are involved with county services and receive Medicaid or Medicare. We take patients without a HMO. Actually straight medicare/medicaid is better for chronically mentally ill because we don't have to do insurance reviews. Most my patients also see improvements BEFORE two weeks. The average length of stay is a week or less. Medication compliance is a common issue. Most times it is not because lack of access to meds but either the side effects or thinking they are better. Some patients have county case managers that help track/deliver meds. Some have court orders and they make quite a few in a shot which helps cut down on compliance. We cannot force anyone to take meds at the hospital unless the courts are involved and there is a specific medication petition.

As a hospital we do NOT FIND PEOPLE HOUSING. I am shocked people expect that. I can provide a shelter list. I can provide numbers/info on housing resources through their county. Other than that my hands are tied.

The issues I see in this very complex issues are lack of funding for increased county service. I also see stigma as a HUGE problem. Often families ENCOURAGE their family members to go off meds. Culture plays a major role. Increased public education and family support could be extremely beneficial. There are a ton of resources out there but if the public is not informed they go unused.

 

[packrat]

It's only going to get worse, at least in Iowa. They keep closing the mental health institutes, leaving people with nothing as far as help/resources. Ours is one of the last remaining, and it's run on a *very* limited basis. It used to house hundreds of people and staff. Now it houses sex offenders in one of the many buildings while they're "rehabilitated" before being released back into the public and most of the other buildings are falling to ruin. One building has outpatient psychiatric care and social workers for mentally disabled.