Picture of Mike Cooke

We have made measurable progress in mental health services over the past six years but there is still too much variation in services and in investment, primarily in services not covered by a national service framework.

Picture of Mike Cooke

We have made measurable progress in mental health services over the past six years but there is still too much variation in services and in investment, primarily in services not covered by a national service framework.

I want to highlight a few of these areas and spotlight an over-arching way of getting into new places, revisiting older places and new ways of growing.

Six years into the National Service Framework for Mental Health, we have seen the addition of more than 700 teams and allowed more capacity to deal with problems earlier (early intervention), quicker (crisis response) and not in hospital (assertive outreach and home treatment).

Acute care forums have concentrated hard on being capable, female services have become a specialty, specialist eating disorder and intensive care services are on the increase. However, what about older people with mental health problems? There is more demand, earlier detections and a future need very clearly ahead, but not enough attention is being paid to this area.

While mental health and ageing got a mention in the older people's NSF it did not make services stick. Service development tends, in older age services, to spin round the dedicated few - the West Midlands Older Peoples' Mental Health Collaborative, to name one. Early onset dementia at 42 is a rare but very scary thing. If you go to a screening of the film Iris- about author Iris Murdoch, a brilliant mind that folded - watch how long it takes people to leave their seats after the credits roll. It takes a long time because people have been scared and feel vulnerable.

If you look at the other end of the spectrum - child and adolescent services - we have seen 10 per cent investment, but some have not been joined up into a 'patchwork quilt of services with smooth seams', as a patient once told me they wanted. Adolescent services is a key area that needs to develop links to school settings, looked-after youngsters and families in need. More flak is generated around on young people on adult in-patient wards just now - rightly so. How and why have they ended up there?

Double trouble

Two others that are on the 'more to do list' are dual diagnostics - the linkages between substance misuse - and mental health and prison mental health. On dual diagnostics the green shoots of capital funding seem available, but more revenue that can be accessed is required. Alcohol is important as well as drugs - for young people is alcohol the new risk-taking cigarette?

So I hope I have put my finger on a few areas largely outside the jurisdiction of our national director for mental health.

What about a way into those areas further to 'join the dots' there. I refer you to the embodiment of that well known Department of Health mental health policy implementation guide Support, Time and Recovery Workers(STR), sometimes known as 'star' workers because that's what they are. They are usually people with personal insight and lived experience - they bring hope, listening skills and empathy to supplement the choice of professionals and services available to service users and carers.

They do what they say on the tin, provide support allowing service users integrity and offering guidance - looking into the dark world of the excluded - just far enough to help someone back (thank you Phil Kay in Hull and my own team here). They provide time to listen and interpret, and help to navigate and enhance the service at key times at low times. They also give hope in the recovery phase - attending with people their first interview or otherwise helping with job induction after a mental health episode.

It is a way of working that can be adapted to all these areas. Youth workers, associates, communities of interest all have a key part to play, as well as STRs - it's the future.

Mike Cooke is chief executive of South Staffordshire Healthcare Foundation trust.