Mike Cooke on mental health

If I did my back in gardening I might go to the GP and be offered three, four, possibly five choices of intervention - usually at different times and different places. All transactions would be supported by payment by results and one of the choices would be private sector.

So what would they be if I got my mind tangled up while gardening; got so anxious that a real mental health problem triggered itself?

I don't think it would be the time (when) and place (where) choices that would matter as much. If I was just shown the prescription pad or the door to the resident community psychiatric nurse or counsellor, could I be satisfied?

I would want to know about the individual and their skills (who), the style of interventions on offer (what) and the rationale (why). I accept it would need to be accessible and not in the CPN?s car because a room was not available in the surgery.

What I am saying is that for mental health and related illness, problems and conditions one needs to be convinced about the who, what and why of the choices on offer.

Mental health service users, people with a learning disability, or issues with children and family, substance misusers and those in prison should get three, four or possibly five choices, too. These might encompass doing nothing, a supported reading or CD package, one-on-one psychological assessment, a group intervention or a pharmaceutical route with choice (looking at side effects as well as efficacy). When you add in books, exercise, and kite-marked information on prescription, they can add up to a range of real choices.

Within secure settings - with a choice of a male or female key worker, what food they eat, activity and clothing - visiting arrangements can be essential. When dealing with some individuals for whom the last real choice they took got them locked up, we need to think very clearly about motivating them to take choices again.

Perhaps mental health choice plays out differently, with less emphasis on the time and the place, more on the style of service and the motives for key professionals wanting metaphorically to lay their hands on your mind.

An issue that often gets raised is what to do about individuals who lack the capacity to choose; those who are too ill to communicate easily.

My view is we have to try much harder with these individuals. Advance directives are statements about what a person wants to happen when they are ill. These may take time to craft, but are surely worth the investment so that respectful choices can be made on behalf of someone not well or not safe. Everyone has preferences - it's a question of listening to, receiving and facilitating them.

Encouraging choice across the NHS, private sector and third sectors will mean the mental health market will change.

Clear descriptions of quality hallmarks, outcomes, personal influence, flexibility and intensity of services will have to be available along with much clearer pricing (ouch) to enable choices to be made. Direct payment for people with long-term conditions to commission their chosen care packages could increase.

Walk-in centres for psychological therapies in Doncaster and Newham may well mean the front door to services may change.

People with mental health problems deserve five choices, creatively brokered, that are relevant, timely and geared to meet individual and personalised needs - and that includes me.

Mike Cooke is chief executive of South StaffordshireHealthcare foundation trust.