Developing Services in Mental Health-Substance Use

David B. Cooper

• Publisher: CRC Press
• Year: 2018
• eBook ISBN: 9781315357591
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Mental health-substance use is a complex interrelation, with equally complex implications for individuals and their families, health professionals and society. Although its international recognition as an issue of critical importance is growing, clear guidance for professionals on mental health-substance use and its treatment is hard to find. The Mental Health-Substance Use series addresses this need, concentrating on concerns, dilemmas and concepts that impact on the life and well-being of affected individuals and those close to them, and the future direction of practice, education, research, services, interventions, and treatment. Having set the scene with the first book's Introduction, this second book in the series tackles service development: how to evaluate the current state from a firm knowledge base, plan and manage change to provide better services, and continue monitoring and evaluating them on an ongoing basis. The volumes in this series are designed to challenge concepts and stimulate debate, exploring all aspects of the development in treatment, intervention and care responses, and the adoption of research-led best practice. They are essential reading for mental health and substance use professionals, students and educators

CHAPTER 1

Setting the scene

David B Cooper

When it is obvious that the goals cannot be reached, don’t adjust the goals, adjust the action steps.¹

PRE-READING EXERCISE 1.1

Time: 20 minutes

When preparing to read this book you may wish to undertake the following exercise.

Write a brief description of your thoughts and feelings in relation to mental health–substance use problems. When you have read the book repeat the exercise, taking note of the following:

• Have your thoughts and feelings changed? If yes, in what way?
• What information do you feel most influenced that change? What did not?
• Are there any areas that you feel you need to investigate further? If yes, what are they? What resources will you need?
• Make a plan of action to develop your learning and understanding of mental health–substance use.

Introduction

The difficulties encountered by people who experience mental health–substance use problems are not new. The individual using substances presenting to the mental health professional can often encounter annoyance and suspicion. Likewise, the person experiencing mental health problems presenting to the substance use services can encounter hostility and hopelessness. ‘We cannot do anything for the substance use problem until the mental health problem is dealt with!’ The referral to the mental health team is returned: ‘We cannot do anything for this person until the substance use problem is dealt with!’ Thus, the individual is in the middle of two professional worlds and neither is willing to move, and yet, both professional worlds are involved in ‘caring’ for the individual.

For many years, it has been acknowledged that the two parts of the caring system need to work as one. However, this desire has not developed into practice. Over recent years, this impetus has changed. There is now a drive towards meeting the needs of the individual experiencing mental health–substance use problems, pooling expertise from both sides. Moreover, there is an international political will to bring about change, often driven forward by a small group of dedicated professionals at practice level.

Some healthcare environments have merely paid lip service, ensuring the correct terminology is included within the policy and procedure documentation, while at the same time doing nothing, or little, to bring about the changes needed at the practice level to meet the needs of the individual. Others have grasped the drive forward and have spearheaded developments at local and national level within their country to meet such needs. It appears that the latter are now succeeding. There is a concerted international effort to improve the services provided for the individual, and a determination to pool knowledge and expertise. In addition, there is the ability of these professional groups to link into government policy and bring about the political will to support such change. However, this cannot happen overnight. There are major attitudinal changes needed – not least at management and practice level. One consultant commented that to work together with mental health–substance use problems would be too costly. Furthermore, the consultant believed it would create ‘too much work’! Consequently, there is a long way to go – but a driving force to succeed exists.

Obtaining in-depth and knowledgeable text is difficult in new areas of change. One needs to be motivated to trawl a broad spectrum of work to develop a sound grounding – the background detail that is needed to build good professional practice. This is a big request of the hard-worked and pressured professional. There are a few excellent mental health–substance use books available. However, this series of six books, of which this is the first, is ground-breaking, in that each presents a much needed text that will introduce the first, but vital, step to the interventions and treatments available for the individual experiencing mental health–substance use concerns and dilemmas.

These books are educational. However, they will make no one an expert! In mental health–substance use, there is a need to initiate, and maintain, education and training. There are key principles and factors we need to bring out and explore. Some we will use – others we will adapt – while others we will reject. Each book is complete. Conversely, each aims to build on the preceding book. However, books do not hold all the answers. Nothing does. What is hoped is that the professional will participate in, and collaborate with, each book, progressing through each to the other. Along the way, hopefully, the professional will enhance existing knowledge or develop new concepts to benefit the individual.

The books offer a first step, relevant to the needs of professionals – at practice level or senior service development – in a clear, concise and understandable format. Each book has made full use of boxes, graphs, tables, figures, interactive exercises, self-assessment tools and case studies – where appropriate – to examine and demonstrate the effect mental health–substance use can have on the individual, family, carers and society as a whole.

A deliberate attempt has been made to avoid jargon, and where terminology is used, to offer a clear explanation and understanding. The terminology used in this book is fully explained at the beginning of the book, before the reader commences with the chapters. By placing it there the reader will be able to reference it quickly, if needed. Specific gender is used, as the author feels appropriate. However, unless stated, the use of the male/female gender is interchangeable.

Book 2: Developing Services in Mental Health–Substance Use

As mentioned in the preface, the ability to learn and gain new knowledge is the way forward. As professionals we must start with knowledge, and from there we can begin to understand. We commence using our new-found skills, progressing to developing the ability to examine practice, to put concepts together and to make valid judgements. This knowledge is gained through education, training and experience, sometimes enhanced by own life experiences.

Those we offer care to, and their family members, also bring their own knowledge, skills and life experiences, some developed from dealing with ill health. Therefore, in order to make interventions and treatment outcome effective requires mutual understanding and respect.

In the book, primarily we:

• explore the comprehensive concerns and dilemmas occurring from, and in, mental health–substance use
• inform, develop and educate by sharing knowledge and enhancing expertise in this fast-developing interrelated experience of psychological, physical, social, legal and spiritual need.

The analogy of the house purchaser sums up the approach of the editor and authors when writing this book. Once a property is identified, we need to find out more before we invest further – the first step is to visit the property. On arrival, we quickly grasp a view of the surrounding area, the look of the outside of the house and its grounds. Here we make the decision to enter the property to find out more – or we leave. It is hoped that the reader of this book will stay! The book takes the reader through the front door of mental health–substance use, for some that will be all that is needed, for a decision to be made, and they will proceed to own the property. Others will need more information or guidance on the many and diverse approaches to mental health–substance use.

Once we have decided to purchase the property, we look closer and decide what needs updating to meet our needs, what has to be removed, and what needs rebuilding. We decide not to paper over the cracks because this is our property! Providing and developing services in mental health–substance use is not different to this approach. We need to explore what is good about the service provided to date, how this can be improved, what needs revamping, what services, and people, do we need to make the vision work, what must be replaced, and who is best placed to undertake this work effectively.

We look at what is around – we shop for concepts and the functions and facilities that are best for the people we meet, and to whose needs we must relate to. We then plan how we are going to undertake this organisation and when, and how, the changes can be implemented. Once we have a clear idea what is required, we implement – put into practice – the plans.

Then we leave it for years on end untouched! Do we? Should we? Services, like properties, need constant monitoring – they cannot merely be left until we are forced to do something – until they are damaged. Therefore, we must continually monitor and evaluate the service provision. From here, we can develop, build on new services, and update existing services. What we must not forget is that there are people at the end of this change process(es) who need us, the professionals, to make the right decision, for them, at all stages.

We can never know all there is to know. There is always the need to remain open-minded in the approaches to the individual’s needs and expectations. It is essential that we are open-minded to the many differing ways we can bring about change, and how we can access new information and knowledge. This applies in terms of both self-learning, and the way we approach interventions with those who are in need of advice and guidance. Each chapter provides direction to further learning, and exploration.

Many learned professionals are willing to share what they know, and listen to the knowledge and advice of others. It is hoped that this fundamental introduction will stimulate us to ‘purchase the property’, to take full ownership of service delivery, concerns and dilemmas for the individual in need of therapeutic interventions and treatments resulting from problems related to his/her, or someone else’s, experiences of mental health–substance use.

From the outset, and at all levels of the health and social care process, the manager and the service developer play a pivotal role in ensuring that care and quality interventions and treatment are achieved. What he/she does at that point depends on his/her knowledge, skills and attitudes. Moreover, it requires that these professionals acknowledge their responsibility to use the knowledge of others when providing the best services for the individual experiencing mental health–substance use problems.

To have knowledge and skill, there is a need to know something about the bigger picture and how that fits into the care of the individual, the family and carers on whose lives it will impact. Once we have that information, there is a need to know how to develop these services so as to maximise the intervention. To fully comprehend, and understand, we then need to appreciate what it is like to be on the receiving end of these interventions – only then can a service be developed to address the individuals’ needs.

It is one thing to look after the person with the physical, psychological, emotional, spiritual, social and/or legal problems, but there is an inbuilt need to care for the professional who provides that care. By so doing, the good manager has a direct impact on the professionalism of the person providing the intervention.

This book is primarily for the student, junior and senior manager, administrator, and service developer and commissioners. In addition, the ward manager, team manager, and clinician need to have some knowledge of how services come to being, the impact that has on them, what steps he/she can take to improve the lot for him/herself, others and the individual with the health issue. Therefore, this book has relevance to educators and students as well as those providing and developing services in mental health–substance use that focus on the therapeutic relationship (see Book 4, Chapter 2). Senior managers, service developers, and ward-based professionals need to understand the experiences of the individual and family, and accept their individual needs without judgement. Moreover, there is a need to understand what factors, beyond the mental health–substance use concerns and dilemmas that affect their lives and influence the services they need. This cannot be achieved without involving the individual, the family and the carers, who also experience the concerns and dilemmas associated with mental health–substance use, at all levels of the service development, provision and ongoing practices.

There is a trend towards ‘targets’. This appears to have taken over from the care of the individual to the extent that meeting the target(s) takes precedence. A recent number of experiences highlighted this fact for the author while on an orthopaedic ward. The professionals involved in the care were excellent. However, the demands for bed space precluded care of the individual. The responsibility to ‘clear beds’, lay heavily with the ward professionals, who had a number of people in a cramped space waiting for the ‘bed’. This meant that the individual could progress to theatre without knowing where he/she would be. The anxiety this provoked to vacate beds was the primary focus – taking care away from the individual. Hence, we employ the ward-based professional to ‘bed care’ and not ‘individual care’. When planning services, the good manager ensures that the ward-based professional is employed to do what he/she is best trained to do – otherwise ‘care’ becomes counter-productive.

In Chapter 2, we look back at the history related to policy in mental health and substance use. By looking back, we can examine where we need to go. Epidemiology issues need to be addressed in that such data helps us to formulate concepts and approaches to a given group of people, this is demonstrated in Chapter 3. Tom Dodd and Ann Gory describe their work in relation to the National Mental Health Development Unit in England in Chapter 4, then Hermine Graham takes this forward to look specifically at developing integrated services in Chapter 5. Gary Croton, in Chapter 6, describes the actions taken in Australia to developing a rur...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• About the Mental Health–Substance Use series
• About the editor
• List of contributors
• Terminology
• Cautionary note
• Acknowledgements
• Dedication
• 1 Setting the scene
• 2 Historical policy context of mental health–substance use
• 3 Epidemiological issues in mental health–substance use: a case for a life course approach to chronic disease epidemiology
• 4 National Mental Health Development Unit: an English perspective
• 5 Severe Mental Health and Substance Use: Developing Integrated Services – a UK Perspective
• 6 An Australian rural service system’s journey towards systemic mental health–substance use capability
• 7 Developing and evaluating innovative community programmes
• 8 Guidelines for working with mental health–substance use
• 9 Strategy development, model policy and procedures
• 10 The implications of workplace stress on service development
• 11 Team working
• 12 Communication: the essence of good practice, management and leadership
• 13 Spirituality, mental health–substance use
• 14 Sexuality, mental health–substance use
• 15 Mental Health in the UK: the Legal Dimension
• Useful chapters
• Useful contacts
• Index