Treatment and care

• If you are concerned about someone’s mental health
• Specialist mental health services
• Care Programme Approach
• Care pathways
• What sort of treatment and care?
• Family involvement
• Moving house
• Personal health budgets

If you are concerned about someone’s mental health

If you are worried about someone’s mental health, the first person to talk to is their GP. If your relative is having experiences that may be symptoms of psychosis, the GP can help rule out other possible causes and make sure he or she is referred to a psychiatrist, psychologist or other mental health professional who can carry out an assessment and arrange appropriate treatment and care. The GP will be able to tell you what specialist mental health services are available in your area.

Sometimes people who have experiences that may be the symptoms of psychosis may be reluctant to visit their GP or seek help from mental health services. You may need to try to persuade them to seek help.

This is particularly important when someone first becomes unwell, because research has shown that the earlier people start getting treatment, the better. If your GP thinks your relative is experiencing the symptoms of psychosis for the first time, he or she is likely to be referred to the local early intervention service. In some areas, people can access early intervention services directly, without having to go through their GP. You can search 'early intervention' on the website of your local mental health trust to see if this is the case where you live.

If someone has been given a diagnosis of a mental illness like schizophrenia or bipolar disorder, and you are concerned that they are becoming unwell again (see Relapse page), try to persuade them to talk to the mental health professionals who organise their treatment and support. If your relative has a care coordinator (sometimes still called a 'key worker'), you could contact them to talk about your concerns.

If the situation becomes urgent, you can take your relative to an accident and emergency department. If you are worried about their safety, or your safety, ring the police (see In an emergency page).

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Specialist mental health services

A GP will refer your relative to specialist mental health services. These are normally run by the NHS mental health trust that covers your area. Each mental health trust may organise their services differently according to local need or within budget constraints. For example, family therapy and cognitive behaviour therapy are recommended for people with schizophrenia by the National Institute for Health and Care Excellence (NICE) but these talking therapies are not available everywhere. The report of the National Audit of Schizophrenia 2012 (published December 2012 and carried out by the Royal College of Psychiatrists) showed that overall, across England and Wales, less than 70 per cent of people had been offered any form of psychological therapy. In some areas the number was much smaller.

Sometimes people access mental health services through accident and emergency departments, or because they have been detained by the police under the Mental Health Act. The Act gives police the powers to take someone to a 'place of safety' (mostly a hospital) if they are behaving in an unusual way that could be because they have a serious mental illness, and they need immediate care or control.

Most people who experience the symptoms of psychosis are offered treatment from community-based teams comprising different mental health professionals. The teams usually include psychiatrists, psychologists, social workers, occupational therapists, community psychiatric nurses and sometimes there are vocational specialists (who can help people keep a job, or get back to work or education). Mental health professionals who work in community-based teams may be employed by the NHS or may be employed by local authority social services. (NHS organisations work with local authorities to run some mental health services. These types of jointly run services are called 'integrated' services. In some parts of the country, NHS organisations work with local authorities more formally through 'care trusts' – these sorts of organisations run both mental health services and social care services.)

There are different sorts of community-based teams available in different parts of the country. Some teams specialise in psychosis, for example, or in recovery, or in 'assessment'. 'Crisis resolution' teams support people who are very unwell – when they are experiencing an episode of psychosis or have tried to take their own life, for example – instead of admitting them to hospital. Some of the different types of teams you may come across are listed on the Mental health services page (the page is in the Services and support section of this website). Your local mental health trust should clearly present their services on their website, and describe what sort of teams there are in your area. If the information is difficult to understand or not clear, you can ask the trust's 'Patient Advice and Liaison Service' (PALS) to explain. Search for PALS on the trust's website, or ask the GP to do this for you.

There are changes in NHS community-based mental health services. Some of them are prompted by a move towards services that are more supportive of people's personal recovery (see Recovery page). Some may be to do with 'efficiency savings' being made in the NHS until 2014.

In some areas, charities, voluntary organisations or private companies are 'commissioned' by the NHS to run some mental health services. The charity Rethink Mental Illness is commissioned in some parts of the country to run 'Recovery Houses', for example, where support is offered to people during and after a crisis.

Your local NHS mental health trust will also run some hospital-based services. When someone has an episode of psychosis, they may need to spend time on a psychiatric ward.

Sometimes your relative may not accept that they are unwell and may not want to have the treatment they need. Because of this, people are sometimes compulsorily admitted to hospital – or ‘sectioned’ – under the Mental Health Act (see Mental Health Act page). People can only be admitted to hospital against their wishes if it is in the interests of their health and safety, or to protect other people.

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Care Programme Approach

The ‘Care Programme Approach’ (CPA) is a system that sets out the way treatment and care is given to people who have a serious mental illness like schizophrenia. The CPA has been used in mental health services for more than a decade and the most recent version is called the 2008 CPA. Some mental health trusts have stopped used the CPA – but the process described here still happens.

The first step in the system is an assessment, where mental health professionals recommend what treatment someone needs, and what sort of social support they need. This is then written down in a care plan. Some mental health trusts may have another name for this plan – some, for example, call it a 'care pathway' (see below).

During the assessment, mental health professionals are likely to discuss someone’s symptoms and experiences; their thoughts and actions; their physical health; their housing and financial circumstances; whether they have a job; whether they take drugs and how much alcohol they drink; and their family circumstances.

Whoever is carrying out the assessment should also talk to your relative about their personal aims and ambitions so support can be given to their future plans, with an emphasis on their personal recovery. This means your relative should be given a lot of clear information to help them contribute to decisions about their care, rather than be told what is best for them (see Recovery page).

Family members should be involved in the assessment and planning of future care, as long as your relative agrees.

The Care Programme Approach says the care plan should be regularly reviewed and appropriate changes agreed in consultation with the individual and their family members, unless the person who is unwell does not want their family involved. Your relative should be given a copy of his or her care plan.

Your relative will be given a care coordinator (who is still sometimes called a 'key worker', a term left over from a previous version of the CPA). This is someone in the team who will be responsible for your relative's care and will be their, and your, first point of contact. The job of the care coordinator is to make sure your relative gets the package of care that has been decided, and answer any questions about treatment. 

An assessment can be carried out by either members of a community-based team, or by hospital staff. If a care plan is drawn up in hospital, the staff there should make sure plans for treatment and support are transferred to the relevant community-based team responsible for your relative’s care when they are discharged.

The results of a survey carried out by the Mental Health Foundation and the National Survivor User Network and published in February 2013 showed that the CPA is not always supportive of recovery. You can download a copy of the report (Service users' experience of recovery under the 2008 Care Programme Approach) at the Mental Health Foundation website. 

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Care pathways

A care pathway is a sort of template that sets out what should happen and what sort of treatment and care a person should be offered when they are given a diagnosis of a particular mental health problem or physical health problem. Some mental health trusts use the term 'care pathway' to describe the assessments and treatments that are offered to your relative, rather than 'care plan.'

Care pathways are designed for health professionals to follow and are based on national guidelines and research showing the best possible treatment. They are often presented as 'flow charts' that prompt health professionals to make assessments and take decisions at particular times and in different circumstances. Your relative may be given a copy of your local mental health trust's care pathway for his or her particular diagnosis.

Care pathways are also sometimes called 'critical pathways', 'integrated care pathways', 'care maps' and 'anticipated recovery pathways'.

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What sort of treatment and care?

People who experience the symptoms of psychosis are normally treated with a combination of medication – antipsychotic drugs, for example – and psychological or ‘talking’ therapies. The National Institute for Health and Care Excellence (NICE) guideline on schizophrenia says people who are given a diagnosis of schizophrenia should be offered cognitive behaviour therapy and family therapy as well as medication. NICE also says that talking therapies like cognitive behaviour therapy and family therapy may also be offered to people who have a diagnosis of bipolar disorder. However, not all these therapies are available in all parts of the country (see What you can expect from the NHS page).

The team of mental health professionals responsible for your relative’s care or your GP should explain different treatments and medications, and talk about any potential risks or side effects. If your relative agrees, family members should be given the chance to be involved in these discussions and decisions about care.

Many people who have a diagnosis of a serious mental illness qualify for social care support from their local authority to help them live independently in the community, whether or not they have a family member supporting them. Members of a community-based mental health team should also help make sure your relative is assessed to find out if they are eligible for social care.

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Family involvement

Family members can play an essential role in planning treatment and care. They can also give mental health professionals a history of their relative’s problems when an assessment is being made. Family members and carers should be involved and consulted by mental health professionals, unless their relative says he or she does not want that to happen (see Confidentiality page).

Mental health professionals should give family members clear information about their relative’s diagnosis and how they can help promote recovery.

Family members may also be involved in family therapy if it is available locally and offered to your relative.

Physical health care

People with psychosis are more likely to develop physical health problems than other people.

This is partly because of changes in lifestyle due to the symptoms of psychosis, and partly because of the medication people are prescribed. Some antipsychotic drugs may make people gain weight and become more at risk of developing diabetes and high blood pressure.

A GP should check people’s physical health at least once a year – including their weight, their blood pressure, their blood sugar and cholesterol levels, and people should be given treatment for any physical health problems they develop. If your relative has a care coordinator, he or she should be told about any physical health problems and any treatment given.

If you are worried about your relative's physical health, talk to the GP.

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Moving house

Your relative may need to change their GP if he or she moves, or if the whole family moves. It is important to find and register with a GP that is near to their, or your, new home because all specialist mental health support is accessed through a GP.

If a community-based mental health team is currently responsible for your relative's care and support, that team may also change if he or she moves into a new neighbourhood.

If your relative has a care coordinator, he or she should make sure a new service or team responsible for your relative’s care and treatment gets all the information they need to continue to offer support. Otherwise, a new team can contact your relative's GP who will have access to all relevant information.

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Personal health budgets

A personal health budget is an amount of NHS money given to a patient after an assessment. The individual then personally controls that sum of money and uses it to buy services to meet their health needs. Each person gets a care plan that includes the amount of money in the budget and details how it is going to be spent.

A personal health budget is different from a personal budget that is allocated by local authorities to pay for social care support.

The government has been piloting and evaluating personal health budgets and people with mental health problems have been involved in some of the 20 pilot schemes. In November 2012, the final report of the 'Personal health budget evaluation' was published. The evaluation found personal health budgets generally improved people's quality of life and were cost effective. The government announced it now wants to make personal health budgets more widely available.