People with physical impairments who also have mental health support needs have tended to be overlooked by both policy-makers and those commissioning services. The majority of respondents said they had difficulty accessing mental health services because of their physical impairments. The majority also had difficulty using physical disability services because of inadequate recognition of mental health needs and negative attitudes amongst staff towards mental health issues. In-patient experiences were often characterised by inaccessible physical environments and a lack of assistance for even simple things. There was a lack of understanding of the assistance that people needed, and staff were often too busy to provide it. Medication required for a physical condition was commonly withdrawn on admission to a psychiatric ward and was not always available when needed. This caused considerable distress, particularly when the medication was required for the control of pain. Community mental health services were appreciated when needs relating to physical impairment as well as mental health were addressed. However, this was unusual. Staff were often unfamiliar with needs relating to physical impairment and this could be associated with unhelpful attitudes. There was commonly poor or no communication between mental health and physical disability services. Many respondents found that services accessed because of physical impairment ignored mental health issues; some staff had negative reactions to such needs. Medication given for mental health needs often had an impact on physical impairment, but most people said they had not been warned about these potential effects. 'Talking treatments' received the highest rating of any service, but it was often difficult to find an accessible and, within the private sector, affordable therapist or counsellor. When people were asked what they wanted from mental health and physical disability services, they said they wanted to be seen as "a whole person", with attention paid to both mental health needs and those relating to physical impairment. They wanted services and professionals to communicate and work together, and easy access to flexible services which could address individual needs. Above all, they wanted to be listened to and treated with respect.
People with physical impairments who also have mental health support needs have tended to be overlooked by both policy-makers and those commissioning services. The majority of respondents said they had difficulty accessing mental health services because of their physical impairments. The majority also had difficulty using physical disability services because of inadequate recognition of mental health needs and negative attitudes amongst staff towards mental health issues. In-patient experiences were often characterised by inaccessible physical environments and a lack of assistance for even simple things. There was a lack of understanding of the assistance that people needed, and staff were often too busy to provide it. Medication required for a physical condition was commonly withdrawn on admission to a psychiatric ward and was not always available when needed. This caused considerable distress, particularly when the medication was required for the control of pain. Community mental health services were appreciated when needs relating to physical impairment as well as mental health were addressed. However, this was unusual. Staff were often unfamiliar with needs relating to physical impairment and this could be associated with unhelpful attitudes. There was commonly poor or no communication between mental health and physical disability services. Many respondents found that services accessed because of physical impairment ignored mental health issues; some staff had negative reactions to such needs. Medication given for mental health needs often had an impact on physical impairment, but most people said they had not been warned about these potential effects. 'Talking treatments' received the highest rating of any service, but it was often difficult to find an accessible and, within the private sector, affordable therapist or counsellor. When people were asked what they wanted from mental health and physical disability services, they said they wanted to be seen as "a whole person", with attention paid to both mental health needs and those relating to physical impairment. They wanted services and professionals to communicate and work together, and easy access to flexible services which could address individual needs. Above all, they wanted to be listened to and treated with respect.
Subject terms:
medication, mental health problems, mental health services, multiple disabilities, physical disabilities, unmet need, access to services, acute psychiatric care, commissioning, communication, counselling;
This research is about the involvement in risk assessment and management of mental health service users considered by professionals to pose a potential risk to other people. The research was carried out due to concerns that the voices of these service users are not being heard in research, policy or practice. Many service users were aware that they could pose a risk to other people when experiencing psychosis and they wanted help to reduce the chances of this happening. Full and frank discussion of risk to others was difficult for many professionals. Some people could not be asked to participate in the study because they did not know they were considered to be a risk to other people. Reasons for talking about risk to others included the user's right to know what is written about them, and increased trust between user and professional, with the potential for collaborative risk management. Reasons against talking about risk to others included increasing stigma and distress; this prompted disengagement from services, and fears for personal safety. Levels of agreement between service users and professionals about risk and how to respond to it ranged from full agreement to very little or none. Service user involvement in risk assessment and management was variable and depended upon individual professional initiative. Few professionals were undertaking systematic risk assessment or risk management plans. Some service users influenced the support they received but, generally, users' main role was to accept or reject what was offered. Professionals had less room to accommodate user views where the risks were considered too high. Little use was made of advocates, and users were not provided with a full picture of the different supports available. Medication and supported housing emerged as key issues for potential tension and disagreement between service users and professionals. Serious gaps and inaccuracies were sometimes found in information held about service users that potentially put themselves and others at risk.
This research is about the involvement in risk assessment and management of mental health service users considered by professionals to pose a potential risk to other people. The research was carried out due to concerns that the voices of these service users are not being heard in research, policy or practice. Many service users were aware that they could pose a risk to other people when experiencing psychosis and they wanted help to reduce the chances of this happening. Full and frank discussion of risk to others was difficult for many professionals. Some people could not be asked to participate in the study because they did not know they were considered to be a risk to other people. Reasons for talking about risk to others included the user's right to know what is written about them, and increased trust between user and professional, with the potential for collaborative risk management. Reasons against talking about risk to others included increasing stigma and distress; this prompted disengagement from services, and fears for personal safety. Levels of agreement between service users and professionals about risk and how to respond to it ranged from full agreement to very little or none. Service user involvement in risk assessment and management was variable and depended upon individual professional initiative. Few professionals were undertaking systematic risk assessment or risk management plans. Some service users influenced the support they received but, generally, users' main role was to accept or reject what was offered. Professionals had less room to accommodate user views where the risks were considered too high. Little use was made of advocates, and users were not provided with a full picture of the different supports available. Medication and supported housing emerged as key issues for potential tension and disagreement between service users and professionals. Serious gaps and inaccuracies were sometimes found in information held about service users that potentially put themselves and others at risk.
Subject terms:
medication, mental health problems, mental health services, management, risk, risk assessment, risk management, severe mental health problems, stereotyped attitudes, stress, supported housing, user participation, user views, assessment;