Monday 10 January 2011


Because Hafal is managed by people with a serious mental illness and their families (rather than by health care ethicists or hand-wringing Guardian-readers) we have never been very interested in the stale old “medical versus social” argument about mental health care. What our Members are interested in is getting the range of care and treatment they require to achieve recovery.

For people with a serious mental illness that often, but not always, includes medical treatment but (equally) it is folly to imagine that medication will go very far without other areas of treatment and care being systematically addressed.

The new Mental Health Measure itemised the 8 key areas which need to be addressed as follows:

(i)finance and money
(iii)personal care and physical well-being
(iv)education and training
(v)work and occupation
(vi)parenting or caring relationships
(vii)social, cultural or spiritual
(viii)medical and other forms of treatment including psychological interventions

The more alert among you may have noticed that this is one less than the 9 areas identified in the Assembly Government’s Interim Guidance on CPA published previously. This is because two areas have effectively been combined, namely medical treatment and other forms of treatment.

This is more interesting than may first appear so bear with me!

Hafal has always been in favour of separating the two in the context of serious mental health illness because a single heading for treatment can allow a “traditional” professional to tick the box about treatment having actually only considered (and probably prescribed or recommended) a medical treatment. Let’s face it, that’s what normally happens at the moment. By contrast if there is a separate box for other treatments then the professional effectively has to propose other forms of treatment or explain a decision not to suggest a psychological or other therapy. That’s a useful pressure, we think.

However, I understand that in consultation events on the Guidance and the Measure some people thought it gave “too much status” to medical treatment to give it its own box. A well-intentioned point but a tactical mistake because in real life medical treatment is always at least considered for a serious mental illness whereas other treatments are scandalously often scarcely thought about.

Why is this important now? Because shortly the Assembly Government will be consulting on the format for Care and Treatment Plans required under the Measure and we need to ensure that:

Either: there are two separate sections for medical and other treatments

Or: if there is just one section (which is fine) then there is a requirement to record explicitly in that section consideration of both medical and other treatments.

A care and treatment plan for somebody with a serious mental illness can’t be called holistic – or even adequate – if it doesn’t include active consideration of both forms of treatment.

For an overview of treatments see Treatment for Severe Mental Illness - A Practical Guide and to get the broader context of an holistic approach to recovery see My Recovery - a Step-by-Step Plan for People with Serious Mental Illness .