Service Improvement; a Critical Psychiatry Perspective

What is it about?

1. the Care Quality Commission (CQC) has identified several deficits in psychiatric services in its summary report (2017) of the state of NHS Mental Health. this includes increasing admission rates, inappropriate use of antipsychotics for challenging behaviour by Old Age and Learning Disability Sub Specialities and lack of connected up working with Primary and Acute Hospital Services regards physical health care in light of the widening mortality and morbidity gap between people with severe mental illness and the general population (sat least four times the suicide rate, due to insulin resistance, hypertension, Brest / Bowel cancers). 2. Critical Psychiatry has expertise in joint working with patients and carers (co-production), including a system of consultation called Open Dialogue (OD) where the patient and carers come up with their own narrative, formulation and solutions from all available resources, with guidance from attending peer support workers. OD has an emerging evidence base of reducing admission, reduced length of stay, reduced psychotropic use and increased employment in people with psychosis. Reduced admissions are an active issue as there has been increasing admissions under the Mental Health Act. 3. Critical Psychiatry also recommends communication templates such as SBARD (Situation, background, assessment, Risk, Decision) to facilitate brief but salient communication, and increased use of new technology such as Skype consultations. Competency in the safe withdrawal of antidepressants and antipsychotics is also discussed. 4. This article also discusses potential biases affecting doctor's thinking (including remediation and safeguards), competency in jointly writing safety plans (for example when there are suicide or falls risks) and use of non-drug and non - psychological therapies such as horticulture. The need for continuous reflection via case studies over the longer term is recommended.

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Why is it important?

1. Implementing CQC recommendations 2. safe management of challenging behaviour, without incurring stroke and falls risks 3. improved learning of psychiatrist via objective feedback and reflection on case studies long term

Perspectives