General aspects of care: settings of care
Current mental healthcare services in most of the developed world are unrecognizable compared with those of the mid twentieth century. There has been a major shift from long- term institutional to community care. This chapter describes current approaches to providing mental health services, particularly for people between the ages of 18 and 65 (services for children are discussed in Chapter 17, and services for the elderly in Chapter 18). It is important for all doctors to have a basic understanding of the structure of services for three main reasons: … 1 It will help you to get the most out of clinical rotations in psychiatry, either at undergraduate or postgraduate level. 2 All clinicians need to know when and how to refer their patient to appropriate services. 3 Patients being treated by other medical specialties may have psychiatric co- morbidities. Effective management and liaison with mental health services requires a working knowledge of common conditions and their treatment. … Mental health services are organized in different ways from country to country. This chapter describes mainly the provision of services in the UK, but the principles apply generally. To understand the range of psychiatric services that are required for a specific community it is necessary to know: … 1 the frequency of mental disorders in the population; 2 the severity of these conditions and the impact they have upon a person’s ability to function; 3 how patients with these disorders come into contact with the health services; 4 what type of services people engage with and find effective. … The local prevalence of mental disorders will vary, but approximate estimates can be obtained from national surveys (Table 11.1). Approximately 20 per cent of adults and 10 per cent of children experience a mental health problem in any given year. A more detailed discussion of the epidemiology of mental health as a whole can be found in Chapter 2, p. 5, and for specific disorders in their individual chapters. The basic principles of the provision of mental health services are the same as for any other health service. Services should be accessible, comprehensive, appropriate to the needs of the community, offer up- to- date treatments, effective, and economical. Patients should be offered a choice in the treatment they receive, although the caveat to this is when an individual is being treated under the Mental Health Act.