Psychiatric services and treatments

The key to the patient's remaining well is to have a good and continuing relationship with his psychiatrist, and his care coordinator, who will usually be either a community psychiatric nurse or a social worker.

There has recently been a good deal of development in services. Assertive outreach teams have been developed in community mental health services; these are concerned with patients who disengage with treatment, and they can be effective in reducing hospital admission and improving the lives of some of these severely affected ('revolving door') patients.

Crisis teams are designed to step in in emergencies and provide extra help; typically, this will be according to the results of a joint assessment with the community mental health team and other interested parties. They can be helpful in reducing hospital admissions; however, it is important that inpatient admission is not seen as a failure, let alone as a bad thing. On the contrary, hospital admission frequently achieves progress, even when the best efforts of community services have not.

The latest trend is for the introduction of early intervention teams; these are intended to identify and treat early or even prodromal cases. Their watchword is that, by reducing the duration of psychosis before treatment commences, prognosis can be improved (see Chapter 25 on services for more about organization of care).

The development of the foregoing teams, although largely driven from central government, is often in practice done 'within existing resources'. What this means in effect is that the new teams can take staff and resources from the existing community mental health teams, which can be depleted as a result. There may also be 'boundary problems', with patients having to be assessed repeatedly for the same fundamental problem, as they move from one team to another. Nevertheless, the prevailing direction of development of services at the moment is toward the setting up of specialized small teams. They can work well if adequately resourced, with a stable staff group.

ECT (see Chapter 24) is an effective treatment for acute psychotic states that have failed to respond to inpatient care and medication. It continues to be widely used in developing countries, and has been a first-line treatment in this setting. However, it is seldom used for schizophrenia now in the UK.

0 0

Post a comment