Treatment and Care

• If you are concerned about someone’s mental health
• Specialist mental health services
• Care Programme Approach
• What sort of treatment and care?
• Physical health care
• Person-centred care and personalised care planning
• Family involvement
• Moving house

If you are concerned about someone’s mental health

If you are worried about someone’s mental health, the first point of contact is a GP. If your relative is having experiences that may be symptoms of psychosis, the GP can help rule out other possible causes and make sure the individual is referred to a psychiatrist, psychologist or other mental health professional who can offer appropriate treatment and support. A GP will know about specialist mental health services in your area.

The earlier someone starts getting treatment, the better. Many parts of the UK have specialist ‘Early intervention’ services for people who are having experiences that may be the warning signs of psychosis (see Early intervention services page). In some areas, people can access early intervention services directly, without having to go through their GP.

Sometimes people who have experiences that may be the symptoms of psychosis may be reluctant to visit their GP or seek help from early intervention services. You may need to try to persuade them to seek help.

If someone already has a diagnosis of schizophrenia or bipolar disorder, and you are concerned that they are becoming unwell again, try to persuade them to talk to the mental health professionals who organise their treatment and support. Family members can get in touch with their relative’s ‘care co-ordinator’ or ‘key worker’ – your relative’s main contact to talk about any concerns. If the situation becomes urgent, you can take your relative to an accident and emergency department, or, if you are worried about their safety or your safety, ring the police.

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Specialist mental health services

A GP will refer your relative to specialist mental health services, run by the NHS Mental Health Trust that covers your area.

Sometimes people access mental health services through accident and emergency departments, or because they have been detained by the police under the Mental Health Act. The Act gives police the powers to take someone to a place of safety if they are behaving in a way that could be as a result of having a serious mental illness and need immediate care or control.

Most people with psychosis are offered treatment from community mental health teams. These are made up of different types of mental health professionals employed by both the NHS and local authority social services, including psychiatrists, psychologists, social workers, occupational therapists, community psychiatric nurses, and sometimes vocational specialists who can help people keep a job, or get back to work. There are other sorts of community-based teams available in some parts of the country, and these are listed on the Mental health services page.   

Your local NHS Mental Health Trust will also run some hospital-based services. When someone has an episode of psychosis, they may need to spend time in hospital, or they may be supported by members of a crisis resolution team (also known as a home treatment team), if that sort of service is available where you live. The role of a crisis resolution team is to offer the treatment your relative needs near to home to avoid, if possible, admitting them to hospital. The team may come to your house, or offer treatment in a residential service or day care centre, depending on what’s available nearby.

Sometimes your relative may not accept that they are ill and may not want to have the treatment they need. People can be compulsorily admitted to hospital – or ‘sectioned’ ­ under the Mental Health Act (see Mental Health Act page). People can only be admitted to hospital against their wishes if it is in the interests of their health and safety, or to protect other people.

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Care Programme Approach

The ‘Care Programme Approach’ is the system that sets out the way treatment and care is given to people with serious mental illness.

The first step in the system is an assessment, where mental health professionals work out what treatment someone needs, and what sort of social support they need. This is then written down in a care plan. Your relative will then be given a care co-ordinator (who is sometimes called a keyworker), someone in the team responsible for his or her care who is their, and your, first point of contact regarding treatment and support. The job of the care co-ordinator is to make sure your relative gets the package of care that has been decided, and answer any questions about treatment. The Care Programme Approach says the care plan should be regularly reviewed and appropriate changes agreed in consultation with the individual who has psychosis, and their carers, unless the person who is unwell does not want them involved. People should be given a copy of their care plan.

During the assessment, mental health professionals are likely to discuss someone’s symptoms and experiences, thoughts and actions; their physical health; their housing and financial circumstances; whether they have a job; whether they take drugs and how much alcohol they drink; and their family circumstances. They should discuss an individual’s strengths and their aims and goals, so support can be tailored to help someone that is in line with their future plans. Family members should be involved in an assessment, as long as their relative agrees.

An assessment can be carried out by members of a community-based team, or by hospital staff. If a care plan is drawn up in hospital, the staff there should make sure plans for treatment and support are transferred to the relevant community-based team responsible for your relative’s care when they are discharged.

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What sort of treatment and care?

People with psychosis are normally treated with a combination of medication – antipsychotic drugs, for example – and psychological or ‘talking’ therapies. So for example, The National Institute for Health and Clinical Excellence (NICE) guideline on schizophrenia says people with schizophrenia should be offered cognitive behaviour therapy, family therapy and arts therapies as well as medication. However, not all these therapies are available in all parts of the country (see What you can expect from the NHS page).

The team of mental health professionals responsible for your relative’s care should explain different treatments and medications, and talk about any potential risks or side effects. If your relative agrees, you should be given the chance to be involved in these discussions and decisions about care.

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Physical health care

People with psychosis are more at risk of developing physical health problems than other people. This is partly because of a change in lifestyle due to the symptoms of psychosis, and partly because of the medication people are prescribed. Some antipsychotic drugs may make people gain weight and be more at risk of developing diabetes and high blood pressure. A GP should check people’s physical health once a year – including their weight, their blood pressure, their blood sugar and cholestorol levels, and people should be given treatment for any physical health problems they develop. Your relative’s mental health care co-ordinator should be told about any physical health problems and any treatment given.

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Person-centred care and personalised care planning

‘Personalisation’ describes a government plan to reform health and social services and give people the chance to live their own lives in the way they want to. ‘Direct Payments’ and ‘Individual Budgets’ are part of personalisation policies and are designed to make it easier for people to make their own decisions about the sort of support they receive, rather than be dependent recipients of care. There are links on this page if you want to find out more about Direct Payments and Individual Budgets.

‘Personalised care planning’ also comes under the umbrella of ‘Personalisation’ and aims to give people with long-term conditions more control over treatments and services, and put people on more of an equal footing with health and social care professionals. This means your relative should be given a lot of clear information to help them make decisions about their care.

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Family involvement

Family members can play an essential role in planning treatment and care. They can also give mental health professionals a history of their relative’s problems when an assessment is being made. Mental health professionals should give family members clear information about their relative’s diagnosis and how they can help promote recovery. Family members and carers should be involved in planning treatment and care, and consulted by mental health professionals, unless their relative says he or she does not want that to happen.

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Moving house

Your relative may need to change their GP if he or she moves, or if the whole family moves. The mental health team responsible for your relative’s care and support may also change if he or she moves into a new neighbourhood. The current care co-ordinator, if your relative has one, should make sure a new service or team responsible for your relative’s care and treatment get all the information they need to continue to offer support. Otherwise, your GP has access to any relevant information, and a new team can contact them directly.