Over the 20 years I’ve made some observations about clients, and the practitioners and the organisations tasked with supporting them.

1. Most people don’t get the help they need

I spent the first 10 years working as a psychologist providing assessments and therapy in specialist secure services and I was effective as a therapist but was only helping one or a few at a time. I then transitioned to supporting people under the responsibility of both community mental health and non-mental health organisations and teams. One eye opener was seeing most people under agencies such probation, housing, local authority managing the needs of people (including their mental health) who hardly ever get into mental health services.

Whilst these people had mental health and psychological needs they were clearly were not ‘referral ready’ for mental health services due to the following barriers:

• Low 'motivation', made worse by long wait times and numerous hoops to jump through to access mental health support

• Low help seeking behaviours - stigma/shame to receiving help, or fear and avoidance of change meant that some people don't reach out and persist in getting help

• Inability to attend to scheduled appointments (for one reason or another) - imagine a single parent with a job trying to get their child with behavioural problem to an appointment across town during office hours.

• Therapies being too demanding

• Eligibility criteria for mental health services being vague, unclear, too strict

• Commissioning gaps so the service needed didn't exist

I found it was incredibly important therefore for mental health specialists to go where people were and upskill non-mental health practitioners that were already supporting them. Instead, most mental health services were set-up to expect people to come to them and many non-mental health practitioners were left floundering in the dark about how to manage mental health needs and associated challenging behaviours.

2. Mental health services can't keep up with demand

Not just with mental health, but demand for statutory human services outstripped supply. And to make things worse, limited funding means services are forced to increase their access threshold in order to manage demand. So I was left thinking "is there a way to increase capacity without burning out staff?".

I found helping the workforce in non-mental health services to adopt psychologically informed ideas and approaches could reduce the emotional weight on practitioners and increase their understanding and control over what to do next. It also meant fewer people were referred to mental health services but their needs could still be met. I have also found that whole systems or whole pathway approaches are necessary to improve the 'customer journey' through the design and delivery of mental health support offers.

3. People get stuck in a loop once they get into traditional mental health services

Of the relatively few people with mental health problems that got into mental health services, community or inpatient, the path to living a life worth living, and gain independence and social inclusion was never clear. As a result many people stayed in community or inpatient mental health services, almost (I hate to say) warehoused.

Albeit a sweeping generalisation, mental health services and treatments (particularly those that were highly medicalised) tend to focus on managing people's symptoms rather than help improve their lives, or build their human and social capital to live to their fullest potential. Terms like 'mental health recovery' are used but for the most part not practiced.

And this isn't great for mental health services either. Caseloads get bigger, practitioners feel more and more burned out, and both wait times and quality suffer.

4. No single team or agency can meet people’s long-term needs

I used to see practitioners from different multi-agency or multi-professional teams duplicating work (e.g., multiple case managers) or leaving gaps when assuming the other(s) were addressing certain needs.

I found the need to provide something akin to clinical project management, enabling true coordination between services who could provide bespoke and targeted interventions rather than each service providing their own standard off-the-shelf or one size fits all approach.

Workforce capability building - a missing link

Over 10 years ago I took a fork in the journey as a psychologist from treating individually to upskilling practitioners in psychologically informed practices. Rather than replace what existing practitioners (like case managers) did, I found that with slight adjustments they could become more effective and it made the existing capacity within the system go further.

For me, psychologically informed approachess help practitioners see there is no use running faster up the wrong road. Whilst sometimes practitioners are very effective, sometimes they are not and unfortunately make things worse and stack up problems in the long-term - e.g., reinforcing the wrong behaviours, not having an understanding why an approach wasn’t working. Some practitioners tend to focus on the person, not on the environment and missing the significance of their own behaviour or the behaviour of their organisation or the system that was maintaining the problem. There have been times when it was like seeing someone use a spanner again and again on a screw and getting frustrated that it wasn't working.

Even for those people who do access mental health therapy or treatment services, they will often spend 6 days 23 hours per week outside of the therapy room / treatment service. A system without a psychologically informed workforce could easily undermine a person's progress, but one that is psychologically informed could accelerate their progress.

Stuart John Chuan