What is the current issue in Jersey surrounding mental health support?
THE HISTORY OF PSYCHIATRIC ARCHITECTURE
Jersey’s Health and Social Services Department (HSS) have recently had numerous debates about the lack of mental health support on the Island, with some suggesting it should be prioritised equally to physical health. Current provisions are unsustainable and the department face substantial challenges in ensuring the accessibility of high quality care within an affordable budget (States of Jersey 2012). Many would agree that mental health budgets are just as important as those for physical illness, however, Karson (2014) argues that these illnesses should not be treated alike, as physical illness occurs due to primarily biological illness as opposed to behavioural problems. These points question whether budgets should be equally distributed if their subjects vary significantly.
Nevertheless, statistics surrounding mental health problems are quite startling with levels of suicide in Jersey being higher than in England and Wales, and 40% of repeat visits to GP’s being due to depression and/or anxiety issues (States of Jersey 2015). In a recent interview one of Jersey’s general practitioners, Dr Dean Balbes, agreed with these figures and added that “the majority of cases I deal with relate to stress and depression, with the predominant age group being 34-45”. These statistics highlight that attention is needed in this area of care, not merely for patients' well-being, but also due to economic cost. Depression and anxiety can also lead to sickness absence, which is outlined in the report ‘Caring for each other, Caring for ourselves’, which states that approximately 50% of all claims made to Social Security are due to mental health issues, equating to an estimated annual cost of £7.9m (HSS 2012).
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At present the majority of Jersey’s current service provision is secondary care, with the Jersey Annual Social Survey illustrating that Jersey receives 35% of referrals from secondary care, which is the highest amongst the areas surveyed (KMPG, 2011). Although these statistics are high and suggest that Jersey is currently focusing its resources in the correct place, another report ‘A proposed new system for HSS’ outlines that the prevalence of Tier 3 mental ill health (severe or enduring symptoms) represents 15% of the population, considerably lower than that of mild to moderate symptoms (Tiers 1 and 2) (KMPG 2011). This information suggests that Tier 1 and 2 require more attention, by improving primary care within the community setting.
Fig.2 : Tiers of mental health need
Tier 1 – First onset: mild symptoms
Tier 2 – Second or more onset: moderate symptoms
Tier 3 – Continuing mental health issues: severe or enduring symptoms
Tier 4 – Tertiary such as inpatient eating disorders or secure services: risk of significant harm to self or others
Fig 3: Adult Referrals (aged 18+)
In interview with Dr Murphy (2015, pers. comm., 21 December), she summarised the present community care model; “following discharge patients are assigned to a community mental health team with an identified community worker and a package of care in place. These provisions typically involve home visits and phone calls to keep track of progression”.
Nonetheless, unfortunately some patients do not feel that this support is adequate, as identified in interview with Mr Kilms (2015, pers. comm., 17 November), who was discharged from hospital 8 months ago, he explained that “although the members of the team as individuals are great, I felt very isolated when I first returned home and I struggled to get back into my day-to-day life. I felt that I didn’t have anything to contribute to the community, as I was no longer working, I lost a lot of confidence and retreated from social situations”. Perhaps this process could have been a lot easier for Mr Kilms if social integration was considered, with group sessions or a facility he could visit to meet people in similar circumstances.
Video 1- An alternative guide to mental health care
Video 2 - How mental health affects people
These issues with community care were acknowledged by HSS in 2005 when 16 Clairvale Road was purchased, which was to be utilised as a Mental Health Rehabilitation Unit (States of Jersey 2005). However, sadly the facility closed down in 2015 due to lack of funding, which could imply that it was not as necessary as once thought. Nevertheless, figures imply it was quite successful; maintaining an average occupancy of 87% (States of Jersey 2015).
Fig. 4 - Site plan of Clairvale centre, located in the heart of the community
Arguably mental health illnesses may be described as personality disorders, which cannot be simply entwined with physical illness, however, the issues explored illustrate the substantial impact that mental health has on individuals, as well as a society, and therefore needs to be addressed.