- lack of meaningful involvement of service users and survivors in mental health service design and delivery eg not paying out-of-pocket expenses, top-down agenda making, focus groups rather than participation and leadership groups (see feedback report from Mary O'Hagan presentation March 2011, event funded by NHS Fife and Fife Council)
- lack of shared decision-making, partnership working and clear communication eg users/carers not given all the information, only involved in some/few areas, patronising behaviour from staff
- lack of real recovery-focused services, more about maintenance and risk
- lack of resource, the "cinderella service" eg psychiatric wards with no therapeutic input, voluntary sector organisations unsure of funding and having to compete with each other to survive
- hierarchical relationships between paid workers and service users - protecting, patronising, punishing rather than enabling, empowering, employing exit strategies so people can leave services and get back on with their lives recovered
- a lack of trust and even fear about people with "mental illness", that they are a risk to society and need to be controlled so as not to harm themselves or others
These are not exhaustive and the issues are no doubt more complex and to do with history, culture and systems: "we've always done it that way"
However I have a son using mental health services in another health board area and it has been a far more positive experience. More resource in hospital and community, therapeutic input in psychiatric wards, respect for carers, partnership working between user and worker, more recovery focus in the services.
Because I now have this comparison between health board areas it has clarified in my mind what the gaps are and why our experiences where we have lived for over 23 years, and used mental health services for 18 of these years, have been so negative.
Next blog on suggestions for improvement.