Outpatient & community services

Experiences of outpatient and community services

The majority of mental health care is provided by services in the community. People described using day centres, day hospitals, rehabilitation centres and being a hospital outpatient. Various professionals were involved in their care including support workers, GPs, CPNs (community psychiatric nurses), psychiatrists and social workers. Some people referred to the combination of different professionals as their mental health team.

As with hospital inpatient services, various activities were available through these community services, including leisure activities, therapies, and work training. A few people found going to day centres helpful, but one woman said the day centre was only a “reason to get out of bed” and the only thing she got out of it was the opportunity to write poetry in their creative writing class. A few people mentioned that day centres were no longer available in their area.

Many people talked about professionals who had been helpful and this was usually because they had felt able to talk to them, and they had listened and seemed to understand.

Tariq set out his own care plan and says the mental health system is different from how it's portrayed on television. (Read by an actor).

Mae says she hasn't had much help, but didn't really want any because she didn't trust professionals. She says she can talk to her GP. (Read by an actor).

She felt her GP didn't try to understand what was wrong with her, whereas another doctor gave her practical support. (Audio in Cantonese, text in English).

Edward says he has a good GP who arranged for him to have an assessment when he told him his history of schizophrenia.

People also mentioned receiving practical help and support from mental health services in the community, including noticing when they are becoming unwell, and from their GP - “without her, I don't know what I'd do”. One man felt that community mental health provision should also have responsibility for people's physical as well as mental health problems. Many people went to day centres or saw a mental health professional for their medication (see 'Prescribed medication & side effects').

Professionals who did not listen or give support were considered unhelpful and even intrusive. One woman mentioned that although her GP was good, she didn't have the opportunity to discuss at length the things she felt were making her unwell, and another woman felt neglected because she's been waiting for months for a referral to a psychiatrist. Some people valued the choices they had over their community based care and felt they had been really involved. Others, however, described feeling coerced by mental health professionals.

Sara says her mental health team were patronising and didn't listen; she didn't feel like a "free citizen" when she returned to the community after leaving hospital. (Read by an actor).

Class, gender and ethnicity of professionals

When people considered the impact that the class, gender or ethnicity of professionals many felt that what mattered was that the professional in question was able to understand their experiences and listened carefully to them, whatever their background. Some people felt it could be especially helpful if the professional had similar experiences, for example, of racism or mental health issues.

For some, it was essential that professionals shared the same background (whether gender, class or ethnicity) in order to achieve this understanding, while for others it didn't matter at all. For one man, the professional did not have to be the same ethnicity, but from any ethnic minority background. Another felt it was helpful to have more black psychiatrists in the system, but that sharing the same belief system as the patient was more important. 

Her white, male psychiatrist is supportive, but she says it's important that the rest of her mental health team is made up of people from different backgrounds.

Tariq says the ethnicity of his mental health team doesn't matter, because they've all given him support and wanted to see him recover. (Read by an actor).

Lorenz believes it's important for a doctor to be open minded and to have the same belief system as the patient.

One Asian woman found it difficult to talk to her white, middle class therapist (see Sara's story), although another Asian man felt that ethnicity didn't affect his care because he was middle class. Several people felt that professionals “don't seem to understand Black culture”, including one woman of mixed heritage who felt that her white CPN couldn't identify with her. 

Sara believes that white middle class people can't always understand Asian culture. (Read by an actor).

Another woman noticed that she had expectations for professionals based on their ethnicity and gender which were not met: for example, she was initially disappointed when she couldn't talk openly with a Black female GP, and pleasantly surprised when a white male GP was very helpful. The same GPs, however, acted quite differently in later appointments. 

Imani saw GPs from different backgrounds and reflects on her expectations and experiences of the consultation.

Reluctance to use services

Some people mentioned being reluctant to get help from services because they didn't trust professionals [see Mae above]. One woman didn't want to see an Educational Psychologist because she felt angry that she was perceived to be “the problem” and in need of treatment, not her family. She was also concerned about having a psychiatric diagnosis and whether that would “impede my chances of getting a job in the future”.

A few people felt that the services they received were not culturally appropriate and that more should be done to make services more attractive to people from Black and minority ethnic backgrounds, “I really do think that a lot has to be done to draw the black people in who really do need help and aren't getting any”. 

Jay says there was nothing for Black people at the day centre she attended.

Devon reflects on why Black people don't want to use services and says the system needs to be made more attractive to them.

Ali says he didn't want to seek help because mental health is a taboo and because he was worried about being in the mental health system for a long time. (Read by an actor).

• ·         improve the mental health and well-being of the population
• ·         improve the quality and accessibility of services for people with poor mental health