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What Is "severe"

D

DRAGON

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Apr 15, 2008
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I have an ongoing argument over access to services. I am told by the local mental heralth trust that they only deal with "severe and enduring" mental illness. I quite appreciate this would be the natural focus of their energies and that assessment of the severity woulsd be a clinical matter./ HOWEVER , this term "severe" must relate to a criteria written somewhere which says the things to to be taken into account in assessing severity. Anyone ran into this criteria business before ?
The Trust seem very evasive on the source of this criteria
 
J

johnny ashton

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Sep 13, 2008
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10
Location
widnes
Ive been severely depresssed a severe stutterer ,im finding the fight to learn to talk and learn to deal with my depression .
Im hoping in time to help other people who cant talk .
Ive used all the illegal drugs and drink but am finally rebuilding my life .
It takes time and relaxation and deep thinking .
I have felt worthless and wanting to die but remember guys 1 life 1
chance .
Its all about learning to heal whats happened and this healing wont happen all at once .
Im not angry anymore
Im just trying to learn to be happy .
Take care
Johnnny
learn to laugh and smile more each day
 
N

Northern

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Feb 11, 2011
Messages
93
I've had this "severe and enduring" claptrap too. A psychologist referred me to the MH trust because I had a nasty phobia about needles, but this was not "severe....etc" so nothing was going to be done. Never mind that I couldn't give the blood test the GP wanted, or that I coudn't have dental treatment....
 
F

firemonkee57

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Mar 23, 2009
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This pdf from 2000 listed following definitions of SMI .

87
Paul Lelliott, April 1997
EXISTING DEFINITIONS OF SMI
Proposals
C1. Goldman et al. (1981) proposed the following criteria:
- Diagnosis : According to DSM-III criteria, either:
l organic brain syndrome
l schizophrenia
l paranoid and other psychoses
l major affective disorders.
- Disability : Erosion of, or prevention of the development of, functional
capacities in relation to three or more primary aspects of daily
life:
l personal hygiene and self-care
l self-direction
l interpersonal relationships
l social transactions
l learning
l recreation
l economic self-sufficiency.
- Duration : Most have required > three months hospitalisation in one year
or > one year in preceding five years. Although some have
required short-term hospitalisation (< three months) or have
only received out-patient care.
C2. McLean and Liebowitz (1989) considered at least one of the following must be
present:
- two or more years of contact with services
- depot prescribed
- ICD-9 classification 295 or 297
- three or more in-patient admissions in the last two years
- three or more day-patient episodes in the last two years
- DSM-III-R highest level of adaptive functioning in the past year = level 5 or
less.

C3. The Department of Health (1995) proposed the following criteria be
considered:
- Safety History of significant violence, self-harm or self-neglect or
at risk of exploitation due to mental illness.
- In/formal help Need for intensive support in the community either from
informal carers or from formal services such as more than
one contact with specialist services per week, involvement
of two or more agencies or subject to Section 117 of the
Mental Health Act, Supervised Discharge or a Restriction
Order.
- Diagnosis Presence of severe mental disorder including psychotic
illness, severe neurotic illness, personality disorder,
dementia, development disorder.
- Disability Significant impairment of functioning in role performance
in one or more of occupation, family responsibility or
accommodation; particularly where this has led to social
isolation and/or difficulties with the activities of daily
living. Indicators of this may include being in receipt of
Disability Living Allowance, being homeless or requiring
supported, sheltered accommodation.
- Duration Length of illness of greater than one year or likelihood of
illness persisting; three or more admissions, or aggregate
total of one year stay, in past five years.
C4. The Audit Commission (1994) defined three categories of people with mental
illness in contact with secondary care services:
- Psychotic diagnosis, organic illness or injury and previous compulsory
admission or aggregate one year stay in hospital in past five years or three
or more admissions in past five years.
- Psychotic diagnosis, organic illness or injury or any previous admissions in
past five years.
- No record of hospital admissions and no recorded psychotic diagnosis,
organic illness or injury.

Summary
C5. In summary, all definitions which have been developed from the service
provider perspective have included:
- certain diagnostic categories which would include ICD-10 categories FO,
F2, F30, F31, F32 and F33

- some measure of duration of illness either a specified time since onset of
illness or a specified period of hospitalisation
- some measure of intensity of contact with services usually specified as a
certain time in hospital or a certain number of admissions over a given
period.
C6. In addition, most definitions have included:
- statement about extent of disability as perceived by the user in terms of
impairment of functioning in role performance.
C7. One definition has included:
- statement about risk posed, to others or self
- applicability of statutory powers to compel the patient to receive treatment.

C9. In the absence of any widely accepted definition of severe mental illness, the
Working Group proposed the following which it is recognised only takes into
account the service provider perspective:
There must be a mental disorder as designated by a mental health professional
(psychiatrist, mental health nurse, clinical psychologist, occupational therapist
or mental health social worker) AND one or more of the following must apply:
- There must have been a score of 4 on at least one, or a score of 3 on at least
two, of the HoNOS items 1-10 (excluding item 5 “ physical illness or disability
problems”) during the previous six months.
- Any admission in the past year under a treatment Section of the Mental
Health Act.
- A total of six months in hospital, mental health residential care or day
hospital or three admissions to hospital or day hospital over the past five
years.
- Six months of continuous community care involving more than one worker
or the need for such care if unavailable or refused.

Perhaps someone has knowledge of more up to date definitions?
 
ally41

ally41

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Yeh I think that recent or current need for hospital admission is pretty much their criteria. So if you're psychotic i.e. delusional to the point of being a danger to yourself or others; if you're dangerously suicidal. If you don't fit that category then the Mental Health teams just dont have the person hours to spare for you. You should still be able to get regular therapy though and sometimes they can be available by phone in office hours, mine is. I did have to wait for 18 months on the waiting list though and I tried to get care from the cpn's whilst I waited but they just didnt see my case as 'severe' enough, those 18 months were the hardest ever.....
 
F

firemonkee57

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Yeh I think that recent or current need for hospital admission is pretty much their criteria. So if you're psychotic i.e. delusional to the point of being a danger to yourself or others; if you're dangerously suicidal. If you don't fit that category then the Mental Health teams just dont have the person hours to spare for you. ...
Which just goes to show how ****ed up and underfunded mh services are. Not everything that significantly/seriously affects a person's functioning and quality of life involves being a danger to oneself or others. Unfortunately if your problems are chronic/severe but don't fall into that 'danger to yourself or others' category you're as good as ****ed,especially if you have been told that therapy isn't an option.
 
maxitab

maxitab

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I don't understand, you just posted this:

Disability Significant impairment of functioning in role performance
in one or more of occupation, family responsibility or
accommodation; particularly where this has led to social
isolation and/or difficulties with the activities of daily
living. Indicators of this may include being in receipt of
Disability Living Allowance, being homeless or requiring
supported, sheltered accommodation.
- Duration Length of illness of greater than one year or likelihood of
illness persisting
This is criteria you have posted, so no, it is not about being a danger to oneself or others, it is about lots of other stuff too......
 
ally41

ally41

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In my area the access to mental health teams and cpn's is strictly limited, it's therapy only and then you have to wait a very long time. I dont understand why therapy would 'not be an option' firenmonkee? Because it's not availabale? it should always be available on the nhs but you do have to go on a waiting list. If your doc is saying not then he/she's is wrong and you need to try another. Have you got a patient liaison service in your area?
 
F

firemonkee57

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I don't understand, you just posted this:



This is criteria you have posted, so no, it is not about being a danger to oneself or others, it is about lots of other stuff too......
I think even if you fall into the category of being termed severely mentally ill unless you happen to be a danger to yourself or others and/or dual diagnosis then mh services aren't that geared to or interested in helping you.
 
F

firemonkee57

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In my area the access to mental health teams and cpn's is strictly limited, it's therapy only and then you have to wait a very long time. I dont understand why therapy would 'not be an option' firenmonkee? Because it's not availabale? it should always be available on the nhs but you do have to go on a waiting list. If your doc is saying not then he/she's is wrong and you need to try another. Have you got a patient liaison service in your area?
I think in my case it's because i had two abortive attempts at therapy with trained therapists and then therapy with an untrained person, allocated to me by my day centre,who suddenly dumped me when i upset her religious sensibilities (she had told me a few weeks before she was part of a small religious sect).

The two trained therapists i had problems with because they both adopted a 'If you want to be a good person 'approach as though i was a bad person rather than show any empathy or understanding that i was a decent person with poor coping skills in certain areas due to the effects of past experiences .
I also think that because i was seen as having psychotic symptoms might also have had something to do with being deemed not suitable for further therapy.
 
pepecat

pepecat

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It always amazes / fascinates me how different NHS trust areas define illness, and how their access to services works. Hell, even within the SAME trust, it seems to be totally different routes that people go down, depending on the gp your with. It's so weird that there's not 'set' route for everyone, seems to be a very random thing.....
I wouldn't have called my depression severe (though others might say different), yet the psychotherapy i have is provided by the YASCC - Youth, Addictions, Secure and Complex Care team. (I'm not youth, nor do i have an addiction, and have never been sectioned, so I'm not Y,A or S). The blurb on the trust website for the psychology service i have is 'an out patient service which provides psychodynamic psychotherapy to people who experience complex, severe and enduring mental health difficulties'......

Wouldn't have said that was me...... but i'm damn glad to get the psychotherapy, so if I have to be severe and enduring, then fine!
 
Passionflower

Passionflower

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The CMHT I see doesn't state that the person has to have 'severe' problems. All it says is the person has to have problems that cannot be managed by primary care.
 
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