16 September 2009

Mickey Mouse indicators

Simon Darragh writes about his experiences of mental health care in the UK:
[A]bout nine years ago I was close to suicide again and found myself being taken into another hospital. Things had changed. Now we had the policy of ‘care in the community’. All notion of protection, of asylum, had gone: a patient (or was it ‘client’?) information leaflet explained that one’s stay would be as brief as possible. Nurses no longer spent much time with patients: they were closeted together in an office filling in ‘care plans’, and could get quite cross if one knocked on the door to point out that a patient was smashing up the furniture or another patient. Usually, in fact, knocks on the door were ignored. True, we saw psychiatrists as often as once a week, but their concern was to see whether we were ready to be discharged. We lived in dread of being called before the psychiatrist: many, including myself, tried to seem madder than we were in the hope of delaying discharge. I managed to stay a month – twice as long as the ‘target’ period – before being ejected despite my vigorous protests. I was soon back. Returning to the same hospital I expected the nurses to be surprised and disappointed to see me again; they batted not an eyelid. Soon I noticed familiar faces among the other patients; people who had been discharged during my earlier stay and who were back again. Nine years later I have lost count of how many times the NHS has ‘cured’ me of severe depression. Clearly the new policy is statistically – and that’s what counts – very successful. It must have cost them far more than one long stay, but they’ve had half a dozen cures instead of one. Simon Darragh, Letter to the Editor of London Review of Books, dated 24 September
Our big, complex societies do require the targeting of some sort of numerical indicator and mental health is an extremely difficult concept to quantify. But surely we can do better than the number of discharges from psychiatric hospital care? Such indicators are rather like economic variables: if they are too narrow, the tendency will be to game the system, consciously or not. I've blogged before about meaningless targets in the UK health system.

Under a Social Policy Bond regime, there would be similar problems in choosing the best indicators to target. But there would be much more ingenuity applied to devising them. They would be broad rather than narrow, and transparent. But most important, they would be inextricably tied to societal wellbeing, in a way that 'number of hospital discharges' plainly is not.
Every 100 posts, I update progress on the Social Policy Bond idea. This is my 700th post, and there has been zero progress in the past few months. Sales of my book have been negligible, and after initial bursts of enthusiasm from one tv producer in particular, interest has fizzled out. The Social Policy Bonds concept has now been in the public arena for 20 years but, as far as I know, nobody issues them. I intend, though, to continue to post on this blog, and to maintain the main Social Policy Bonds website.

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