Editorial

Published date12 February 2019
Date12 February 2019
Pages1-4
DOIhttps://doi.org/10.1108/MHSI-02-2019-059
AuthorRachel Perkins,Julie Repper
Subject MatterHealth & social care,Mental health,Social inclusion
Rachel Perkins and Julie Repper
Pathways to where? Some thoughts about care pathways and recovery
There are many different agencies that offer support to people with mental health challenges,
but too often the system is characterised by confusion, repetition, delay, duplication of efforts
and gaps:
A persons care may be provided by several different health and social care professionals, across
different providers. As a result people can experience health and social care services that are
fragmented, difficult to access and not based around their (or their carers) needs (Department of
Health, 2014, p. 1).
This situation has led to a number of initiatives to achieve better integration of care[1]. In 2016,
NHS organisations and local councils came together to fo rm 44 Sustainability and
Transformation Partnershipscovering the whole of England. In some areas these
partnerships are developing even closer collaboration in an Integrated Care Systemand
Vanguardshave been identified to lead on the development of new care models.
In order to achieve better integrated care for individuals, integrated care pathwayshave been
developed[2]. The aim is to describe a chain of care to meet the needs of patients with a certain
condition by linking primary care, hospital care and community care through care pathways,
based on local agreements between providers(Kings Fund, 2011, p. 5). The idea is that
everyone with a particular diagnosis receives evidence-based support within a defined period of
time, post code lotteriesbecome a thing of the past and systems are streamlined.
While, at first sight, this makes sense, such streamlined care pathways have not been without
their problems (see, e.g. Hall, 2010; Schrijvers et al., 2012). Among the potential disadvantages
identified by Schrijvers et al. (2012) are reduced patient choice and dehumanisation:
the relationship between health professional and patient is less personal [] If experienced
professionals rely too much on routine [] there is a chance of increasing indifference, cynicism
and reduced empathy with the patient(p. 6). Similarly, the literature review conducted by
Hall (2010) indicated that integrated care pathways were useful for focusing on technical
procedures whilst the human elements, the therapeutic relationship and interpersonal aspects
were potentially overlooked(Hall, 2010, p. 69).
However, there are other major challenges, especially in the field of mental health. For example,
what about those who have multiple conditions? What about those who have long term
fluctuating conditions? Where are these pathways leading?
The problem of condition specific pathways
As an integrated care pathway relates to people with a specified condition, problems arise
when people have mu ltiple conditions which may spa n a range of ongoing physical and men tal
health challenges:
Multimorbidity matters because it is associated with reduced quality of life, higher mortality,
polypharmacy and high treatment burden, higher rates of adverse drug events, and much greater
health services use (including unplanned or emergency care). A particular issue for health services and
healthcare professionals is that treatment regimens (including non-pharmacological treatments) can
easily become very burdensome for people with multimorbidity, and care can become uncoordinated
and fragmented (NICE, 2016, p. 17).
DOI 10.1108/MHSI-02-2019-059 VOL. 23 NO. 1 2019, pp. 1-4, © Emerald Publishing Limited, ISSN 2042-8308
j
MENTALHEALTH AND SOCIAL INCLUSION
j
PAG E 1
Editorial

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