Experiences of psychosis

Experiences of Out-Patient and community support

The majority of current day mental health care is provided by services in the community and not in hospital. For example, people talked about using day centres, day hospitals, and being a hospital outpatient. Various kinds of professionals were involved in caring for people in the community including: support workers, GPs, CPNs (community psychiatric nurses), psychiatrists and social workers. There are different types of mental health teams that operate in the community. ‘Home Treatment’ or ‘Crisis Resolution’ are teams that are available 24 hours a day for help in an emergency. These teams try to treat people in the least restricted way and as close to home as possible. Early intervention teams also operate in the community and these services are aimed at 14-35 year olds during their first episode of psychosis. People experiencing psychosis for the first time often received intensive support in all areas of their lives to try to help towards a lasting recovery. Many people had contact with a Community Mental Health Team (CMHT) that is a multi-disciplinary team to help support people in the community on a daily basis if they need it, or only at times when they need support. If many people are involved the care of an individual, people will often be allocated a ‘care coordinator’ or a ‘keyworker’ to oversee the type of support they are getting. Occasionally people see Assertive Outreach Teams that provide intensive support for people who have traditionally avoided mental health services and are judged to be vulnerable. For more information on the different types of mental health team see the ‘Resources’ section.
 
First contacts
When people were first experiencing problems - often feeling anxious or depressed – they often went to see their GP. Some people didn’t go to their GP even when feeling highly distressed, and only had contact with their doctor when they were first in crisis. Some people didn’t want to admit that they might have mental health problems, and so avoided getting help. Others were too frightened to get help. Stuart thought that his GP might belong to the KGB, and so was too scared to see him. When people were in crisis the GP often referred them to a mental health team immediately, and some people were admitted to hospital straight away.
Janey can’t remember why she first went to the GP, but that they ‘picked up on’ the fact that she was having mental health difficulties; she said that he was nice but it didn’t help that he was a family friend.
People didn’t only get help from GPs. John said that the first person he thought of when he was distressed was his pastor. Arwen’s music teacher, whom she liked, detected problems and thought she might need to see a psychiatrist.
 
Positive experiences of support in the community
Over time people developed some good relationships with a range of different professionals who supported them in the community to maintain and improve their mental health. People managed this in different ways' by being able to talk to an expert psychiatrist about their problems; by being enabled to adopt a radical approach to mental health that supported their own interpretation of their experiences; or just by going for walks with a member of the mental health team. Whatever the route, people valued professionals who took time to speak to them, took them seriously and demonstrated caring.
People got a variety of different types of care. Arwen’s occupational therapist taught her to swim to help combat the weight she had gained through taking medication. Stuart’s GP intervened to advise his psychiatrist to prescribe medication that didn’t lead to so much weight gain. A couple of people had not seen a psychiatrist in some time, and so get their medication from their GP. A couple of people felt that the specialist knowledge that their psychiatrist had about them, and their diagnosis, reassured them.
 
Negative experiences of support in the community
Whilst many people had positive experiences of receiving community-based care, others voiced their dissatisfaction. Some people felt professionals put pressure on them to take their medication; were unreliable; let them get too unwell without intervening or that they weren’t empathetic enough. Some people even thought that health professionals can be frightened of people with mental health problems.
Cat said that she had had to be quite ‘forceful’ in order to get different types of support such as talking therapy and help with housing. David found that it was hard to communicate with his social worker, but found the next one he had helpful at sorting out his benefits. A few people found going to day centres helpful, but one woman said that her day centre was depressing and boring for her son.
For more information about how services in the community may have helped recovery see ‘Recovery’. For more information about talking therapies such as counselling see ‘Talking Therapies’.

Last reviewed July 2017.
Last updated April 2014.

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