This essay will critically analyse the article “out of area treatments in mental health”.
Critical analysis is a method used to ascertain if the argument presented is credible. I t also ensures that the ideas are carefully evaluated rather than just mere acceptance based on probabilities.
Language can be used in many ways in order to sound convincing to the reader. An efficient and effective critical analysis will “ensure awareness of these ploys”, thus enabling “objective evaluation” of the argument that is being presented (Bowell and Kemp 2005). This article will also devolve into the antecedent of the author and the source of his article which would be used to evaluate the entire article.
The article’s structure will be analysed, with a particular focus on the author’s conclusion and how the article was written to support this. This essay will also examine the use of various evidence that was applied in the author’s article, focusing on its’ credibility and searching for any imperfection or weakness. A detailed evaluation of its flaws would be discussed, in which the author used to convince his readers. There would be a short summary that would weigh the article in general highlighting its credibility and limitations.
The essay will begin with the analysis of the author’s antecedent and values. The article was written by Jeremy Pritlov – a mental health development manager at Leeds social services department. As a result of these background checks, I would want to conclude that it appears he is in a position to give a detailed overview of costs to service users and services of out of area treatment.
In the second paragraph of the article where Jeremy Pritlove says: “Not only does this not make economic sense, but people may be taken away from their families and communities for no good reason” (Pritlove), I would be inclined to agree with this because the presence of family and friends showing love and affection during the convalescent stage of mental health patient is essential.
In the subsequent paragraph, the author insisted that “the origin of outpatient treatments lie in the reduction of NHS inpatient psychiatric beds over recent years and this appears to be true” (Pritlove). It is evident that there were austerity measures taken by the present government which was felt particularly at the NHS which may have, as a result, led to rationalising of treatments. However, I would want to imagine that if the author had thought about the possibility of an increment in the rate people abuse drugs that lead to mental health anomaly, (Class A drugs to be specific) then this might have been too overwhelming for NHS to cope with, hence other drastic actions were taken including “out of area treatment”.
A focus on the Leeds experience
Leeds Partnerships Trust states that its aim is: “to ensure that all service users will receive high levels of appropriate care and treatment within services local to them” (Leeds Partnership Trust).
The trust has taken action to decrease the number of out of area treatments and there has subsequently been a big decrease the number of such placements from 2009 to 2010: 403 to 196.
After an intensive search to ascertain whether there is a national statistic on the “out of area treatments in mental health”, it appears that the author was on track with that fact.
Numbers of Leeds patients sent out of area
The author wrote about various figures, linking different dates without satisfactory publication. One can cross-check to ensure they actually correlate with one another especially the part which states “reaching a peak in 403 of 2009” (Pritlove). However, the statement that suggests “2010 saw a dramatic decline to 196”, is quite mesmerising and needs to be verified.
Leeds out of area treatments: the personal cost
The author showed an in-depth understanding of the personal cost here, besides the financial cost of travelling to visit their loved ones recuperating, the author also mentioned the other cost like those with children and the distance shortcomings. However, the author did not proffer any solution to this. Instead, he claimed that one would imagine that his known solution would be to reduce out of area treatments “significantly” but there may be other relevant temporal measures that can be taken to combat the “personal cost” which may include; fare vouchers and organised weekly travels to different non Leeds areas which would be highly welcomed by affected families. This relates closely to a national study by Ryan and Ryan, which showed that “significant numbers of people were placed at a great distance (i.e. up to 300 miles) from home.” (Ryan & Ryan, 2004).
Leeds out of area treatments: the financial cost
The author’s figures therewith correlate with stated facts as seen on http://www.rcpsych.ac.uk.
The author further wrote that placements were on average 66% more expensive than local treatments. This further justifies his reiterations, i.e. Out of area treatment is not sustainable. As mentioned above, the financial costs also included personal cost, however, the author did not include in the summary of his figures. I would argue that he was clear on the financial cost not being sustainable with verifiable figures and convincing argument. The author also claimed that “the longer a patient stayed out of area, the more likely it was that the provider was private”. However, I would argue that the author was giving an indication of bias or deliberate mismanagement of public funds (to at least be mild not to point at fraud).
It is important to mention that the majority of the money that Leeds health commissioners spent on out of area treatment, went to private healthcare providers. From 2004 to 2009, more than two-thirds of placements were with private providers, but this dropped to just over half of that during 2010. Steve Gold, a journalist, argued in the Guardian last year that the private healthcare sector has come “a very long way in the last 10 years, and the government’s health and social care bill looks set to provide significant new opportunities.” (Gold 2011)
Why out of area treatments?
The author started with a strong point by exhibiting the reason behind the cause of out of treatments. He further brought out some important facts that had eluded his article so far. For example, he mentioned that other reasons for out of area treatments could be as a result of confidentiality and lack of specialists in Leeds. These are credible and tangible facts that I presume the author (deliberately) tried to cover-up because he had only mentioned his so called “lack of space” to ensure his readers get hypnotized by agreeing strongly with him. Furthermore, he also wrote about the possibilities of mental health discrimination though he refused to elaborate.
Moving on to Leeds Partnerships Trust’s response section, the author portrayed the achievements and possibly the readiness of the trust together with its commitments as seen in “fall in the number of such placements from 2009 to 2010: 403 to 196”. As good as this seems to be, although he was rather quoting the response, he did not write on its limitations, challenges and shortcomings.
He moved on to agree that the situation in Leeds was not “unique” therefore it is a national problem supposedly. Moreover, he gave huge credence to the fact that the trust is responding the problems in an acceptable way despite his heavy criticism at the beginning.
It has been revealed by national studies, that the situation in Leeds is not unusual. The personal cost of placements to patients and their families is ‘enormous’ (Mountain et al, 2009) an ‘overwhelming expenditure’. However, when this is added to the overall financial cost, taking any form of action is a huge expenditure.
Chris Naylor, a Senior Researcher at The King’s Fund, and Andy Bell, a Deputy Chief Executive for Mental Health, both argue that the National Health Service (NHS) faces “an output gap of about ?14 billion over the next three years” (Naylor, Bell), thus, supporting the article by Pritlove. They argue that this is as a result of it” needing to make improvements of around four per cent per year” (Naylor, Bell). Around 12 per cent of the delegation budgets of primary care trusts (PCTs) accounts for mental health. That will therefore need to feature highly in responding to this ?nancial challenge This is prime support of the fact that Leeds is not in a unique situation, something in which the author also argues.
Naylor and Bell move on to argue that “The National Health Service (NHS) is confronting a very big and important challenge financially” (Naylor and Bell). Unless there is a great change in how services are delivered, there will be a “substantial gap between the actual funding available and that required to improve the quality of patient care and to respond to demographic changes and other cost pressures.” (Naylor and Bell) This is the case even with the smaller increases in funding over the next four years which were announced in a Comprehensive Spending Review by the government.
To summarise, this essay analysed the ‘out of area treatments in mental health.’ It concludes that whilst a lot of work still remains to be done and the need for action must be a priority, Leeds is not alone in this problem. There is evidence to suggest that the trust in Leeds is attempting to respond to these issues in a positive way and attempting to reduce, decrease and diminish the personal, and financial effects of out of area treatments. The author showed an in-depth and knowledgeable understanding of the personal cost of out of area treatment, but unfortunately did not come up with any ready solution. He was also very clear on the financial costs of the out of area “treatment” but there was evidence of some bias towards public funds. The author also argued very comprehensively and clearly the reasoning behind the cause of out of area treatments. However, he then failed to elaborate on the possibilities of mental health discrimination.
In conclusion, it would appear that a fundamental priority for commissioners at the moment would be to “reduce the use of out-of-area placements” (Naylor and Bell). Diverting current spending on these placements into local services will make it possible to achieve abundant savings, as well as improving the quality of care that the people currently placed outside their local area are receiving.
Healthcare Commission (2004) Ratings 2004: Out of catchment area treatments (adults).London: Healthcare Commission.
Killaspy, H. (2010) Quoted in ‘Millions wasted on treating mentally ill away from their communities’. The Guardian, Society, 14 April 2010.
Leeds Hospital Alert (2009) Out of Area Treatments in Mental Health: The Leeds situation 2004 to 2008. Available at: www.leedshospitalalert.org.uk or from Leeds Hospital Alert, The Cardigan Centre, 145/149 Cardigan Road, Leeds LS6 1LJ.
Mountain, D., Killapsy, H.& Holloway, F. (2009) Mental health rehabilitation services in the UK in 2007. Psychiatric Bulletin 33 215-218.
Royal College of Psychiatrists (2010) PCTs ‘wasting millions’ on out-of-area treatments, reveals RCPsych (14 April 2010).
Ryan, T. & Rayne, M. (2007) Working with the independent sector and managing out of area treatments. Mental Health Review Journal 12 (2).
Pritlove, J. (2012) ‘Out of area treatments in mental health: the Leeds experience’, mentalhealth Today, May/June 2012, pp. 19-21