Choice in mental health : myths and possibilities †

Creating a Patient-Led NHS (Department of Health & National Health Service, 2005) reaffirmed the strategic aim of the National Health Service (NHS) to be patient centred, making it clear that the old tradition of ‘doing to patients’ was no longer acceptable. Instead, the fundamental relationship between patient and clinician, and equally between patients and the NHS writ large, is to be based on partnership. Improving choice is at the heart of the government’s plans to make partnerships between patients, clinicians and the NHS work (Department of Health, 2003). In the run up to the general election in 2001, the Labour Party promised to give patients more choice in the health service (Labour Party, 2001). Later, in July 2003 John Reid, the then Secretary of State for Health, promised that the ‘choice agenda’ would turn the traditional, doctor-centred health service inside out, arguing that greater choice will help to reduce health inequalities (Reid, 2003). The Prime Minister Tony Blair also presented consumer choice as a means of empowering people and achieving greater equality in the health service (Rankin, 2005). Jennifer Rankin points out that choice goes beyond ‘voice’ mechanisms such as surveys and consultations and is more specific than ‘personalisation’ and the all-embracing concept of ‘modernisation’, although it is undoubtedly part of both these agendas. In practical terms, choice in NHS primary care and acute physical care has been translated as greater consumer choice and more convenience for the patient, what we might call the ‘where and when’ approach. This has put choice on the agenda in healthcare, but, as we will argue throughout this article, it has limitations: critically for mental health services it does not address ‘how’ choice should be implemented. ‘How’ means how service users are informed about choice, how power and dialogue about choices are shared between professionals and users, what choices there are for care, treatment and life outside of the care setting. These issues are, of course, relevant to physical healthcare too, where patients are not routinely offered choices in medications, types of surgery, after-care or therapies. At the moment, the dominance of the issue of long waiting lists has focused the choice agenda in physical healthcare on the ‘where and when’, but as lists reduce, it can be anticipated that people will start asking for more choices – choices we are already exploring in mental health services. Users and carers are calling for more choice and involvement in health service planning and delivery. There is growing consensus that people should be informed about, and able to influence, decisions regarding their own healthcare (Charles et al, 2000; Choice in mental health: myths and possibilities†