Thank you brolly.
You have made some really insightful points too.
Also, there are issues of confidentiality (or lack of), patient and staff safety on the secure ward, lack of therapy availability and limited choice/time limits within the small opportunities, too many managers without any basic clinical understanding of patient issues, lack of rewards and low morale among the staff, under staffing, poor Crisis Line, random access to the Crisis Team, over reliance on threatening to hospitalise patients if you are very unwell but not requiring admission (because it's easier for them), under trained staff to deal with complex cases, lack of stability and continuity for patients with too many locum staff, over reliance on other agencies (usually charitable or patient funded) to pick up the pieces they don't/refuse to provide, improved and proactive response to formal complaints, ideally a MH nurse in every GPs surgery for a proportionate amount of time, better communication to MDTs, fewer organisational changes for staff and patients constantly have to grapple with, more (funded) support groups for targeted groups of patients, employment support, support for dealing with benefits forms and assessments, positive relationships with the advocacy service, more real service user involvement rather than tokenism, supporting carers, improving delivery of courses at the Recovery College and so on.
Having read that back it's put in negative terms mostly, but these are the sorts of issues we are up against/trying to address.
Essentially the MH Trust management and service delivery structure is vertical and the patient pathway is horizontal. Er, huge stumbling block before you start on the detail.
Anyway, when I am well enough I try to do my bit.