Off-rolling has recently become a buzzword in the world of education. It refers to the removal, by various means, of students from schools’ records who are deemed too complicated or who don’t make the statistics look good. However, it’s not just education. Off-rolling is common in mental health services and disproportionally affects those most vulnerable and marginalised.
Off-rolling takes three main forms. The first is prematurely discharging patients from secondary mental health services such as community mental health teams. Traditionally, one could expect better care if one had moderate to severe mental health difficulties, as opposed to mild problems, as funding was based on clinical need. However the relentless obsession with targets and outcome privileges services that give good optics.
So services for people with mild to moderate problems will always perform better by these kind of metrics of success, as the milder the mental health problems, the quicker and cheaper the treatment, allowing vast numbers to be seen. In this context, secondary services are under huge pressure to produce similar improvements despite devastating cuts in funding. To manage these expectations, secondary care has re-oriented to a new value – that of recovery, which, as the pioneering mental health survivor-led campaigning group Recovery in the Bin demonstrate, has become decoupled from its founding principles to discriminate against people who remain disturbed or unwell.