This is a report of discussions we held in Murton, in the Easington constituency in January 2016.

Dr Williams:

Most of my patient live in poverty. That is the key to health inequality.   Communities are more important for mental health than medical treatment.

Health is not just the absence of illness.

Most patients are more comfortable presenting physical symptoms than talking about mental health.

Psychosis gets all the coverage but anxiety and depression affects many more people, and is generally compounded by the abuse of drugs and alcohol.  About 10% of the population are affected at any one time.

Other important factors: Work or the lack of it.  Money.

The Work Capability Assessment does not take sufficient account of mental illness. The stressful process of assessment makes people worse.  Austerity generally increases stress among my patients and increases their use of drugs and cigarettes.  Of course this sort of behaviour exacerbates external health inequality factors.  Half of all cigarettes are sold to people with mental health problems. The effects of nicotine are similar to those of stress.

People with mental health problems are less likely to take up invitations for screening and to develop physical illness.

As far as treatment goes we have locally improved access to IAPT by widening the range of providers – voluntary, community and commercial and this has reduced waiting times. Referral is not required and now waiting time in Teeside is less than a week.

But more fundamentally we ought to tackle health inequality as recommended by Michael Marmot – in the womb and among small children. University tuition is far less important.  Labour did some good things in this area – the Family Nurse Partnership, Sure Start.  This government claims to have protected the NHS but has cut preventive measures.

Dr Anna Lynch:

The new funding formula reduces public health budget for Durham by £19 million in order to spend more in areas with older richer people like Hertfordshire.

We spend too much money on futile interventions at the end of life. We aren’t very good at predicting death but a lot of intensive medicine is clearly wasted – a large proportion in the last few months of life.  Out of 3000 people with dementia in Teeside 1800 were admitted to hospital. Did that do them any good?  We need to talk about the end of life much more than we do.

Large number of children rely on mental health support.  Early intervention would save money.  Social isolation affects children as well as adults.

Importance of public toilets and seats for old people to enable them to get out.

Dr Kamal Sidhu

Do we have parity of esteem for mental health?

  • Affects 1 in 4
  • People with serious mental illnesses die 20 years earlier
  • >70% more likely to smoke yet less support
  • < 30% of people with Schizophrenia receive annual physical checks. Concerns on physical health for these people may be ignored

CCG is investing  in Practice based Community Psychiatric Nurses to be based in practices/clusters. They will support teams in surgeries including education, prescribing support. There is  an element of ‘crisis prevention’

Local challenges:

  • Capacity- funding and workforce
  • Health professionals need to pay more attention to physical health of these patients
  • Lack of services for people who have both substance misuse & mental health disorders
  • Lack of psychology services in Easington
  • Smoother transition from young people services (CAMHS) to adult services
  • Directory of services

What we need:

  • Fair funding
  • Well resourced social care
  • People to be able to self-refer
  • More linking up and less ‘parking’
  • More social prescribing
  • Improved morale
  • GP appointments longer than 10 minutes

Anti-depressants – only 25% are used as prescribed.
Social care budgets have been crushed.  Eligibility criteria now mean those who rely on public provisions only qualify in dire condition.  Those who pay themselves, of course, can have what they are prepared to pay for.

Dementia is on the boundary between health and social care.

Discussion:

Personalised health budgets seem to be developing into “integrated personalised commissioning”

We need to provide more support for carers, including those caring for people at the end of life.  Though recognising that talking about this is hard, for both sides, and not everyone can do it.

There are staffing issues in nursing homes.  Commercial nursing homes collapsing.  NHS may have to build more nursing homes, perhaps in the grounds of hospitals.  The training of nurses should be more holistic, not separated between mental and physical nursing.  Mental health nurse training doesn’t include dementia.

We need to break down institutional barriers to effective for services, especially for areas like medically unexplained symptoms, PTSD and the like.

We could do much more to identify socially isolated people.  Social media helps.  So does community development.  It probably doesn’t cost much money to tackle loneliness.

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