In Easington we held a seminar on January 16th 2016 jointly between Easington Constituency, The Socialist Health Association and Unite and invited the public to come. There was a great turnout, including people who were willing to admit they suffered, or had suffered, mental health issues. There were almost 50 people there.
We had some good speakers too, who were willing to give up their time on a Saturday, Dr Paul Williams from Teesside and Dr Kamal Sidhu from Easington, joined by Anna Lynch, Director of Public Health for Durham. I am very grateful to all of them, as well as the people who made an effort to come.
The following points emerged from the discussion
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The Marmot Report on Health Inequalities addresses the issue of how we are to achieve greater equality in health and advocates concentrating more resources on young children People who suffer from mental health problems often live in communities which do not function well, and are likely to suffer from lack of work and money. Giving children a better start in life will help.
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By contrast many thought we should spend less on end of life care. Many frail older people end their days in hospital rather than in their own homes with the support of friends and family, which is where they would usually much rather be. But caring for the frail elderly in the community sounds very rosy, and even the most dedicated families need support, and at the moment that support often simply isn’t there. It is provided from the social care budget which is funded by local authorities. One response from the government is to transfer money from the NHS, and although the Better Care Fund, which is what the joint working with local authorities is called, works well in this part of the world, it means less money for the NHS. There other response is to say local authorities can levy a higher business rate to pay for social care, but the business rate is likely to be lower in the north than in the more prosperous south. So to ensure that pressure is taken off the NHS, and families receive the end of life care they want, more has to be given to local government, particularly in the North.
- The group agreed with the speaker who had said that priority needs to be given to provision in the early years. The first few years of life are crucially important in providing a foundation for good mental health. The closure of Children’s Centres was certainly not helpful.
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Anna Lynch, Director of Public Health, stressed the bad effects of social isolation and loneliness on not just the old, but everyone, and how this contributed to mental health problems. 18 to 34 year olds surveyed were more likely to worry about feeling alone and to feel depressed due to loneliness than the over 55s according to work done in Durham. Voluntary and community organisations do a wonderful job in helping combat loneliness, but they do need support, particularly in a less well-off area like the North East.
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Dr Sidhu, a GP in Easington, described the initiatives currently taking place in the area, particularly with “Talking Therapies” as an alternative to prescriptions. But concerns were raised about IAPT. It’s too often delivered by phone, when people want 1 to 1 face-to-face attention. 25% of prescriptions are not used as intended in any case. GPs would like to spend longer with their patients to investigate mental health issues. There is a funding issue, as always. It has been calculated that the needs of 100 patients in Easington are equivalent to 123 in more prosperous parts of the country. What doctors call the “inverse care law”. The most money goes to those who need it least.
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Much can be done by the voluntary/community sector (VCS), but it needs proper support. This is not an excuse to save money, or some romantic “Big Society” idea, but a practical way of mobilising community resources and empowering people and communities. The cooperation between the NHS, other agencies such as housing, the local authority, and the VCS as demonstrated by the Area Action Partnerships in County Durham is a good example to follow. Awareness of mental health issues should be part of the school curriculum, and even things like “mental health first aid”, training people to spot symptoms and help, rather like “First Responders”.
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Regarding funding proper funding of Social Care would reduce pressure on the NHS and allow people to be supported in their own homes, and support for the VCS reduces pressure on both families and social care. Organised trips to take older people out reduces loneliness, and activities as varied as fishing and mountaineering allow young people to interact with others and reduce isolation. (There are examples where the NHS and local authorities have funded such things) The important point is to reach those in need. There is a difficult balance to ensure that the better off do not dominate such activities, but that they are not simply reserved for those deemed to be in need. What is needed is a comprehensive social mixture.
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Funding is always a difficult issue when discussing the NHS, and there is no doubt that more funding will need to be made available for the NHS, and that people will have to contribute more, albeit in a fair and progressive way. But the distribution of funding is also important and recent changes in the funding formula have clearly benefitted more prosperous areas, and mental health issues tend to be concentrated in areas of deprivation.
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Regarding the care of the elderly, there is a crisis in the funding of nursing homes. Better trained staff are required, and better links with the NHS. Carehomes could be built in hospital grounds and publicly funded.
- Better information is needed about what services are available. The group liked the idea of Stockton’s ‘Navigators’—people who help others to find their way round the system and get to the right services for them. Better information via social media seems to be needed; that’s especially relevant for younger people. GPs need to put in more effort into finding out what services are available in the community. But it was recognised that things do change–directories of services are soon out of date etc.
- Employers need to be better at supporting employees with mental health difficulties. It was suggested that there could be a mental health occupational health service that employers (especially smaller employers) could link into to support their employees.
- Community development is an essential aspect of good mental health. The group talked about the need for communities to be caring, knowledgeable and prepared to help people with mental health difficulties. Isolation is lessened when a community is really operating as a community. Bear in mind that loneliness is experienced by the young as well as the old.
- Service integration is needed. Still too many people are ‘bounced around’ the system and their issues are not properly addressed. Some left on medication for years. And still too much fragmentation. Why is social care means-tested while health services are free? This points to the need for integration of health and social care which the Labour Party was the first to champion.
- There’s strength in numbers. Everyone needs to realise that the best way to make complaints about inadequacies in the system is by collective action.
- Much care for people with mental health issues is delivered at home, and in the family context. Parents struggle with isolation and stigma. This can often make the condition worse and could lead to self-harm. Proper support is needed, and as pointed out above can be delivered through the VCS and a community development approach so that those who really need it are contacted.
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Responding to mental health issues is something where everyone can play a role. Government has to support and facilitate. That means funding, and ensuring it is distributed fairly.