We held a discussion in Norwich on 28th May.  This is record of issues raised in the four discussion groups, which were led by Dr Brian Fisher, Cllr Emma Corlett, Prof June Thorburn and Dr Chris Jones, to all of whom we are very grateful.   June has already produced a submission to the Mental Health consultation of the Labour Policy Forum on behalf of the Labour Social Work Group, so the points she made are not reproduced here.

Users

  • They often feel that specialists don’t know what they are talking about
  • Essential to have users involved in developing pathways and monitoring outcomes.
  • More talking treatments MUST be available.
  • User experiences should be the start to all Board meetings in the NHS
  • HUGE waiting times must be reduced
  • Dual diagnosis services are desperately needed, integrated with Community Mental Health Teams and inpatient work.
  • We need to speak to service users, include them in decision making, as they are have knowledge and insights about their conditions.

Children and Young People

We need systematic routine school mental illness services with a strong preventative component.  If Mental Health issues have no targets attached, no-one will pay them much attention. School nurses, voluntary organisations etc. need more support and training in mental health issues.

Professional staff

  • Start with their Mental Health and better results will follow. For a service so dependent on staff themselves being a large part of the treatment, making sure they are able to remain well and kind, with a sustainable way of life and not burned out by stress is essential. This is far from the case at present and is at the root of the recruitment and retention crisis and the huge drain on budgets caused by having to use agency staff, many of whom were made redundant in the drive to find “efficiency savings” and are now doing their old jobs at much higher rates of pay. On top of that are considerable payments to the agencies, some of which have links to politicians.
  • A proper theory of well-being and flourishing
  • Professionals need to understand their own Mental Health issues and stresses
  • Schwartz rounds, perhaps in schools and primary care, too
  • People need to feel in control. Stress is wasteful – for staff and for patients. The system at present is traumatising its workers and users and their families and friends, as indeed is the whole language of what remains of the welfare system.
  • Staff professionalism needs to be respected and they need to be listened to in saying which services are vital and how it is best provided. One of the messages from the professionals is the need to truly involve users in design and running of services.
  • There is unease about the plans to use more volunteers and others with very short periods of training to carry out roles previously done by professionals. Unless there is easy access to people with the necessary skills to support these new staff, there will be dangers for patients and the staff themselves.
  • GP Training

    • Many GPs are inexperienced in Mental Health issues. They need to understand chronicity
    • Not enough time to be very useful
    • Training for all GP practice staff

Carers

  • The system assumes you’ll keep caring until you fall over.
  • Team around the family sounds good. Could the carer be in charge?
  • Little support for carers
  • Too little statutory sector support, too much 3rd sector support.

Integration of mental and physical health

  • Avoid making wholesale changes which risk disrupting good working relationships on the ground. Call a halt on the short-term contracts which are time-consuming, expensive and distracts from the main purpose of the organisation/service concerned.  Tendering is expensive and wasteful.
  • Training of Mental Health nurses in basic physical things like blood taking and ECGs etc. in primary and secondary care
  • Signposting skills needed
  • Data sharing essential
  • Training the health and social care workforce: mental health should be a key part of training
  • Dangers of shunting the costs to other areas of health and social care – need to think of how we could fund changes in MH. However, a false economy not to treat MH problems as early as possible
  • It’s better for users – tell your story once, the providers make sure you get to the best person for the job. Better for the providers – refer to the right place directly. Vital that the same funding mechanism is used for both health and care; we need a National Health and Care Service, paid through taxation, not the introduction of means testing for health to align it with care. Markets destroy integration and they must go.
  • Mental illness needs to be seen as the same as any other kind of illness, treated in the same places alongside physical problems. Mental illness can be episodic or long term, as with physical illness, and deserves treatment even if for some people, “recovery” to a position that most people regard as normal is not very likely. Linking in with DWP issues; failure to get better i.e.: return to work should not lead to a risk of benefit sanctions.
How can we best identify and address root causes of mental disorders in our society?
Poverty and inequality, lack of opportunity, stress are the root causes – not something health services can tackle.
  • Educate children at school about mental illness, offering a safe place for them to discuss concerns. Often children experiencing mental illness do not know that there is a term to explain how they’re feeling, and that other people experience it too. Social Workers and nurses in schools in permanent roles. This could help de-escalate problems and prevent issues becoming full-blown social work intervention issues. Importance of schools, teachers, good communications and integration with communities: teachers cannot do all, that must be recognised. Teachers need support.
  • The status of PHSE should be raised and mental health education should be a compulsory part of the curriculum – could have MH PHSE days.
  • An earlier role was the Primary Mental Health Worker, worked well providing a whole school approach plus a one to one approach.
  • Acknowledge stressors for children within education.
  • View mental illness as ongoing, not a series of incidents. GPs don’t monitor certain mental illness such as depression, they check you’ve not harmed yourself and that you’re not suicidal but this doesn’t encompass symptoms that occur along the way such as sleep disorder or eating habits, if GPs were to check in with patients receiving regular medication, then the situation could be monitored a little better.
  • Mental wellness promotion. Promoting and encouraging habits and activities that have been shown to foster good mental health.
  • Welfare fit for work assessments  can clearly be very damaging for some people.
 What steps should be taken to improve early intervention in mental health? Compassion and dignity kept in mind as overarching theme to the following points:

Issues in pre-natal care include the treatment of pregnant women in the benefits system – e.g. pregnant women should not be sanctioned. Mother and baby units needed. There are none in Norfolk. Health visitors are very important as they are seen as non-stigmatizing and key to mother/child attachment and future care. There has to be an understanding of the mother’s networks and risks involved: bonding is very important and the family is core. Children’s Centres remain important but can be perceived as stigmatizing. Need more outreach and more community involvement with these.  Extend age limit to eight (rather than five, a crucial age in children’s development).  Home Start cited as good practice but finding funding is increasingly difficult with different funding bodies requiring services to meet different targets/criteria. Same for Family Action in Swaffham. Valuable work at risk such as raising parents’ confidence to get involved with children’s schools, ease the pathway to schools for children – basically, support parents to overcome their problems related to past poor school experiences, etc, so that they can better support their own children’s education and school attendance.

Social workers used to be generalist but now specialised into different categories which has broken the thread between family networks/relations so a Social Worker focused on the child may miss poor MH in parents because focus is solely on child. Practice recognised with the family nurse partnership which works with young parents where there are intergenerational issues.

We need to think of MH issues as a public health issue, a major public health issue and all of the things that impact on MH such as housing (a very big issue) and environment.

Concerns about social isolation of new parents, especially in rural areas of Norfolk with limited public transport. Community networks and Children’s Centres are important supports. Problem is how to resource these services.

Funding better Mental Health services:

  • Longer term funding; get rid of bidding requirement for short-term funding which is costly, resource intense a poor value for money.
  • Hold CCGs to account re funding, and what is spent where.  Mental Health should be integrated into health and receive its proper share of funding.
  • Work in different ways. Map existing resources and work with what is there in a different way. Get rid of duplication of services and confusion about which agency does what.
  • Train more staff to reduce reliance on expensive agency staff.
  • Eliminate leakage of public funds to private services.
  • Take a whole family approach in Social Work – more cost-effective than fragmented SW approach.
  • Pilot testing before embarking on expensive large-scale changes (see evidence base).
  • More crisis or respite houses for those with poor mental health who need a break, or extra support to avoid a crisis, or to prevent carer burn out. also used instead of full-blown hospital admission, etc which are not needed for all situations, yet are used because there are no alternatives in place. Could also be used to free up beds when people are recovering but not yet ready for home, especially if living alone.
  • More long-term planning and life-course planning to match services with needs across the life course.
  • Raise taxes eg. 1p on income tax ring-fenced for NHS, with at least 0.25p ring-fenced for mental health to reflect the amount of mental health need
  • Routes up to intervention – where to go if you have symptoms but aren’t in distress?
  • Increase availability, length, and type of talking therapy
  • Further training for GPs, who can make you feel like you are wasting their time when you want to discuss mental health concerns.
  • Bring back or fund properly  Sure Start / Children’s Centres, the Early Intervention in Psychosis teams, mother and baby units, dementia support teams etc. etc.
  • Greater cuts are being made in funding for MH than in funding for acute hospitals. It’s clearly much easier to cut services in mental health than in the rest of the NHS.
  • Research is seriously underfunded. Mental Health is under-represented in medical education. [The National Survey of Investment in Mental Health Services assembled data from 2003 to 2012 but with the abolition of Primary Care Trusts and Strategic Health Authorities, the government scrapped further surveys and to reduce the “data burden placed on organisations” (Norman Lamb, 20.03.14), no further attempt to gather comparable data was put in place. The NHS England figure for 2012/2013 was £11.28 bn]

How can we ensure that parity of esteem between mental health and physical health is achieved?

Whilst acknowledging that some progress has been made in increasing the attention paid to mental health because of the campaign to claim parity of esteem, we don’t like the phrase ‘parity of esteem’. We feel that the phrase is often used without a clear account of what it means, as if it’s enough in itself to use it. It can be used to blame acute hospitals for taking more than their share of the money, rather than looking at the political choice to spend a diminishing percentage of GDP on the NHS.

Parity of respect

There has been some improvement in attitudes but a long way to go. It is part of the job of politicians to improve the language used in discussing mental health and to encourage by example.

The UK Bill of Human Wrongs: Many bits of legislation in the name of reducing the deficit over the last few years have undermined services that any of us could need at times and access to which a civilised society regard as a human right. Taken together, they amount to a Human Wrongs Act as people in difficulty, because of the range of things which can go wrong in life are further wronged by the deficiencies in the provision of services, be it benefits, health care, legal advice, housing, education etc.

Despite the likelihood of experiencing or knowing of someone who is experiencing hardship because of changes to services, the public have become much less generous in their attitude to people with problems. We need to harness social media to generate a better public appreciation of what has happened and why people need help, and to stop their demonization.

Campaigning by disabled people has been accompanied by a rise in hate crime against them.

There is a tendency to blame the user for failures of services e.g. those who drop out are said to “not be ready” and receive no service with no attempt to reach out to people with significant mental health difficulties. The easiest to help get the service and targets are met. Those with more complicated problems, often a dual diagnosis of mental illness and substance misuse, can fall between services.

The drug strategy of 2010 has moved substance use services towards a model of ‘recovery’ and away from the harm reduction principles of engaging and retaining people in treatment. Whilst a clearer route and pathway to recovery should be encouraged, there is a risk with the fragmentation of substance use services, the replacement of statutory services with many varied third sector organisations, and tough commissioning targets emphasising moving people through treatment as quickly as possible and dis-incentivising working with the more challenging patients means that many patients with co-existing mental health and substance use issues fall between the parallel services of mental health and substance uses.

How do we make it clearer to people with limited access to accurate information that austerity is a dreadful failure, both at reducing the deficit and in the damage caused to our society?

Recommendations

  • More is data needed on the differences between treatments available for MH and physical health; both depend heavily on staff but physical medical care has a need for very expensive equipment and drugs and we all want those to be available. How this should be reflected in the respective budgets for physical and mental health spending needs teasing out.
  • Parity of funding for research between Mental Health & Physical Health.
  • Politicians to improve the language used in discussing mental health and to encourage by example.
  • Spend a greater percentage of GDP on the NHS and ensure that this is distributed more equally between MH and PH services.
  • Vital that the same funding mechanism is used for both health and social care; we need a National Health and Care Service, paid through taxation, not the introduction of means testing for health to align it with care.
  • Reinstate the NHS and remove the internal and external markets. Markets destroy integration and they must go.
  • Mental illness needs to be seen as the same as any other kind of illness, treated where possible in the same places alongside physical problems.
  • A focus on recovery should not preclude those with more chronic issues to be denied a service. Linking in with DWP issues; failure to get better i.e.: return to work should not lead to a risk of benefit sanctions.
  • The professions in health and care need to be respected and not undermined with poor working conditions, terms and conditions and job insecurity.
  • There needs to be greater collaboration in the design of services with staff and service users
  • We need to harness social media to generate a better public appreciation of what has happened to our NHS, MH services, social services and social security – and why people need help, and to stop their demonization.
  • We make it clearer to people with limited access to accurate information that austerity is a dreadful failure, both at reducing the deficit and in the damage caused to our society?
  • We need to reclaim the language of our social security system and avoid talking of a ‘welfare system’.
  • There needs to be a greater awareness of hate crime against those with a disability and this to be taken seriously by the criminal justice system.
  • We need to ensure that those with a dual diagnosis are not falling between a parallel service model of Mental Health and Substance use services. There needs to be integration between MH and substance use services. There needs to be dual diagnosis teams, assertive outreach teams and an emphasis on engaging these often challenging patients in treatment.
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2 Comments

  1. dinah morley says:

    Training of non-mental health workers is advised. Teachers should be specifically mentioned here particularly as work is going on to get compulsory training on mental health into teacher training courses.

  2. Mina Rodgers says:

    Now you got the facts it’s time to set priorities , a workplace and a time line for achieving all your priorities.

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