Category Archives: Mental Health

This is a discussion document not agreed policy.

Mental Health services are “overwhelmed” by soaring demand according to a report by the body representing community, ambulance and hospital service providers, NHS Providers (July 2017, ref 1). Demand has increased by 5-10% over the last 3-4 years, but by 30-40% for children and young people. Patients are facing long delays to access mental health care, and people too often receive inadequate treatment. The numbers of people in need of specialist post-trauma mental health services has escalated dramatically following recent terrorist and civilian disasters. These intractable problems are the result of the Conservative Government’s unremitting policy of economic austerity, the prolonged real terms reduction of NHS funding over the past 7 years, and worsening shortages of key mental health staff such as nurses and psychiatrists.

The Socialist Health Association is committed to ensuring fulfilment of repeated high level commitments to ‘parity of esteem’ for mental health, and urgent implementation of proposals set out in the cross-agency Five Year Forward View for Mental Health (February 2016, ref 2) and Five Year Forward View for Mental Health: one year on’ (February 2017, ref 3). This must be combined with the future freedom from political interference of NHS policy making and delivery.

mental health

The origins of mental wellbeing and good mental health

The SHA policy on mental wellbeing is founded on the recognition that societal factors impact significantly on the whole spectrum of mental wellbeing to mental ill-health. The effects on individuals and families of social deprivation impacting on income, debt, access to appropriate accommodation, rewarding employment and security of tenure, community and family support networks, the availability and content of education, and other factors all play their part. The physiological reactions to stress of an expectant mother with pressing social difficulties affect the developing brain of her child. Experiencing or witnessing abuse and violence in the domestic setting at an early age can have severe lifelong effects on mental wellbeing and health.

In addition to the effects of absolute deprivation, living with extreme socio-economic inequalities has an independent impact: the experience of being judged socially inferior is a chronic cause of stress with negative effects on physical and mental health. Even severe mental illnesses with a genetic component are influenced by such social factors.

‘’.. . although genetic vulnerability may underlie some mental illness, this can’t by itself explain the huge rises in illness in recent decades – our genes can’t change that fast.’ Richard Wilkinson and Kate Pickett – The Spirit Level.

Virtually every aspect of policy – economic, housing, education and training, environment, equalities, health and social care – impacts on mental wellbeing, and should be seen clearly and addressed collaboratively to serve the promotion of good mental health, personal autonomy, and full access to civil society. At the same time, responsibility for determining and delivering health and social care must be freed from the highly disruptive cycle of repeated organisational change and political interference in NHS management.

Promoting knowledge, support, and care

A general understanding of the promotion of mental wellbeing, and the way mental health problems are manifest should be promoted at all levels in society through ante-natal care, children’s centres, school and further / higher education, to places of employment, and this should be a central facet of a National Strategy for Public Health.

The vast majority of people with mental health problems, including those who need highly specialised inputs to their management, will rely on primary and community care for diagnosis and ongoing care and support. For the large number of people who have both physical health and mental health problems these are managed together in primary care. Access to social support and integrated resources can best be managed by community based mental wellbeing collaboratives bringing together service users and carers, community groups including ‘Being Well’ projects (Plunkett Foundation: ) commissioners, voluntary sector organisations, local authority services, and primary and secondary health services.

To make these effective,

  1. The severe reduction in funding for primary care, and in particular general practice, must be reversed urgently
  2. Community based mental wellbeing collaboratives (see above) should be established in all areas, with appropriate public health support.
  3. The progressive and continuing erosion of funding for mental health services, itself the product in part of continuing real-terms reduction in funding for the NHS more widely, must also be reversed urgently and in line with ongoing rhetoric about ‘parity of esteem’ for mental health. Parity should not mean a race to the bottom for mental, physical and social health funding.

Specific SHA policy recommendations include:

  1. Parity of funding for the prevention of, treatment services and related social care for, and research into mental ill-health; and for treatments including psychological alternatives to medication; and funding to ensure research findings are applied in clinical practice more quickly. To reflect the accepted burden of disease, 23% of NHS spend should be committed to secondary mental health service provision rather than the present 13%. Funding must be ring-fenced.
  2. An integrated cross-party, cross-government National Strategy for Mental Health including public education, universal support, and clear policies for tackling the societal determinants of poor mental health, ie poverty, debt, housing need, low educational attainment, low employment aspiration and community disintegration.
  3. A new National Service Framework for Mental Health drawing on the ‘Five Year Forward View for Mental Health’ and linked to the National Strategy for Mental Health, incorporating urgent review and reinstatement of national standards for mental health service provision, including for illness prevention and improved access to services.
  4. Establishment of an Independent National Health and Social Care Service Commission to oversee the rapid integration of health and social care, and to govern a new National Health and Social Care Service in future free from party political interference.
  5. Confrontation and breaking down of stigma should be a fundamental part of mental health strategy – this requires more public information and education about mental illness, the building of community cohesion, how to help oneself, and about the principles of early intervention.
  1. Improved and better resources including mental health services in Primary Care / General Practice, funded in addition to and not at the expense of more specialised secondary mental health services
  2. Continued development of integrated services which jointly and holistically address mental, physical and social needs, especially for children, women in the perinatal period, people with learning disabilities and associated mental ill-health, people with serious mental illness, people suffering comorbid physical and mental illness, and older people with multiple physical and mental conditions and related social needs.
  3. Review and possible reversal of the ill-considered and austerity-driven dismantling of specialist mental health teams (eg for people in crisis, people with complex needs and personality disorders, assertive outreach for people with psychotic illnesses), or greatly enhanced resourcing of integrated Community Mental Health Teams.
  4. Further extension of psychological therapy services to provide more alternatives to medication, including increased provision of longer term psychotherapies for those with more complex and enduring mental health problems.
  5. Greatly enhanced services for children and young people with mental health problems (anxiety, depression, self-harm and eating disorders are increasingly prevalent), including collaborative mental health & wellbeing provision in schools and colleges, increased numbers of health visitors and school nurses, ready access to specialised mental health services (CAMHS), an increase in inpatient provision to avoid children and young people being admitted to hospital far from family and home, and specialist provision for eating disorders, post sexual abuse and other post-traumatic disorders, autistic spectrum disorders, Attention Deficit Hyperactivity Disorder, and drug abuse.
  6. Service development and further research for the identification and treatment of ill-health, and provision of integrated social care for older people with mental disorders or dementias, in domestic, community and residential (care and nursing home) settings.
  7. Substantial additional funding and improvement in health and social care services for children and adults with learning disabilities, including for autistic spectrum disorders.
  8. Urgent research and clinical intervention to reduce mortality rates for people with serious mental illness who still die 15-20 years before those without SMI.
  9. Urgent review of the escalating incidence of suicide and attempted suicide, urgent updating of suicide prevention strategies, and resources for rapid intervention and inter-agency collaboration following suicide attempts.
  10. Greatly improved cross-agency provision for people with acute mental health emergencies, including mental health / police interface services and crisis intervention services – including helping friends and families to cope. We should treat mental health crises with the same urgency and import as other medical crises.
  11. Reduction in the number of patients who are subject to Compulsory Treatment Orders, which have not been shown to benefit patients. This will require increased and improved in-patient treatment provision.
  12. Reversal of austerity-driven and counter-productive reductions in psychiatric in-patient bed numbers, including for children and young people.
  13. Comprehensive provision of integrated health and social care services for adults and children who have been exposed to significant traumatic experiences recently or in the past, including specialised psychological treatment services for those suffering from post-traumatic and related disorders.
  14. Urgent and rapid enhancement of mental illness diagnostic and treatment provision in the criminal justice system, especially in prisons for both adults and young people.
  15. Provision of comprehensive, country-wide mental health facilities with essential translation services for refugees and migrants, both in mainstream community services and in detention / removal centres.
  16. More research and sensitive provision for people who experience mental health problems as a result of exposure to stress in the workplace.
  17. Research on and more systematic approaches to evaluating the outcomes of treatments for the full range of mental health problems, including both common, episodic ill-health (eg anxiety and depressive disorders) and severe, enduring mental illnesses (eg schizophrenia, bipolar disorder).
  18. Resources for mental health services have been stretched to the point of dangerousness, so substantial additional funding, imaginative development of more integrated services, and persistent determination will be required to bring about the improvements and changes that are so urgently needed. Only a robust policy framework, freedom from repeated political interference, and ruthless commitment to delivery will achieve true ‘parity’ of esteem and funding for mental health.


  1. NHS Providers (2017) ‘The State of the NHS Provider Sector’

  2. NHS England (2016) ‘The Five Year Forward View for Mental Health’

  3. NHS England (2017) ‘Five Year Forward View for Mental Health: one year on’

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Government austerity measures since 2010 have impacted healthcare across the UK.

Holyrood is the administrator for NHS funds in Scotland but the Scottish Government has struggled to mitigate the impact of Westminster cuts.

In the short-term they’ve had limited successes in keeping various healthcare plates spinning in the air — but with no clear end to cuts in sight, they might soon come crashing down.

So here are three ways austerity is impacting health in Scotland and an overview of the stakeholders combating cuts.


Prior to Scottish GDP figures being released in early July, the mainstream media was awash with warnings that the economy was on the brink of recession.

Yet organs like the BBC were forced to flip their doomsday scripts overnight when it was revealed that GDP had grown by 0.8 per cent — outperforming the UK as a whole.

But national statistics don’t reflect the challenges faced by those struggling regions where the economic picture isn’t so rosy.

The downturn in the oil and gas industry has led to a 50 per cent rise in unemployment in North-East Scotland — with a serious knock-on effect on mental health.

The Scottish Association of Mental Health’s Open Up campaign encourages residents in affected communities to openly discuss mental health problems — and helps them find sources of support.

In terms of the employment rate the high level picture is healthy in Scotland —but figures are partially propped up by part-time roles and zero hour contracts.

And workers in precarious employment are also facing rising rents — so it’s crucial to read between the lines with Scottish employment statistics.

Mental health

A report from the mental Welfare Commission in April revealed that even as austerity pressurised NHS mental health services, staff shortages in mixed psychiatric wards made female patients feel unsafe.

The Scottish Government pledged to spend £300 million recruiting 800 new mental health staff over the next five years to plug the gap.

This might present an opportunity for mental health nurses with diplomas to take online distance learning degrees that upgrade their skillsets for senior positions.

But the NHS across the UK is haemorrhaging skilled overseas staff because of Brexit.

Welfare reform

The Welfare reform Acts of 2012 and 2016 have had a huge impact on some of Britain’s poorest and most vulnerable citizens.

A UN report in late 2016 confirmed that these reforms show ‘grave or systematic violations of the rights of persons with disabilities’.

And the study also highlighted the cultural shift that means disabled Britons and other disadvantaged groups are cast as scapegoats for Britain’s economic woes.

Holyrood has spent £396 million over the past five years mitigating Westminster policies such as the bedroom tax — while their budget was slashed by £5 billion.

And Westminster Welfare cuts mean another £2 billion has disappeared from the Scottish economy as those affected save the little cash they have, rather than spending in shops.

Austerity has affected Scotland in similar ways to the rest of the nation. But it’s unclear whether the Scottish Government’s mitigation measures constitute a sticking plaster solution rather than a permanent cure.

Have you experienced the effects of austerity in Scotland? Share your stories in the comments section.


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Levels of rough sleeping have escalated rapidly in recently years, with reports of deaths on the street now increasingly common. The strong presence of homelessness-related commitments in all of the major UK political parties’ 2017 manifestos is welcome, but does little to dispel intense controversy over how best to intervene in this area.

At the most basic level, responses to rough sleeping can be distinguished by whether they explicitly seek to alter or ‘control’ the behaviour of homeless people (‘interventionist’ responses) or not (non-interventionist responses). Interventionist responses include the use of ‘force’, such as arresting people for begging, rough sleeping or associated activities, or excluding them from particular areas (using civil orders like ASBOs or Public Space Protection Orders). They also include ‘coercive’ approaches which seek compliance via a ‘threat of deprivation’, for instance, by making access to accommodation conditional on signing up to a support plan. ‘Persuasive’ techniques, such as ‘motivational interviewing’ are core to the more ‘assertive’ forms of street outreach now used in many major cities.

These interventionist approaches, and particularly ‘harder’ measures that employ force or coercion, are extremely controversial, often described as punitive or even as criminalisation. Some argue, however, that it is the non-interventionist stance of some soup kitchens, day centres, and traditional night shelters, generally run by faith-based organisations, that should be subject to moral censure, and that the ‘non-judgemental sanctuary’  that they offer can sustain damaging, even  life-threatening, patterns of behaviour among a highly vulnerable group of people.

These polarised and emotive debates pose a challenge to policy-makers and service providers, and risk obscuring the need for cool-headed reflection in determining the most ethical approach. In a recent paper, Suzanne Fitzpatrick, Sarah Johnsen and I propose a four-point framework (inspired by Ruth Grant, a political philosopher at Duke University) to cut through this contested moral territory.

First, does the intervention in question have a legitimate purpose? The idea that enforcement-based responses are pursued in defence of the aesthetic concerns and financial interests of wealthy gentrifiers has fuelled a great deal of the controversy that surrounds them. But in the UK at least, their adoption has also often been shown to be driven by the understandable concerns of ordinary local residents about health hazards like discarded needles or human waste in public spaces. The wellbeing of the homeless people targeted has also informed the Rough Sleepers Initiative of the 1990s as well as the more recent ‘No Second Night Out’ programme. Thus, despite widespread media hype, it is not the case that interventionist approaches necessarily reflect punitive intent on the part of politicians and policy-makers.

Second, does the intervention allow for a voluntary response on the part of those targeted, therefore respecting their autonomy and capacity for self-determination? Here, non-interventionist approaches may seem at first glance to have the ethical advantage over more controlling interventions. However, the waters are substantially muddied by clear evidence of the highly constrained capacity of some individuals sleeping rough, especially those suffering from severe addiction and/or mental ill health, to act autonomously – that is, in pursuit of their own settled and authentic preferences. In such circumstances, a refusal to countenance ‘paternalistic’ interventions which seek to safeguard, restore or establish some basic level of personal autonomy for a vulnerable adult appears to us (as to James Gregory in his paper Engineering Compassion) “more like a moral abnegation… than respectful distance”.

Third, what are the impacts of the intervention on the ‘character’ of those involved? There have been concerns, for instance, that commissioning practices that require faith-based organisations to engage in interventionist practices undermine their ethos of providing sanctuary and care unconditionally. Similar, homelessness organisations working with the police or UK Border Agency have been heavily criticised for ‘selling out’ and abandoning their core values. But we would argue that the material impact of homelessness interventions on their intended ‘beneficiaries’ should be given a much higher moral weighting than their impact on the character of the ‘benefactor’. An undue emphasis on the latter could be considered ethically dubious, even rather self-indulgent.

This takes us to our fourth, and most important, moral consideration: what are the actual outcomes of the intervention in question? In particular, is it effective in improving the wellbeing of rough sleepers and, crucially, is it more effective than alternative (less controlling) methods? For example, while there is evidence that ASBOs have led to positive benefits for some street homeless people, acting as a ‘crisis point’ prompting engagement with support services, the use of such strong enforcement measure can only be justified as proportional when used as a last resort. The full range of consequences of any intervention must also be considered, including unintended negative effects. This would include, for example, displacing rough sleepers into more dangerous or isolated areas of the city.

Equally, though, a key implication of this analysis is that the ‘tolerant’ approach taken by many soup runs, day centres and shelters ought to be subject to the same level of ethical scrutiny as interventionist responses. They should not be assumed to be morally unproblematic simply because terms like ‘unconditional acceptance’ sound innocuous. At a minimum, the possibility that tolerant approaches may inadvertently act to erode vulnerable people’s longer-term autonomy by sustaining them in street-based lifestyles must be taken seriously.

These four criteria are offered as a route through what continues to be an extremely polarised debate on how to best respond to escalating levels of rough sleeping. A priori arguments, emotional intuitions, the (good) intentions of staff and volunteers, or even the views of current users of a service, do not suffice to settle these controversies. Instead, we should pursue responses that have the most significant and lasting positive impacts on those at risk on the streets.

This was first published on the  British Politics and Policy blog

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Recent figures show that only one third of workers who experienced a mental health problem in the last five years felt well-supported by their managers. Line managers routinely overestimate how well their workplace supports staff’s mental health and wellbeing, and less than a fifth of workers with mental health issues said they actually received the kind of support that would help them to remain in work.

But why is this happening? Well, there’s a perception that those with mental health problems won’t be able to cope with workloads and the stresses and strains of the workday, which stops people discussing their health issues with anyone at work. There’s also an erroneous belief that those who suffer with mental health issues are simply using it as an excuse to get off work. There’s also a fear of the gossip, pressure and bad-treatment from colleagues who see an employee with mental health issues as being ‘deadwood’ to a company, all of which culminate to add to the stigma surrounding mental health.

So what can employers do?

One thing employers could do to de-stigmatise mental health issues in the workplace is to enable employees to remain in work with adjustments to their role. This is already a requirement under health and safety law, with employers being subject to a general obligation to take reasonable care for the health and safety of employees in the workplace, which means they have a duty towards people who may have mental health issues.

Employers also have a legal duty not to discriminate because of a person’s disability (and in some cases, mental health issues can constitute a disability). However, it’s clear that there needs to be more flexibility than the law currently has the power to enforce, such as making an alteration to responsibilities where appropriate, or an adjustment to contracted hours or place of work. Both these solutions could go some way to closing the gap between duty and what happens in reality.

And, while there’s no magic software solution or technological shortcut to improving a culture of understanding mental health or tackling mental health issues directly, investing in the right infrastructure could free up HR professionals to innovate and focus their attention to other things, including mental health. Employers ought to start investing in HR services on a larger scale, including the use of software to automate processes, as this could ensure HR professionals have time and capacity to focus their attention on matters as pressing as mental health.

In addition, employers could reduce stigma around mental health by encouraging their employees to prioritise their own mental wellbeing, which means offering more sick days at full pay, preventing burn-out and achieving a healthy work-life balance. This might require better resourcing, a review to the number of sick days issued to staff, and a company culture of taking lunch breaks and leaving the office on time: a pipe dream for many, perhaps, but a major step towards looking after the mental health of all employees.

Open communication is also required, as a lack of communication and understanding is perhaps the largest source of stigma around mental health in the workplace. This might mean holding learning lunches on the subject, organising training from external agencies, making support from mental health professionals available or even subsidising treatment such as counselling services.

Furthermore, much of the stigma around mental health in the workplace could be reduced by enabling mangers to help others. This will require training managers so that they feel confident supporting their team, recognising mental health issues and knowing how to communicate confidently about them. Chris O’Sullivan, head of workplace mental health at the Mental Health Foundation even suggests encouraging those who have relevant experience to use it to support others.

For example, he suggests that it might be valuable for managers to share their lived-experience of dealing with mental health issues. Whether or not this is a solution to de-stigmatising mental health depends on a manager’s willingness to share their experience, (and there certainly shouldn’t be any pressure placed on managers to do so), as respect for their privacy and facilitating the separation of their personal life from their work life is key. Managers should only be encouraged to share their personal experiences if they are genuinely willing to do so.

Finally, employers need to work on the gap between policies regarding mental health and the actual everyday experiences of employees. Can a business truly be said to be aware, understanding and accommodating of mental health issues if their staff are routinely overworked, stressed, under-resourced or over-burdened? Is their sufficient provision for sick days, and would a mental health issue be challenged, sneered at or simply not accepted if someone called in sick for depression, anxiety or a similar mental health issue? 

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Beyond Stressful: Why Anxiety and Addiction Are a Dangerous Combination

Most people experience anxiety from time to time. Many individuals living in the UK, however, experience frequent, unceasing forms of anxiety. These symptoms make it more difficult for some individuals to live fulfilling, productive lives.

According to a 2013 study published in the Journal of Psychopharmacology, more than 8 million cases of anxiety disorders were reported in the UK. Managing anxiety is possible with treatment, but this task becomes significantly more difficult when an anxiety patient is also struggling with drug or alcohol addiction.

Anxiety and addiction are major health risks on their own, and both become considerably more dangerous when co-occurring with another disorder. Data collected by the National Health Services suggest that up to 50 per cent of people facing mental health problems also have a substance use disorder.

Considering that anxiety is the most prevalent mental health problem in the world, it is safe to say that the combination of anxiety and addiction represents a common dual diagnosis.

When Anxiety and Addiction Form a Pair

Anxiety and substance use form a problematic pair for individuals trying to manage both disorders at the same time. It is not unusual for the symptoms of a substance use disorder to exacerbate the symptoms of anxiety. Likewise, those who see relief from their mental health issues via substance abuse will find that their anxiety symptoms grow more unmanageable when they are sober.

This vicious cycle underscores just how dangerous this combination of mental health issues can be. Examples of co-occurring substance use and anxiety disorders include:

  • A post-traumatic stress disorder patient who uses alcohol to lesson psychological trauma and experiences more severe depression symptoms
  • A person with a social phobia uses prescription pills to lessen his or her inhibitions in social settings, but finds that the phobia symptoms get worse when sober
  • An obsessive-compulsive disorder patient begins using marijuana to ease his or her compulsions and develops a new obsession with the physical act of smoking

The Need for Dual Diagnosis Treatment

The term “dual diagnosis” refers to any time a patient is afflicted with more than one mental disorder simultaneously. These patients are particularly at risk because the symptoms of one disorder typically interfere with the treatment of the other. Patients dealing with co-occurring anxiety and substance use disorders are a prime example of this phenomenon.

A person with a social phobia, for example, may find it difficult to participate in group therapy for his or her addiction. Similarly, a person who is going through withdrawal symptoms to overcome addiction may be more likely to experience a panic attack and feel the urge to continue using. These scenarios emphasize the need for specialized treatment that addresses the root of both disorders.

Solving Anxiety and Addiction

What’s the best way to treat co-occurring addiction and anxiety? Today, most experts believe that the most effective approach is to treat these conditions simultaneously. That’s why leading treatment facilities hire psychiatric professionals as well as medical doctors to join their staff. With both types of expertise available in house, these treatment centers can develop personalized recovery strategies that address the symptoms of both mental disorders.

Considering the massive overlap of individuals with anxiety disorders and addiction, it would not be surprising if dual diagnosis treatment becomes the default treatment approach for these co-occurring disorders. In the meantime, dual diagnosis patients and their families must be diligent in finding a treatment center that can serve their needs.


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Fulfilment of repeated high level commitments to ‘parity of esteem’ for mental health, and urgent implementation of proposals set out in the cross-agency Five Year Forward View for Mental Health (Feb 2017), including:

  1. parity of funding for prevention of, treatment services and related social care for, and research into mental ill-health treatments including psychological alternatives to medication; and funding to get research findings into clinical practice more quickly;
  2. a new integrated National Service Framework for Mental Health, urgent review and reinstatement of national standards for mental health service provision, including for access to services;
  3. greatly enhanced services for children and young people with mental health problems (anxiety, depression, self harm are increasingly prevalent), including collaborative mental health & wellbeing provision in schools and colleges, increased numbers of health visitors and school nurses, ready access to specialised mental health services (CAMHS), an increase in inpatient provision to avoid children and young people being admitted to hospital far from family and home, and specialist provision for eating disorders, post sexual abuse and other post-traumatic disorders, autistic spectrum disorders, ADHD, and drug abuse;
  4. urgent review of the escalating incidence of suicide, and urgent updating of suicide prevention strategies;
  5. continued development of integrated services which jointly address mental, physical and social needs, especially for children, women in the perinatal period, people with learning disabilities and associated mental ill-health, people with serious mental illness, and older people with multiple physical and mental conditions and related social needs;
  6. urgent reduction of mortality rates for people with serious mental illness who still die 15-20 years before those without SMI;
  7. greatly improved cross-agency provision for people with acute mental health emergencies, including mental health / police interface services and crisis intervention services – including helping friends and families to cope. We should treat mental health crisis with same import as other medical crises.
  8. reversal of austerity-driven and counter-productive reductions in psychiatric in-patient bed numbers;
  9. reversal of the ill-considered and austerity-driven dismantling of specialist mental health teams (eg for early intervention in psychosis, people with complex needs, assertive outreach)
  10. breaking down of stigma should be a fundamental part of a mental health strategy – more information about mental illness / how to help self / early intervention.

This document is one of a series developed by the SHA that underpin our recommendations for the Labour Party Manifesto. Each has been developed with contributions from many experts and curated by Brian Fisher through an SHA Policy Commission. They remain in draft and have not been approved by SHA Central Council. They offer an opportunity to explore policy in more detail through debate. They are timely as the NHS is such a key part of the election.

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Mental health problems represent the largest single cause of disability in the UK. Mental illness accounts for 23% of the total burden of disease in the UK, yet only 13% of the NHS budget is allocated to it. One in four adults experience at least one diagnosable mental health problem in any given year. One in ten children aged 5 – 16 has a psychiatric disorder and children from low income families have three times the rate of those from the highest. The suicide rate is rising after many years of decline and the rise is most marked amongst middle aged men. For men aged 15 – 49, suicide is the leading cause of death. People with severe and enduring mental illness die on average 15 to 20 years earlier than other people. Three quarters of people with mental health problems receive no support at all and of those that do, too few have access to the full range of interventions recommended by the National Institute for Health and Care Excellence (NICE).

Following the publication in October 2014 of the document “Five Year Forward View” for the whole NHS, NHS England set up a Mental Health Taskforce in March 2015 to create a new five year all-age national strategy for mental health in England. It reported in February 2016 and its recommendations are to be implemented by 2020/2021.

The report, ‘The Five Year Forward View for Mental Health’ makes 57 recommendations, many of them far reaching which immediately brings into question their feasibility both in general and certainly within the time scale. Priorities include

  • a seven day NHS – there has always been a 24/7 assessment service for psychiatric emergencies, but the report recommends a greater availability of crisis/home treatment teams. This is good in its own right and is particularly geared towards avoiding admissions to a psychiatric hospital bed. However, beds have reduced in number by 39% between 1998 and 2012 and the UK has only 63% of the EU average, way below that of France (120%) and Germany (174%). The bed shortage puts a strain on the whole adult service. Detentions under the Mental Health Act continue to rise year on year. The shortage of clinicians makes expansion of the out of hours service unrealistic. Labour has opposed the ill-founded Tory 24/7 policy for the whole NHS.
  • integration of mental and physical health approaches – people with long-term physical illnesses suffer more complications if they have concurrent psychiatric disorder and costs go up by 45%. By 2020/21 at least half of all acute Trusts are to have liaison psychiatric availability to medical services including A&E.
  • prevention at key moments in life – while this is an admirable objective, there is little evidence to show that interventions can prevent mental disorder.
  • building mentally healthy communities – there is welcome acknowledgement of the need for decent housing and stable employment in maintaining good mental health and of the importance of wider social determinants.

Child and adolescent psychiatry is recognised as being particularly under-resourced. “At least 70,000 more children and young people should have access to high-quality mental health care when they need it” including timely access to psychological therapies. Crisis and home treatment teams for children and young people are to be developed – out of area placements for acute care should be reduced and eliminated as quickly as possible. However even for the most treatable difficulties such as panic disorder, 30% have not recovered at the end of treatment and for anorexia nervosa the figure is close to 50%. Treatment also has the potential for harm and one shouldn’t assume that access to a specialist professional is always the best way to address mental health problems. From the outset there needs to be a focus on what the young person wants and shared decision making. Empowering parents may be particularly effective and schools may have a key role in mental health promotion.

For adults there is to be a huge expansion in availability of psychological treatment including for those with psychosis, bipolar disorder and personality disorder. 600,000 people are to be treated, presumably over the five year period. There are recommendations for public mental health in relation to suicide prevention, primary care, perinatal psychiatry, rehabilitation and social psychiatry, old age psychiatry, addictions psychiatry and forensic psychiatry. There is to be a 10 year strategy for research.

The Five Year Forward View for Mental Health states that mental health must remain a priority in the current NHS financial climate and that £1 billion additional investment in mental health is needed. This has been accepted by NHS England. However, it is not clear how much of this has already been allocated in the £10 billion promised for the whole NHS. Currently spending per capita on mental health across clinical commission groups (CCGs) varies almost two fold. In 2011 the House of Commons Health Committee report on NHS Commissioning concluded that there had been “20 years of costly failure” in England in relation to the purchaser-provider split. Scotland opted out of this market in 2004. The Five Year Forward View for Mental Health mentions some of these commissioning problems. Future developments include amalgamating CCGs with clinical services thereby abolishing the purchaser provider split in a few areas with a more widespread emphasis on collaboration between services rather than competition as a means of driving improvement. Labour will promote this development towards a non-marketised NHS.

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One component of Labour’s 1997 campaign was the ‘pledge card’ – five succinct, specific pledges, detailed in the manifesto and circulated on a small card. The approach was deployed again in 2001 and 2005. Pledge card politics do not automatically equate to Blairism.

So what could a mental health pledge card at the next general election highlight? Here are some ideas:


The marketization of NHS and local government mental health services has left many areas with dis-integrated services, characterised by a wide array of organisations stoutly defending their boundaries and their bottom lines. As well as being a breeding ground for inefficiency and poor service user experience, this leads to continuous confusion for everyone involved in the sector, including GPs, voluntary organisations and carers. Instead we need an unambiguous commitment at leadership level for a shift towards seamless services, with commissioners and providers explicitly incentivised to redesign pathways that genuinely put service users at the heart of everything.


The mental health investment standard now needs to be given teeth, with government taking powers to sanction commissioners who fail to meet the standard. CAMHS is one area that would especially benefit from commissioners reading the parity memo. And parity cannot be restricted to the NHS – there is an urgent need for the disinvestment in local government mental health social care to be reversed and rectified.


As a nation, we are currently spending £34 billion a year on mental health services, when we know that the overall annual cost of mental ill health is about £105 billion. There is the business case for serious investment in an ongoing, high profile national mental health promotion campaign, in schools, workplaces and beyond, drawing on international best practice. Our aim should be nothing less than a fundamental and irreversible shift in mental health services towards prevention and recovery.


Nothing about us without us” needs to be wrestled out of the Lansley cliché archive and instead deployed in the spirit in which it was intended. What is the argument against every mental health provider board including an expert by experience? Is it time to improve and elevate the service user survey to something more similar to HCAHPs in the USA, where the combined weight of service user opinion is utilized to make real differences to funding?


Quality services rely on a skilled, consistent, well trained workforce. Far too much of the scarce mental health budget is going into the pockets of hedge fund backed agencies. The systematic cuts in real pay for staff have directly resulted in high vacancy rates and excess reliance on agencies in health and social care. Modern mental healthcare relies on effective team working, which is much harder to deliver when such a high proportion of the workforce is temporary. A fair pay deal would slash the agency bill in short time.

Dave Lee is a member of the Socialist Health Association and writes in a personal capacity.

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Mental health is simply health with mental features. Every GP deals with minor mental disorders every day and occasionally with serious mental disorder requiring referral to the specialist mental health services for serious depression, schizophrenia , dementia, substance abuse , the more crippling anxiety disorders and many other serious conditions.

Labour has a good record for mental health services, from the multiprofessional approach of 1975 on which our present services are based, to the late 1990s when mental health was the first priority. The Tories were very good at closing the asylums: but most of the profits went to their friends the property developers. As with the rest of the NHS, spending has not kept up with need, the extra money granted for mental health is being spent on general hospitals’ debts. Thatcher’s ‘reforms’ of the NHS, were particularly bad for mental health services, causing a separation of mental health Trusts from general medical services, making psychiatrists feel like the ‘alienists’ of the 19th century.

But hey, the future is bright at the forefront, isn’t it? Mental illness is now seen as a neuroscience problem, genomics is fashioning new ways of altering brain dysfunction, psychological treatments are scientifically based and focussed. Demographic change means more elderly: although most are healthier, the incidence of dementia rises with age. Austerity causes more depression, a reversal of the previously falling suicide rate and substance abuse. Cannabis and synthetic street drugs are lighting up those genetically prone to schizophrenia. Managerial interference, arbitrarily changing services without scientific evidence, is leading to disasters. The 2012 NHS and Social Care Act has laid the door wide open for services to be hived off to the private sector, costing more with less accountability. Managerial bed closures means patients are hospitalised hundreds of miles away, often in the private sector.

What is to be done? We had it nearly right in the late 90s. Hospital beds were provided near to where you lived . The front end of the specialist service was a mental health centre in your neighbourhood,.The multiprofessional teams were geographically organised, thus familiar with local social and economic factors. Seriously disabled patients were housed in fully staffed community homes, publicly provided.

What we must ensure is that our services are based on scientifically evidenced research, so NICE, the National Institute for Clinical Excellence, is important for mental health services.

The specialist services for our children has been left to deteriorate so that months can go by without a child receiving a referral, and this in an era when social media is so pathological to children. This is the most urgent funding claim to be settled.

Mental illness services for the elderly could benefit from greater integration into services for the elderly and frail. No-one now seems to know what to do in psychiatric emergencies, because that knowledge is not being publicised.

Our forensic services deal with mentally disordered offenders. Their standard is high, but they cannot cope with the increase in offenders sent to prison. There has been some involvement by the NHS, but prison is still another world in which the suicide rate is rising. Recent disasters have shown how the Police need more education into mental disorder and its emergency handling.

If you are severely mentally disabled, you should be entitled to the appropriate welfare, yet the attitude of the Tory government of thinly disguised discrimination against those in need is particularly harmful. Someone with schizophrenia cannot be assumed to ‘ just go online to find your benefit’. Disability assessment must be carried out by properly qualified personnel, working to standardised procedures.

In UK our legal framework around mental disorder is something to be proud of. It was the first to activate in a mental health case, Labour’s assimilation of the European Convention on Human Rights into all UK law. Human Rights still sadly needs to be fought for and defended.

The remedy is not just funding the NHS to the same level as other major European states, nor even returning the services to their previous standard, but also structural change, to rid the NHS of the artificial split between commissioners and providers. NHS England has recently ignored it, when implementing their Sustainability and Transformation Plans.



Samaritans released a report ahead of Wednesday’s Budget linking inequality with a higher risk of suicide calling on the government, businesses, industry and sector leaders to be aware of the risks of suicide and to direct support to those with unstable employment, insecure housing, low income or in areas of socioeconomic deprivation.

The report, Dying from Inequality, is far-reaching and highlights clear areas of risk to communities and individuals, including the closure and downsizing of businesses, those in manual, low-skilled employment, those facing unmanageable debt and those with poor housing conditions.

Suicide is an inequality issue that we have known about for some time. This report says that’s not right, it’s not fair and it’s got to change. Most importantly this report sets out, for the first time, what needs to happen to save lives. Addressing inequality would remove the barriers to help and support where they are needed most and reduce the need for that support in the first place. Government, public services, employers, service providers, communities, family and friends all have a role in making sure help is relevant and accessible when it matters most.

Everyone can feel overwhelmed at times in their life. People at risk of suicide may have employers, or they may seek help at job centres, or go to their GP. They may come into contact with national and local government agencies, perhaps on a daily basis. So, in the light of this report we are asking key people and organisations from across society, for example those working in housing, in businesses, medical staff, job centre managers, to all take action to make sure their service, their organisation, their community is doing all it can to promote mental health and prevent the tragedy of suicide.

Samaritans has already started addressing the inequalities driving people to suicide, by making its helpline number free to call, by calling on Government for more frontline staff to be trained in suicide prevention in England and by campaigning for local authorities to have effective suicide prevention plans in place. Now, in response to the findings of this report, the next steps will involve instigating working groups, in different sectors, bringing together businesses and charities who can influence in the areas highlighted, in order to tackle this issue in a collaborative, systematic and effective way to ensure that fewer people die by suicide.

Each suicide statistic is a person. The employee on a zero hour’s contract is somebody’s parent or child. A person at risk of losing their home may be a sibling or a friend. And each one of them will leave others devastated, and potentially more disadvantaged too, if they take their own life. This is a call for us as individuals to care more and for organisations that can make a difference, to do so.

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There are many of us who might suffer from some sort of mental health issues to a varying degree and there are still plenty of aspects we don’t really understand, although we are now in a climate of improved awareness.

This means that there are more self-help options available now than ever before, including some mobile methods that can soothe you wherever and whenever you need it.

Here is a look at some useful apps, including one that taps into the benefits of CBT and a childhood activity that is proving popular with stressed-out adults. There is also an overview of an app that works on improving your sleep patterns plus details of an anxiety management option to download on your smartphone.

Accessible therapy

Some mental health issues are more complex than others and might require some professional intervention as part of your healing process, but there are some apps that can help you to cope with things like depression, anxiety disorders and other issues that you might be trying to contend with.

A method of treatment that has come to the forefront in recent years is cognitive behavioral therapy (CBT) and there are some apps like MoodKit which aim to cover most of the bases surrounding the general concepts of CBT.

You can use the app in conjunction with working alongside a therapist and it teaches you self-monitoring and encourages you to engage in mood-enhancing activities.

Coloring can make you happy

There has also been a real surge in popularity for adult coloring books and it is perfectly understandable when you start to list some of the health and psychological benefits attached to this activity.

If you think back to your childhood you will most likely have some happy thoughts of time spent drawing and coloring your favorite characters and pictures, and you can tap into these positive emotions by returning to this popular pastime.

You can even get a coloring book app on Google Play so that you can improve your mood with an activity that has been used to help with anxiety and other stress-related disorders.

A good sleep is always important

You can’t really expect to function at 100% when you are not enjoying a regular and restful sleep pattern.

To combat this problem there is an app called Sleep that aims to help you improve your sleeping patterns. It uses a combination of CBT methods together with some other customizable programs and even has a virtual sleep expert to consult when you need some pointers on how to get the sleep you need each night.

SAM can help with anxiety management

SAM is the acronym for self-help anxiety management and this is an app that is designed to help anyone suffering from anxiety.

You can self-evaluate your current mood and level of anxiety using this app, and SAM is an app aimed at trying to help you look at things more calmly and patiently, working through any issues in baby steps rather than giant leaps. You should also see progress being made as it records where you are at on the road to recovery.

If you want to improve your mental health issues and work your way through some specifics, there is bound to be an app that can help you with that.

Harvey Woods is a therapist who writes about self-care and managing our feelings and thoughts in today’s fast-paced world where stress is the norm.

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The psychological impact of a break-in

Home break-ins can have an extreme physical and psychological impact on us. That’s why many of us take a steps to prevent intruders from entering our homes: from investing in security doors to installing alarm systems and CCTV cameras, there are many things we can do to protect your property. But, if the worst should happen, what can an invasion of privacy do to your mind?

Feelings of contamination and violation

The thought of a stranger rummaging through personal and private belongings can leave victims feeling contaminated and violated. In fact, it’s not uncommon for victims to dispose of their possessions in a bid to cleanse their house following an intrusion.

Those burgled also tend to feel extremely vulnerable, particularly if they don’t know who entered their home without permission or how they did it.  In turn, this can lead to paranoia, suspicion, false accusations and just a general sense of unease with everyone, including close friends, family members and neighbours.

A persistent sense of fear

A person ought to feel safe in their own home, but those who have experienced a burglary are often plagued by a persistent sense of fear they can’t shake off. While leaving home makes them worry that another break-in might occur, staying in alone (particularly overnight) can lead to severe anxiety. In fact, if the criminals are not caught, feelings of fear can be more extreme as a new offence could be committed at any time.

Symptoms of post-traumatic stress disorder

While post-traumatic stress disorder is most-commonly associated with those who’ve experienced warfare, it can also affect anyone who’s been through an emotionally turmoil experience – including robbery. Symptoms of PTSD typically include: flashbacks, nightmares, repetitive and distressing images or sensations and physical sensations such as pain, sweating, nausea and trembling. Some people even feel extreme guilt and repeatedly question if there’s anything they could have done to have stopped the burglary from happening. This relentless questioning often hinders the mental healing process and makes the whole recovery period longer.

Symptoms caused by a lack of sleep

Being the victim of a burglary can have many psychological affects including the inability to get a good night’s sleep. Unfortunately, insomnia causes profound psychological affects and can lead to a short attention span and even mania including psychosis, hallucinations and aggression. Of course, not sleeping can also make you feel generally unwell which will certainly impact your daily life.

Thieves rarely think about the psychological impact their actions will have on individuals, however, it’s clear that many people do not cope well following a break-in. If you’ve been a victim of burglary, you can find support here.

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