Current provision of mental health services – new data

Earlier this month, the NHS Benchmarking Network published its report on mental health service provision in England and Wales. In the absence of official data about the performance of these vital services, the report provides some significant insights into both inpatient and community services for both adults and children.

The report is available at http://www.nhsbenchmarking.nhs.uk/CubeCore/.uploads/PressReleaseMentalHealthBenchmarking201413112014.pdf

The Benchmarking Network brings together data collected from all NHS mental health trusts in England and all local health boards in Wales. It provides information about levels of activity, about use of their services and about the people they employ. In doing so, it paints a picture of services working under pressure and finding ways of managing in difficult circumstances.

For working age adults, the survey finds that on average mental health trusts had 5% fewer beds in 2013/14 than they did the previous year. But hospital admissions remained unchanged from the year before (at 232 per 100,000 population) and lengths of stay rose slightly (to an average of 32 days).

The report suggests that this was achieved by increasing levels of bed occupancy, from an average of 89% to 93%. By contrast, safe practice standards suggest occupancy rates should be about 85%. The report also found a worrying rise in the number of reported incidents of restraint and of violence but a fall in the use of seclusion, with wide variations between trusts in all of these.

Demand on community mental health services for adults is also rising, particularly for crisis resolution services, which increased by 5%. In just under three-quarters of cases, teams responded within four hours to calls for help.

The report examined early intervention in psychosis services, soon to be the subject of new waiting time standards. It found big variations in waiting times, from between one and six weeks for routine referrals, with an average just above the new standard of two weeks. The maximum waiting time for each services was an average of nine weeks. This suggests that investment will be required to ensure these services can meet the new standards when they are introduced next year.

The report also looked at the balance of care between community and inpatient services. It found that 89% of care is provided in the community, yet community services have just 62% of the workforce and 54% of the money allocated to mental health services.

The greatest pressures of all, however, appear to be facing child and adolescent mental health services (CAMHS). Here, the report found that both activity levels and staffing for community services rose in 2013/14 compared with the year before, despite extensively reported budget cuts. But maximum waiting times for access to community CAMHS are rising, from an average of 15 weeks to 16 for a routine assessment.

In all, the report demonstrates ways in which mental health services are managing with rising demand and diminishing resources. But it also shows wide variations from one area to another in how quickly people get seen and what they experience. And it demonstrates the continued need to refocus on earlier intervention and supporting personal recovery.

Parliament Week reflections

alec_williamsAlec Williams

This year, Parliament Week aimed to encourage young people to become more involved in politics. The three meetings we set up between young people and the MPs provided a good opportunity for doing just that – they presented the setting for young people to learn more about the political system, the platform to discuss mental health and politics with an MP and ultimately, the opportunity for their voices to be heard.

The young people looked to explore the following questions:

  1. what are the attitudes of young people towards mental health?
  2. What support are young people currently getting with regards to mental health?
  3. And, what could any aspiring Government be doing to improve this?

What all three groups were in agreement about – MPs and young people alike – is that currently, there is nowhere near enough mental health and emotional wellbeing support for young people. So what needs to change? A good place to start is schools. The MPs and young people agreed that this is where young people should (a) receive the necessary mental health support from counselling, peer mentor groups and other various outreach projects and (b) be educated and develop their understanding and attitudes towards mental health. The format for the latter is PSHE (a programme for personal, social and health education), and provides the focus for Amber and Sophia’s ‘Stop it before i starts’ campaign, which aims to have PSHE placed on the National Curriculum.

This idea is gaining momentum – a Private Members Bill from Caroline Lucas MP supporting statutory PSHE lessons is currently going through Parliament and just this week the Government has announced a new schools-based initiative to address the crisis in mental health support for young people. Statutory mental health and emotional wellbeing lessons within PSHE would capture the importance of educating the next generation about mental health. But in taking this important step, new hurdles would appear. As Frankie and Amira pointed out, the current framework for mental health and emotional wellbeing lessons within PSHE is somewhat ineffective and would need to be revised and developed for this step to be successful.

One topic all groups were ready to discuss was the stigma associated with mental health. This was something that the young people and MPs were not only all very aware of, but could relate to within their own social and professional circles. In June 2012, four MPs stood before the House of Commons and made the personal political by challenging stigma and revealing their mental health issues. Yet despite this, our three MPs confirmed that mental health stigma is still very prevalent in Parliament.

Likewise, the young people highlighted the stigma that surrounds mental health in their schools and the difficulty this creates for young people in speaking out. In contrast, though, the three sets of young people spoke with an openness and frankness about their mental health history which was particularly inspiring. Glenda was right to highlight the difficulty in reversing the issue of stigma – it is deeply entrenched within the nation’s psyche and it will take a long time to see a complete shift in public attitudes. That being said, much work is being done to rectify this and as our Parliament Week experience has highlighted, there is a younger generation coming through who are aware of mental health and responding appropriately.

From reading the blogs, it seems that the three groups of young people are more determined than ever to make a difference to mental health as a result of this process and that the MPs listened carefully to their opinions. It is up to this generation of young people and the forthcoming governments to continue to foster positive public attitudes towards mental health and work to provide better support for young people. With young people like Yara, Frankie, Amira, Sophia and Amber, their half of the bargain seems to be in good hands. And hopefully, as Glenda Jackson pointed out, future governments will listen to their voices and develop methods for providing them with better mental health support.

A big thank you to all the young people and MPs for taking part in this project.

Frankie and Amira meet Glenda Jackson MP

glenda_frankie_amiraOn the 4th of November, we and the Gloucestershire participation group travelled to London to meet MP Glenda Jackson to discuss what the government should be doing to support young people with mental health issues. We set off early on the train and discussed our pre-made notes and questions for Glenda.

Once we arrived into Paddington we got straight on the tube and straight to Portcullis house to meet Alec. We met Glenda in reception and got mildly told off for being slightly late (due to train delays). We met in the canteen of Portcullis house and started to talk to get to know each other and how this opportunity had come about. We explained about the participation group and how it has benefited us both.

Next we all spoke about some of the points from the notes we had both made prior to the meeting, about referrals and waiting times for assessment and Glenda explained that there wasn’t much she could do about this as it is simply funding and the main governments cuts that makes this one of the areas to be affected. We also bought up the issue of inpatient care and how it was grossly underfunded and how young people in crisis were being turned away from the care that they needed. Glenda explained that this was the same issue as referrals and assessment times concerning money and local budget cuts.

The next topic was raising the stigma of mental health and how we could all go about trying to do this, Glenda explained that this isn’t just a new issue, and this has been an ongoing issue since the start of time, and really there wasn’t anything that we could do except start at the beginning of the problem with educating people about the issues that surround mental health.

I bought up the issues of schools and them not educating young people about mental health including self-harm long/short term issues and ways of coping with difficult thoughts also educating young people on why people get mental health issues and explaining about chemicals and help and support. People go into schools and talk to young people about drugs and alcohol even STI’s and safe sex, but never mental health. I explained that I had planned a project to get a team together to go into schools and educate young people (years 7, 8 & 9) on mental health to reduce the stigma in primary and secondary schools. Glenda liked the sound of this project and has since called my mum to discuss this, also she sent us a package including the third CAMHS report of the mental health committee, to help with the project. We are now planning the lessons and project outline to take to our local MP, Jeffery Clifton Brown.

Once we had finished our conversation, we went outside to the member’s garden and had our photo taken with Glenda and Amira took a selfie with her! We then left Portcullis house and got back on the tube to see the poppies outside the tower of London where we sat and ate our lunch. Then we got the train home.

This was an absolute honour to meet Glenda Jackson and discuss our issues with the support network of mental health, and explain our new plans for future improvements. And all in all, it was a very positive, enjoyable day.

Amber and Sophia meet Jeremy Corbyn MP

Amber-SophiaAmber and Sophia

On the November 3rd, we were invited to Portcullis House to discuss our campaign on Making Mental Health Awareness compulsory on the National Curriculum with the Labour MP Jeremy Corbyn.

Sophia, having suffered from Anorexia Nervosa in the past, alongside Amber who had to learn how to deal both with Sophia’s illness and her personal despair at the situation, wanted to hear his opinions on what we can do to change “ the Dark Ages of Mental Health”.

Although we had already spoken with a number of MPs and given speeches both on BBC radio and Channel 4 News in addition to the House of Lords, this meeting was equally valuable in pushing our campaign further. We learnt more on what we can do on the political side of our campaign to promote the cause, such as creating an Early Day Motion in order to raise awareness within parliament on what we are trying to do.

Moreover, during a casual discussion on our University applications, the topic of stress at top universities arose and the number of stress-related mental health problems that often proceed as a consequence. This made us even more determined to promote education on mental health awareness so we can enable young people to become resilient and also prepared for the every-day stresses that will arise during adolescent years. We also discussed how more funding is required in Mental Health Services, as many are not fortunate enough to either be near NHS services or be able to fund the cost of private treatment. The conversation we had was not only thought provoking but gave us plenty of ideas to work on for the future.

If you would like to support our campaign please click on this link and sign our petition!(http://epetitions.direct.gov.uk/petitions/59244) Or if you would like to know what you can do to get involved, please don’t hesitate to contact us on either of these two email addresses: soppar00@highgateschool.org.uk or ambvan00@highgateschool.org.uk.

Thank you so much to the Centre for Mental Health for this opportunity to meet Mr Corbyn and thank you to the man himself, for inspiring us to continue in our pursuit of good mental health. As Gordon Smith once said: “We take our kids for physical vaccinations, dental exams, eye check-ups. When do we think to take our son or daughter for a mental health check-up?”

 

Jeremy Corbyn MPjeremy_corbyn

I always enjoy meeting students, and meeting Amber and Sophia from Highgate Wood only confirmed this.

These two very interesting students from Highgate Wood School visited me at the House of Commons as part of Parliament Week. It was a memorable visit and the students also spent some time talking to my assistant about the tools of parliament including EDMs and Parliamentary Questions. It was immediately obvious from the outset that Sophia and Amber are clearly two very impressive individuals with a mission to enlighten us all to the fact that Mental Health can affect any one of us and importantly, that we can, and do recover from it in its many guises. Their ‘Stop It Before It Starts’ campaign was particularly commendable and highlights the importance of providing better support to young people at schools regarding mental health.

Hopefully these young women went away better informed on the workings of parliament than when they arrived. It is also quite significant that their friendship, and Amber’s concern for Sophia when she was suffering very badly with Anorexia Nervosa brought them to a better understanding of mental illness, and indeed the determination to learn more about solutions and treatments and what part the political process plays in such things. There is still so much to do around mental illness, and there is much stigma associated with it, often stemming from ignorance. Eating disorders in particular often bring a lot of shame to the sufferer and it is time this needs to be dispelled before we can begin to progress. We must keep our NHS safe and buoyant, and ensure that this very important area gets the priority it deserves in the process.

Yara Al Tuhafi meets James Morris MP

Yara Al TuhafiYara_Al_Tuhafi

My name is Yara Al-Tuhafi. At the start of November, I met James Morris MP to discuss young people’s involvement in politics, as well as mental health and politics.

I thought James Morris felt passionate about the involvement of young people in politics and was able to explain to me how he himself has engaged with young people in schools and outreach projects which I feel is very important for the future of our government. Creating a relationship with young people allows the government to build a stronger foundation to be able to address the needs of this country’s younger generation who hold a large percentage of votes and have the potential to influence politics immensely.

On the area of mental health, I felt that we were able to discuss a range of issues that need to be further addressed. Some of these issues included stigma and stereotypes surrounding mental health, today’s welfare system for people who are in need of support due to mental ill health, as well as a lack of education on this subject.

James Morris informed me how the government is working towards improving these issues, but it’s important to understand that this will never be a short process.

Personally, I’m extremely passionate about mental health as I am a young person battling such issues. I feel it is key that there is a change in the country’s perception of the issue. I am confident that there will be an improvement in education, awareness and support surrounding mental health in the near future so long as MPs like James Morris continue to engage with people of both younger and older generations.

Overall, I’m grateful for being given the opportunity to not only speak to James Morris, but to also be heard. I’m hopeful that this level of engagement with MPs will continue for other young people.

 

James_Morris_MPJames Morris MP

I joined the All Party Parliamentary Group for Mental Health in 2010, soon after I was elected to represent Halesowen & Rowley Regis in the West Midlands. Mental health is an important issue that affects as all – as individuals, within families and as a society.

Since joining the APPG, and particularly since becoming the Group’s chairman 18 months ago, I have been very fortunate to meet with a wide range of groups who are involved in mental health all over the country. Some of the most interesting conversations that I have had have been with young people like Yara, and these conversations remind us how important it is that we ensure child and adolescent mental health services are up to the job of looking after and treating young people facing mental health problems.

Yara is typical of young people that I come into contact with – eloquent, passionate about what she believes in and eager to engage with politics. I don’t recognise the charge that young people are apathetic about politics. From discussions I have had with students in my constituency I find them to be interested in the world around them and about how they can make a difference in that world. We as politicians must get better at listening to them and making sure that they have opportunities to express their views and that is why I was very happy to meet to discuss these issues with Yara.

The current Child and Adolescent Mental Health Service (CAMHS) is under a lot of pressure and is having to deal with an increased prevalence of mental health problems among young people. CAMHS is not working as well as it should for the people it should be helping and I believe that the Service needs to be closely looked at and reforms implemented where required.

But pressure is not just being felt by front line health care services. Schools in particular are having to deal increasingly with students who require help either to deal with issues they are facing at home, through the increased use of social networking and cyber bullying or through pressures to look or act in a certain way. Teachers that I speak to in my own constituency tell me that more and more pupils are coming to them to talk about these problems.

Schools have an incredibly important role to play in the prevention and early detection of mental health problems. And I believe that it’s crucial that they are given the support that they need and that teachers know where they can go when a pupil needs more help than they school can give. School counselling is enormously important and can often prevent problems from escalating, but sometimes outside help is needed. That is why I want to make sure that the Government commitment to 18 week access to psychological therapies is followed through, so that teachers, GPs and parents can be confident that young people will be seen by a professional therapist when they need that help.

Parliament Week

alec_williamsParliament Week (14-20 November) is an annual programme of events that aims to connect people with parliamentary democracy in the UK. This year, Parliament Week has set up a campaign called ‘Do Democracy’ which focuses on young people and their engagement in politics. In keeping with this theme, the Centre for Mental Health set up a project centred on the exciting opportunity for young people to meet with MPs to discuss mental health.

The MPs and the young people met on the 3rd and 4th of November at Portcullis House, London and were then asked to reflect on this experience in a blog which we will release on each day of Parliament Week.

The meetings were between:

1. Amber, Sophia and Labour MP Jeremy Corbyn. Amber and Sophia are two young people (17) attending Highgate School. Sophia suffered from Anorexia Nervosa and Amber, her best friend, felt disheartened by the lack of support she could offer due to her lack of knowledge regarding the issue. Over the past 18 months they have set up and campaigned for ‘Stop It Before It Starts’ – a campaign that aims to have Mental Health and Emotional Wellbeing placed on to the National Curriculum. Please find their petition at: http://epetitions.direct.gov.uk/petitions/59244

2. Yara Al-Tuhafi and Conservative MP James Morris. Yara is a young person (18) from South London. Yara is associated with the Who Cares Trust – an organisation that supports young people in care. Yara has had long-standing interest in mental health due to her own life experiences and is especially interested in the stigma associated with mental health.

3. Frankie Hopkins, Amira Nandhla and Labour MP Glenda Jackson. Frankie (16) and Amira (13) are two young people from Gloucestershire associated with Action for Children. Frankie and Amira both have personal experiences of mental health issues and have long been interested in how young people could get better mental health support – they were very keen to discuss this with Glenda.

This project provided a brilliant opportunity for young people to have their voices heard and hopefully the blogs will provide inspiration for more young people to continue the conversation about mental health – we hope you enjoy reading them!

Alec Williams

Children’s mental health: the Commons Health Committee Report

seandugganby Sean Duggan

The House of Commons Health Select Committee has today reported on mental health support for children and adolescents and found the whole system wanting in many vital respects.

The Committee’s report, Children’s and Adolescents’ Mental Health and CAMHS, finds “serious and deeply ingrained problems with the commissioning and provision of children’s and adolescents’ mental health services” at all levels, from early intervention to specialised services.

It finds that provision of services at all levels is patchy from one area to another, and that information about levels of need and how well they are met is poor. It speaks of schools where teachers are ‘scared’ to discuss mental health with students and where how to promote children’s safety online is poorly understood. It unearths evidence of children being turned away from services or made to wait for weeks and months when they or their parents seek help, and it raises continued concerns about children being taken to police cells in a crisis.

The report reflects growing evidence about pressures on child and adolescent mental health services and serious shortcomings in the way the NHS, local authorities and schools meet young people’s mental health needs. Its warnings must be heeded as a matter of urgency and lead to concerted action across the whole system to make major improvements in the level and quality of support for children’s mental health.

There is growing evidence that investing in children’s mental health is both essential to their future and excellent value for public money. Better mental health support for women during and after pregnancy can cut some of the £8 billion annual cost of perinatal mental health problems. Targeted access to parenting programmes for families whose children have severe behavioural problems can dramatically improve a child’s future prospects and generate savings to a range of public sector budgets. And schools that take a ‘whole school approach’ to mental health – offering teaching about mental health and wellbeing, tackling bullying and supporting children when difficulties emerge – can also benefit considerably in terms of improve attainment and behaviour.

Improving children’s mental health requires leadership at all levels – from the Department of Health, NHS England and the Department for Education to local Health and Wellbeing Boards, clinical commissioning groups and every school in England. We need better data about levels of need and we need to hold commissioners accountable for meeting them. But we also need a new form of leadership that seeks to engage children and young people in designing and delivering mental health support that meets their needs, speaks their language and offers them helpful support to recover on their own terms.

No child or young person, of any age, should be turned away when they seek help for their mental health. No child should be made to wait unacceptably long times for treatment they need, especially in a crisis. And no one should be left on a ‘cliff edge’ at the age of 18 when children’s services stop working with them.

Today’s report is a wake-up call for government, for CCGs, for local councils and for schools to make children’s mental health the priority it deserves to be and to act now.