More funding for mental health

AndyBellby Andy Bell

In his 2015 Budget speech, the Chancellor of the Exchequer announced an extra £1.25 billion investment over five years for improvements in mental health support for children, for women during and after pregnancy, for people who are out of work or at risk of losing their jobs, and for service personnel and veterans.

This is welcome news for services that have faced numerous cuts and budget freezes and which are currently meeting only a fraction of the need for support. It recognises the particular importance of children’s mental health – and that of their parents – and the lifelong shadow that poor mental health can cast over a child’s future.

Broken down across the country over five years, it has already been noted that the funding announced today is equivalent to just over £1 million per clinical commissioning group (CCG) area each year. Whether this will be sufficient to meet the levels of need that exist is a matter for debate.

What is harder to contest is the importance of investing in the mental health of children and their parents, and the benefits of doing so. Recently published evidence points to the yawning gaps between levels of need and levels of current provision, and equally to the need for radical changes to the way services are designed and work.

The Government’s taskforce report on children’s mental health, Future in Mind, set out a wide range of changes that would be needed to offer support that children and young people would find helpful, accessible and engaging. And our report, Investing in children’s mental health, showed the scale of social and economic benefits that can arise from a range of effective interventions for depression, anxiety and conduct disorder as well as school-based anti-bullying programmes and social and emotional learning.

Recent reports on the mental health of women during pregnancy and in the year after giving birth, meanwhile, have shown the costs of failing to offer the right help at the right time and the need to create more opportunities for women to disclose distress in a way that feels safe for them and that gets them access to support without delay. Falling through the gaps, published today with the Royal College of GPs, showed the importance of raising awareness among family doctors as well as midwives and Health Visitors about the signs of distress and the actions to take when they are asked for help. It also noted the importance of targeted action to battle the stigma and fear that prevent many women from asking for help when they need it.

Today’s announcement should help to fill some of the gaps in mental health support for children and parents. It is important to note, of course, that people of all ages and from all backgrounds can experience mental ill health and only a minority of any age group get the support they need. There is never a wrong time to ask for help and it is vital that all health professionals are able to respond appropriately when someone seeks support, and that access to care is improved across the board.

It is now up to every CCG, every local authority and every school to look at how far they are meeting the mental health needs of the people they serve and what they can do to enhance it. The evidence of the scale of need and the benefits of intervention are so overwhelming that no local area can afford to do nothing, nor wait for additional funding to appear to take action that is required without delay.

The case for reinvesting in mental health is overwhelming. Failing to do so can no longer remain unchallenged.

Prevention is the best cure – mental health equality matters

Edward Davie, Councillor in Lambeth, South London

Recently I had the privilege of speaking at the Local Government Association’s annual public health conference in support of the Local Authority Mental Health Challenge.

Fellow Lambeth councillor Jacqui Dyer and I were introduced by the Centre for Mental Health’s Andy Bell who has worked so hard to support councillors like us.

It was great to have a receptive audience because trying to convince sceptics of the value of investing time, energy and money in mental health can be a real struggle. I get the impression that, even now, a lot of people think all mental illness is inevitable, untreatable and just not worth the effort. Whilst they can grasp the link between helping people to stop smoking and thereby reducing the risk of lung cancer they cannot conceive of things we can all do to help people stay mentally healthy. So it was heartening to be reminded of Andy’s new four-point, mental health mantra based on the evidence: ‘Prevention is possible; early intervention works; recovery is achievable; equality matters.’

Those were the tenets behind our work in Lambeth to improve mental health with our black residents which Jacqui and I talked about at the LGA conference. ‘Equality matters’ does not mean everyone is the same, or that the same things work equally well for everyone. It means recognising that, for many reasons, not everyone starts in the same place or needs the same kind of support in order to get an equal chance to succeed. What could be a starker illustration of this than the fact that African and black Caribbean people make up 25% of Lambeth’s general population but 70% of our residents in secure psychiatric settings? Our commission to address this inequality focused on working with residents to improve prevention, ensuring appropriate early intervention and supporting recovery through better patient experience.

We found that prevention really is the best cure and it is also the most humane and cost effective action any of us can take. To that end we recommended parenting programmes to give children the best start in life; ensuring all of our schools teach their pupils resilience and an intensification of efforts to tackle poverty, abuse and neglect. Parenting programmes have been shown to save up to £200 per £1 invested and social and emotional education saves £84 per £1 spent on it. No accountant has been able to show me a better investment as councils face the ‘graph of doom’ showing rising demand and falling revenue.

It is coming up to six months since we launched our commission report last World Mental Health Day and whilst it is relatively easy to come up with a glossy report it is much, much harder to implement the recommendations. We have been helped by a committed health and wellbeing board who commissioned the original work and who have accepted all of our findings. Public health colleagues are drawing up a list of actions that have been taken or that are outstanding and national charitable trust funds are showing great interest in supporting implementation and evaluation of the changes we are making.

In our borough and nationally there is now a real chance to influence the way mental health is thought about. We have to work together to support all of our residents get the chance to enjoy better mental health enabling them to fulfil their potential and take a full part in our communities.

2015: a year of opportunity for mental health?

AndyBellby Andy Bell

Mental health issues received unprecedented levels of media and political attention last year. Calls for fair treatment and better care were louder and stronger than ever, from the centre of government to town halls, social media, television and newspapers. Yet at the same time evidence mounted of growing pressure from all directions on people living with mental health problems and of cuts to vital services.

As we begin 2015, the thirtieth year of Centre for Mental Health’s work, there are signs of both great hope and great anxiety for the near future: of opportunities to build on the progress we have made and of fears that people’s lives will be made harder, poorer and shorter because of a lack of support and understanding.

In planning guidance published at the very end of 2014, NHS England set out its expectation that next year clinical commissioning groups will secure real terms increases in mental health care funding, reversing the cuts we have seen in the last three years. And from April, for the first time the NHS will have specific waiting time standards for two areas of mental health care: Improving Access to Psychological Therapies (IAPT) services for adults and Early Intervention in Psychosis services for young people.

These are, of course, only starting points to turning around a health care system described by care services minister Norman Lamb MP as having an ‘institutional bias’ against mental health. To truly secure ‘equal care for equal need’ for people with mental health problems, the NHS will have to change in many more ways, sustaining extra investment in mental health support and offering each person care and help tailored to their needs and goals. It will need to address the current postcode lottery in the availability of cost-effective, evidence-based interventions such as supported employment. And it will need a payment system that reflects what people want from the NHS, not one which reinforces the current disparity between mental and physical health and rewards activity rather than impact.

Despite the pressures on mental health services, many are innovating and making changes that encourage earlier intervention and support personal recovery. There are now more than 30 Recovery Colleges in mental health services across the UK; more peer support workers are being recruited; and the physical health of people using mental health services is beginning to be taken more seriously by health professionals.

Beyond the NHS, understanding about mental health in society is growing. More and more schools are now recognising the importance of mental health to children’s attainment and future life chances. But mental health support in schools remains patchy and emotional wellbeing is the least taught topic on the PSHE curriculum.

More employers (large and small) are taking the mental health of their workforce seriously. But this is far from being the norm and NHS organisations have been slower than most to support the mental health of their staff. And too many people with mental health problems are getting inadequate help to get or keep paid work despite its importance to recovery for so many. For some, benefit sanctions and conditions have got in the way of finding work and keeping well.

Nonetheless, the year ahead will bring opportunities to make change for the better. People living with mental health problems have a bigger, stronger voice in public debate than ever before, largely through social media. Translating lived experience and knowledge into commissioning and policy development is a vital next step to ensure that mental health services can no longer be planned and delivered without the equal participation of the people they are supposed to help.

In public services, opportunities to improve will come with the limitation of ever-tightening finances. Local councils are subject to particularly tough funding pressures, yet many have found ways to promote better mental health, for example through their public health powers, local partnerships and the work of ‘member champions’.

The biggest opportunity of all, however, is to keep lifting our sights further – to raise our expectations of what we can do and should expect, and no longer to accept the disparities we still see every day as facts of life.

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.