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World Mental Health Day 2018

October 10, 2018 17 comments

It has been a few months since my last post on mental health and it seems right to post today, to mark World Mental Health Day (WMHD). This day has been celebrated – if that is the correct word – since 1992, and is co-ordinated by the World Federation for Mental Health (WFMH). This year’s theme is ‘Young People and Mental Health in a Changing World’ – you may have seen the logo:

On their website, the WFMH explain the reasons for this choice of theme:

“Imagine growing up in our world today. Constantly battling the effects of human rights violations, wars and violence in the home, schools and businesses. Young people are spending most of their day on the internet – experiencing cyber crimes, cyber bullying, and playing violent video games. Suicide and substance abuse numbers have been steadily rising, LGBTQ youth are feeling alone and persecuted for being true to themselves and young adults are at the age when serious mental illnesses can occur and yet they are taught little to nothing about mental illness and wellbeing…..We want to bring attention to the issues our youth and young adults are facing in our world today and begin the conversation around what they need in order to grow up healthy, happy and resilient.”

Here in the UK the Education Policy Institute (EPI) published the results of its recent survey at the weekend, and although news coverage didn’t mention its relevance to the WMHD theme I don’t think the timing was a coincidence. The EPI undertook Freedom of Information requests from 60 providers of Child and Adolescent Mental Health Services (CAMHS) and from local authorities, and received 54 provider responses, so I think it safe to describe the study as comprehensive. Their headline finding is that referrals to CAMHS have increased by 26% over the past five years. Based on data from 50 of the respondents there were more than 264,000 referrals of under-18s in 2017/18. Having worked a lot with our CAMH services during my years in the NHS I find this figure horrifying: the service was already overrun with referrals, and is now under even more pressure. And we should never lose sight of the fact that every single one of these referrals represents a child (or children) and family which is being torn apart by their problems. It’s heartbreaking.

There is a good report on the study here on the BBC’s website: it makes for interesting reading. Interesting, but very scary and worrying. Some 27 local authorities (out of 111) reported that they had ceased to provide services for the mental health and wellbeing of children and young people in the past eight years. Over and above the loss of those related services, far too many – more than 20% – of provider referrals were refused treatment as not meeting required criteria. In effect, the children and young people weren’t considered sufficiently unwell!

The BBC report quotes the official Department of Health position: “We are transforming mental health services for children and young people with an additional £1.4bn and are on track to ensure that 70,000 more children a year have specialist mental health care by 2020-21.

“We are improving access to mental health services through schools with a brand new dedicated workforce, as well as piloting a four-week waiting time standard in some areas, so we can better understand how to reduce waiting times.

“We are completely committed to achieving parity between physical and mental health as part of our long-term plan for the NHS, backed by an additional £20.5bn of funding per year by 2023-24.”

This is being followed up by a speech today by the Prime Minister, in which she is fleshing out some of these commitments. For the first time we are to have a minister with specific responsibility for suicide prevention, and £1.8m is to be provided to the Samaritans to enable them to continue their helpline for four years. For children and young people, the government is promising more support in schools, bringing in new mental health support teams and offering help in measuring students’ health, including their mental wellbeing. There will also be a new annual progress report each year on WMHD. This is all being announced at a global summit on mental health being held in London, attended by representatives from around fifty countries. I wonder what, if anything apart from the usual platitudes, will come out of this, and what the composition of that attendance is – does it, for example, include large countries who are really in a position to make a difference? We can but hope so.

Of course, any government initiatives on mental health are welcome, but please forgive me for being a little cynical about this: the government has been making noises about improving mental health services – both for children and adults – for quite a while now. But, as I covered in my piece Mental Health Matters in September 2016, there doesn’t seem to be any certainty of service commissioners making this additional funding available to the providers for whom it is intended. To date, there has been a lack of joined up thinking about mental health treatment, and drastic changes are needed. And then there is the question of whether this funding exists at all. Remember that Vote Leave promise of making an extra £350m per week available for the NHS if we left the EU? Well, the latest official figures suggest that, rather than making that saving, Brexit is actually losing us more than £500m per week, and that is before we even jump off the cliff! And we also need to consider the haemorrhage of staff the NHS is already suffering pre-Brexit, a position which doesn’t seem likely to improve if the government continues to bury its head in the sand over the disastrous effects of losing freedom of movement across the EU. Even if that funding were somehow to materialise from some magic money tree – which I very much doubt – where are all these new specialist staff going to come from? Even if the money was already being provided – which it isn’t – there is no way that all of the specialist staff required could be recruited and trained in time to meet the government’s stated aim. In short: it’s as valid as a promise to give us all a pet unicorn.

Sadly, I fear that this is all a very long way short of what the WFMH describes in its objectives for this year’s WMHD. The figures I have quoted relate to the more serious cases which require specialist treatment, but there are far greater numbers of young people who are affected by the issues set out in the WMHF statement: how are they going to get the help they need in current circumstances? So much needs to be done, but do we have the resources and the desire to make this happen? I’d love to be proved wrong, but I’m not sure that we do. Of course, I know there are no easy answers to this, but I hope today will be a starting point for us to review our priorities as a society. If we don’t give our children and young people the best possible start in life we are failing them. I hope the Government has the will, money and resources to deliver on today’s announcement. It will be interesting to see how much they will have achieved by the time their first annual report comes round next 10 October, and whether they will have done enough to confound my doubts.

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A Political Football

November 23, 2016 9 comments

A couple of months ago I wrote in my post Mental Health Matters about the way the Clinical Commissioning Groups (CCGs) were diverting the ring-fenced funding they had been given for mental health services into other treatments, against the express instruction of the government. To date, this post has received 38 ‘likes,’ the most for any of my posts, so this must have struck a chord with many people. Just for clarification, I’m using the phrase ‘many people’ in its true sense, not in the way Donald Trump uses it to tell the UK government that it should appoint a racist buffoon as its US Ambassador.

But I digress (it was too easy a target!). Last Friday The Times newspaper ran a front page story headed ‘Nine health secretaries attack government for failing mentally ill.’ The piece related to this letter which the paper carried on the same day:

Copyright Times Newspapers

Copyright Times Newspapers

It refers to this as ‘an unprecedented intervention,’ coming, as it did, from former Secretaries of State for Health from across the UK political spectrum. It goes on to say “the decision…to speak out reflects wider concern that people with mental illnesses are neglected in a way that would never be accepted for patients with cancer or other physical conditions.” I agree wholeheartedly with this, but nevertheless this letter causes me serious concern. Not so much in the letter itself which, taken at face value, is fine, but more in the motivation of those who signed it. In effect, the letter is challenging the government to deliver on promises made – it is making a political statement in a political game, and is using mental health as the football in that game.

But is the government really to blame in this case? Don’t get me wrong, I am not a supporter of our government and the direction it is taking, but as my previous post showed, they had been making the money available, but the CCGs were choosing to ignore its purpose and use it to commission other services instead. As I also said in that piece, the CCGs were created by the wholesale changes made by the government in 2010, despite the fact that this had not been mentioned in any election manifesto, as they would supposedly be a more informed group to commission services. The Health Secretary who brought in these changes was Andrew Lansley, who is one of the signatories of the letter to The Times. Either the man is totally lacking in self-awareness or he is now getting his revenge for being sacked from the job and being ‘promoted upstairs’ to the House of Lords when even the then Prime Minister could no longer make excuses for his monumental incompetence. This Times cartoon from that time sums him up perfectly:

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Blaming solely the government for the failure of support and funding for mental health services is wrong. The CCGs should also be in the firing line – arguably, at the front of it. The only thing letters like this will achieve is to provoke a political argument and, while that goes on, nothing will be done to give the additional support to mental health services that they so desperately need. It could be argued that the outcome of this letter might be that the government will tell the Department of Health to investigate how funds are being spent on the commissioning of services. For all I know they will already have done that after the report two months ago – and in any event, oversight of the CCGs and how they commission services is a regular part of the DoH’s responsibilities. Either way, we don’t need any more debate, and a letter from a bunch of people who can be too easily dismissed as being self-interested isn’t the answer. Mental health services in the UK have been under-funded for decades, and the CCGs need to recognise this. I don’t envy their decisions, as to allocate money to one service means taking it from another. But it is a question of priorities: they have been given money for mental health treatments and have chosen to use it for other services instead. This is wrong, and they should be called to account for it and required to invest in better mental health services.

The NHS in general, and mental health services in particular, have been kicked around for far too long. Turning them into a political football won’t do anything to improve that. As long as this situation continues, I fear for the future of mental health services in this country. We need someone in a position of influence to lead action on this, not write politically-motivated letters to newspapers.

 

More bad news

October 5, 2016 22 comments
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Copyright Times Newspapers – click to enlarge

Another week, another scary story in the newspaper about mental health. The statistics which lead to this headline are very worrying indeed. The high percentage of young women who suffer from a mental illness, and in particular the number of them who turn to self-harm, should be seen by all as a sign that we are failing our young people. As I mentioned last week in my post Mental Health Matters this issue does not appear to be being given the priority it deserves by the Clinical Commissioning Groups, who use the funding they are given to buy the services needed by the populations they serve. As always, they are treating mental health as being of lesser importance than physical health. Spending on Child and Adolescent Mental Health Services (CAMHS) is even worse: for some reason, CAMHS services are seen as some kind of poor relation within the context of mental health services. Surely, it isn’t rocket science to understand that if our children grow up with good mental health and are well supported in this, they will take that with them through their lives, is it? This survey was carried out on behalf of the NHS by the well respected National Council for Social Research, and it is to be hoped that everyone involved will take notice and take action as a result of these findings.

Apart from the headline and the story, what interests me about this piece in The Times is the focus they have taken to create their story: the full report runs to 405 pages, not including the data tables, so presumably there is much else in there which needs to be addressed? Tucked away towards the end of the article is mention of the fact that whilst men are much less likely to suffer from a mental illness or to have suicidal ideation, they are much more successful at taking this to its tragic conclusion. I’m not trying to downplay the importance of the situation in relation to young women – far from it! – but the fact that even in a brief report such as this The Times can draw some attention to the male suicide issue says to me that there is a huge amount that needs to be done in this country and, I suspect, elsewhere. I have downloaded the full report, which is freely available here to anyone who is interested.

I make no apology for writing this brief post which is, in effect, a continuation of where I left off last week. The more information that becomes available, the more widely it is shared, the greater the awareness of one of the major issues affecting society today. In these days of Brexit, immigration, racism, choosing the least bad of two undesirable Presidential candidates, international terrorism and many other important issues, it is easy for mental health to be lost in the tide of news. I, for one, don’t accept that this should be, and will add my own small voice to those who are trying to do something about this. We can only achieve acceptance of mental health as a major issue if we can widen the debate about it – this is the only way I can do this, but I know that I’m one among many who feels this way. Lots of you tell me that in response to my posts and the fact that I have had more new followers for this small blog in the past week, when I posted three times on mental health, than at any time since I began speaks volumes to me.

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