Mental Health Still Matters

Four years ago today I posted what has become – by a distance – my most ‘liked’ post ever, as you can see from the ‘top ten’ in the right hand column. It clearly struck a chord with many. I reblogged it a year later and in the run up to World Mental Health Day (aka WMHD, on 10 October) I thought I’d revisit it. I’ll share the original post unedited, and then return for an updated commentary. This is the original:

MENTAL HEALTH MATTERS

At the risk of repeating myself, I started this blog to share my experience of depression in the hope that it would help others. I worked for more than 20 years in the NHS for a large mental health Trust and although I haven’t blogged much about it recently mental health is still a subject about which I care deeply. Last week there was a story in The Times which alarmed me about the way mental health is supported, and which I felt I had to share. This post is about the situation in England but I suspect that the issues are common to many other countries around the world.

A little bit of background: when the Tory-led coalition government came to power in 2010 they embarked on a major restructuring of the NHS. There had been no mention of this in their manifesto, but that’s another story. One of the key changes was the creation of Clinical Commissioning Groups (CCGs) which were intended to put the power in commissioning health services into the hands of health practitioners (largely, General Practitioners, i.e. GPs) as this would, in theory, mean that those who knew best would be commissioning the services needed by their local population. There is an ongoing debate about how effective this has been and a range of other issues too, but I’m not going there. What interests me at present is this:

Copyright Times Newspapers' Click to enlarge
Copyright Times Newspapers. Click to enlarge

Apart from the fact that they are going against Government policy and misusing their funding, I am horrified that so many CCGs fail to see the importance of providing good mental health services. These are supposed to be the experts, those who know best. It beggars belief that they can be so ignorant. The Times commented further on this in their editorial section:

Copyright Times Newspapers. Click to enlarge
Copyright Times Newspapers. Click to enlarge

I’m with them 100%. The figures speak volumes, both in terms of the abuse of power these CCGs are engaged in, and of the pressing need for more investment to be made in mental health services. I started working in mental health in 1993 and even then it was recognised by many to be a Cinderella service, pushed into a corner and under-supported. And children’s mental health services were seen as the poor relations within that! Finally, it seemed, we had a government that was doing more than say nice words about this, but they are being let down by the very people who they thought would be best qualified to enact their wishes.

There have been many studies which have shown how good mental health can be of benefit to physical health, and vice versa. One of the problems in these days of evidence-based treatment is in measuring the effectiveness of mental health care. With a physical illness it is relatively easy to assess, likewise with injuries, such as broken limbs: there is clearly visible evidence available in such cases. But this is not always true of mental illness. To use my own case as an example, the diagnosis I was given nearly five years ago was treated, I returned to work until I retired, and since then I have not felt any recurrence of the original symptoms. So, does that mean I am a successfully treated case? Probably, as I’m no longer costing my local CCG anything for treatment, but who is to say that I am ‘cured’ or whether that is even possible? And does that mean that my local CCG shouldn’t spend the money it has been given to treat people like me on people like me, that it can choose to use it for other treatments? I think not!

People with mental illnesses have for far too long been discriminated against and stigmatised. Whilst this may be recognised by some, far too little can be done, both in terms of treatment and education, as the funding just isn’t available to do all that is needed. I know that the NHS in general is underfunded and that CCGs are under severe pressure to balance their books, as are provider services, but to take money away from the most needy part of the service is totally unacceptable, particularly when that money is supposed to have been ring-fenced for those services. Are the CCGs deciding on their service commissioning on the basis of discrimination and stigmatisation? Who can say, but it could be argued that they are showing signs of doing this. If the supposed experts don’t take mental health seriously, what hope is there that the general population can come to recognise the need to do so?

(Footnote: I am having a week of mental health awareness posts. This is my second, after yesterday’s reblogging of It Asda Be from three years ago. More is to come.)

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And this is me again today. I’ve been thinking about what I’d be saying for this year’s WMHD post, as we are in such strange times and much of what has gone before has been overtaken by the pandemic. Somehow, given all of the pressures under which they have been working, it feels a little churlish to criticise the CCGs, but that doesn’t mean that I think they have improved their performance on mental health. It just doesn’t feel like the right time to have a go at them – but there will be a time for that, I’m sure!

This year’s WMHD theme is: Mental Health For All – Greater Investment, Greater Access. The focus of healthcare services is, naturally, on treating and controlling the coronavirus: however I am sure there will be a devastating long term effect on our mental health – both collectively and individually. It would be easy for the mental health aspects of the pandemic to be overlooked: given the situation here that I described in my post four years ago, I fear that they will be. Mental health does matter: good mental health, and services to support it, should be seen as equally important as physical health. In current circumstances, mental health may matter more than ever. I just hope that the ‘powers that be’ recognise this, and that they do something about it.

World Mental Health Day 2019


Not that I needed the reminders, but my inbox has been receiving a steady flow of emails about World Mental Health Day (WMHD), which is marked each year on 10 October. This date is recognised by the World Health Organisation and the theme for the year is set by the World Federation for Mental Health. This year’s theme is suicide prevention.

Having had mental health problems myself – mostly depression and anxiety-related – I feel very lucky that I have never once had the remotest hint of a suicidal thought. Others are, sadly, far worse off than I in this respect, and I am pleased that this subject is receiving so much attention. For so long it has been one of those taboo subjects of which we dare not speak, choosing instead to brush it under the figurative carpet.

This week has seen the launch of the Every Mind Matters campaign by Public Health England and the NHS, to encourage people to be more aware of the early signs of mental health issues. Their website can be found  here and is full of loads of useful advice and resources. I strongly encourage you to take a look if you or anyone you know might benefit from getting some good help and advice. The campaign is being supported by the younger royals – the Cambridges  and Sussexes – and is generating good publicity. Many companies and organisations, such as the England and Wales Cricket Board (ECB) have also pledged support.

Today I’ve seen a piece on breakfast tv about Ellie Soutter, a snowboarder champion who took her own life last year on her 18th birthday. It featured an interview with Ellie’s mother and was heartbreaking, really bringing home the devastation caused in the lives of loved ones, families and friends when someone commits suicide. The gaping hole that they leave, all those unanswered questions about what drove them to do it, the guilt about whether their family, friends or anyone could have seen signs of their unhappiness and done something – anything – to help. There are, sadly, no easy answers to any of those questions. None of us wants to be in poor Ellie’s mum’s situation, but we don’t have hindsight to know what we might have done in her circumstances. We shouldn’t need things like Every Mind Matters to remind us of this, but the reality is that we do. The importance of spreading this word, and of sharing awareness of what we can do to help ourselves and our loved ones, cannot be understated.


One of the organisations which supports people with mental health issues is Time To Change. I’ve spoken about them before, and have recently signed up to be a ‘Time To Change Champion,’ which means that I have committed to spreading the word about what we can do to help. This isn’t a big announcement, and isn’t anything for which qualifications are needed. Anyone can do it – the more who do, the more widespread the message becomes. If you’re interested, do visit the Time To Change website. Here you’ll also find lots of good advice, including their campaign for this year’s WMHD, ‘Ask Twice,’ as you can see from the image above. This is the simple thought that, rather than accepting the usual ‘I’m fine’ answer to the ‘how are you?’ question, we might delve a little deeper. Here is the link: you’ll find a good little video about it to encourage you to think more about this, along with more advice on how to start that conversation. I’ll be posting more as a ‘Time To Change Champion’ in the months to come, and I hope some of you will sign up too.

I’m aware that this post reflects the fact that I am in the UK, but this is World Mental Health Day. Wherever you are from, this is an important day. In the column to the right you will see a box labelled ‘Stand Up For Mental Health.’ If you click on this it takes you to the website of HealthyPlace.com, whose campaign this is. They are US-based, and I know that there are many similar initiatives around the world. Wherever you are, please take a few moments to find out what is available to you and what you can do to help. And if you think you might need some support, please do seek assistance, and don’t be afraid to ask.

’How are you?’

‘I’m fine thanks.’

‘Are you sure? You don’t seem quite like yourself…’

‘Well, actually…’

That wasn’t too hard, was it? If you know someone you think might be struggling, #AskTwice today and every day. You may be saving a life.

World Mental Health Day 2018

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.