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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee

 
 

Roundtable: Mental Wellness – developing an holistic Mental Health policy’

Feb 13. till Feb 13.

Invitation Only Event

Hosts: Andrea Leadsom MP & Charles Walker MP

Speakers: Vicki Nash, Head of Policy and Campaigns, MIND
Andy Bell, Deputy CEO, Centre for Mental Health
Matilda Macattram, Director, Black Mental Health UK

Date
February 13, 20132013-02-13T12:45:15 - February 13, 2013 2013-02-13T02:15:58
Time
12:45 PM 2013-02-13T12:45:15 - 2:15 PM 2013-02-13T02:15:58
Location
Portcullis House, Westminster

KEY POINTS:
Actions as well as words
The implementation framework needs to be practical, not theoretical.
Thinking about crisis care
“Warehousing” patients is not the answer; it is easier to get patients into secure units than it is to get them out.
Representation
The mental health strategy under represents minority groups, especially African-Caribbean people, despite them being overrepresented in certain aspects of mental ill health.
Innovation is key
There are some excellent examples of innovative care, including patients staying with host families or foster families immediately following treatment.
Technology
We need to think more carefully and intelligently about deploying the technology we have.
Expectations
Low expectations of those suffering from mental ill health result in them not being encouraged to succeed in—or even enter—the workplace.
Joined-up thinking
There are poor incentives to include other sectors in raising awareness of mental ill health, particularly in the education and ‘physical’ health sectors. This joined up thinking about mental health needs to begin in government, across all departments.
Education
Mental Health needs to be included in the PSHE curriculum in schools, as the current lack of education means that the importance of mental wellness, and the concerns that mental ill health bring, are not raised with children and young people.
Local leadership
CCGs, local authorities and Health and Wellbeing Boards all need mental health champions: people dedicated to furthering the cause for mental health.
Early intervention
Perinatal health (the period immediately before and after birth, for both mother and child) is an important aspect of early mental health intervention.
Research
Mental health could benefit from more research, particularly patient studies, which should be widely circulated throughout the healthcare profession.
Economics
The economics of mental health provision should not be neglected, including how PbR is working for healthcare.
National challenge
Mental wellness is the national health challenge for the 21st century, and should have as prominent a place in the national health psyche as concerns over obesity, alcohol and tobacco.

MAIN DISCUSSION

1. Introduction
• The debate began with the question: what would a holistic approach to mental wellness actually look like? A population-wide change is needed, and there needs to be widespread awareness about mental ill health.
• Mental ill health needs to be regarded on a par with physical ill-health, and mental health (i.e. having good mental wellbeing) is something which we should seek to promote. Educating away myths and preconceptions would help to raise public awareness and increase resilience.
• Issues need to be recognized and accepted, and those struggling with mental ill health should be encouraged to ask for help and for such help to be given. A joined-up system across both physical and mental health needs to be created, as the two are not the separate entities that the current system sets them up to be; rather they are intertwined, and this should be recognized.
• Mental wellbeing needs to be considered as significant an issue as obesity, alcohol and smoking.
• This leads to the question: what do we want from our mental health services? What do we expect from them? The Francis Report is as relevant to mental health as it is to nursing: relationships are crucial to care, and in the mental health sector there is too great a reliance on force and coercion, and not enough importance placed on developing caring and compassionate relationships.

2. Implementation Framework
• Discussion around the new implementation framework indicated that it is designed as a practical support to implement strategy, as the devolution of power has resulted in different people needing guidance on how to effectively implement strategy, and what happens “on the ground” was considered to be the real test as to whether the framework is actually effective. Actions are needed to match the words: the implementation framework needs to be practical, not theoretical.

3. Crisis care
• It was acknowledged that significant investment is made in high-cost, late intervention solutions (crisis care), and money needs to be spent on services based on dignity and compassion.
• “Warehousing” people into sectioned care is often not the answer, and it is often the case that it is easier to get patients into secure units than it is to get them out. Some patients need the constant care and supervision that sectioned care provides, and the concept as a whole should not be too harshly judged.
• The perception of sectioned care as simply another form of detention by ethnic minorities, specifically the African-Caribbean group was raised. The mental health strategy under represents minority groups, especially African-Caribbean people, despite them being overrepresented in certain aspects of mental ill health. Their pathways into care are more often through coercion or force, and treatment within care still a problem, as African-Caribbean patients still have a significantly higher mortality rate when in care. Sectioning is therefore not perceived as being safe to enter or necessarily helpful by all groups.

4. Innovation
• The current top down delivery system may not always be the most efficient delivery method, and there needs to be more innovation into mental health care. There are some excellent examples of innovative care, including patients staying with host families or foster families immediately following treatment, rather than remaining in clinical care settings, as well as peer support and former-patient run treatment and support. However this is not found everywhere.
• Monitoring and evaluation of innovative care is crucial to ensure the highest standards are met.
• Embracing technological innovation is vital, including examples of a private medical Twitter-style forum, in which experts from around the world can be accessible therefore allowing expert advice from a range of health care staff to be available 24 hours a day. We need to think more carefully and intelligently about deploying the technology we have.

5. Low expectations of those with poor mental health
• Poor awareness and understanding of mental ill health has led to low expectations of those with mental health problems pervading society, and in particular, the workplace. These low expectations result in people suffering from mental ill health not being encouraged to succeed in—or even enter—the workplace.
• A diagnosis of psychosis can have a significant impact on a person’s life, and can cause feelings of isolation. To feel further isolated from work makes the situation worse, and although it is important that those with mental ill health receive benefits, the implications of the prospect of a life reliant on benefits were usually negative.
• Work, whether paid employment or not, is a positive therapeutic intervention, and those suffering from mental ill health should not be discouraged from working absolutely.
• However, it is not possible for everyone suffering from mental ill health to enter the workplace. Work is not the only option: those with mental ill health should not be relegated to the sidelines of society. There are different options and different ways for everyone to participate.

6. Inclusion of other sectors
• A joined- up approach across multiple sectors was the most commonly suggested solution to the cause of many issues surrounding mental health care; however there are poor incentives to include other sectors in raising awareness of mental ill health, particularly in the education and ‘physical’ health sectors.
• A specific example is creating links between maternity hospitals/wards and mental health teams. A shift from the current ‘factory’ system (where expectant mothers see whichever midwife is available, and may have a different midwife for every appointment throughout her pregnancy) to a caseload based system, in which women see the same midwife on each occasion, would encourage relationships to develop between midwives and expectant mothers. The importance of relationships in high quality care cannot be underestimated, and in the example of maternity and mental health the relationship between a midwife and expectant mother would make monitoring the mental health of patients easier. Women were more likely to confide in a midwife they know, and many are reluctant to admit they are struggling amid fears of being labelled a bad mother and having their child taken away.
• A second example is the case of social workers; as it can be difficult to get child and family social workers to work with mental health social workers, in large part due to the working culture. Skills and experience sharing is not always encouraged to a fear that if, for example, a child’s case involved elements of mental health concerns, the child’s social worker may want to pass the case onto a mental health social worker. A fear of gaining more cases was held up as the root cause behind a lack of skills and experience sharing in this case.
• Mental health awareness should be included in training across multiple sectors and services.
• Currently, mental health is not covered in the PSHE education programme in schools, and therefore the importance of mental wellness, and the concerns that mental ill health bring, are not raised with children and young people.
• Joined up thinking about mental health needs to begin in the government; across all departments, including health, education, work and pensions.

7. Awareness: professional, social, cultural
• As well as more cross-over between sectors, there needs to be a greater awareness of mental health across different professions and professional roles. Everyone should have a basic working knowledge of mental health and mental ill health; the importance of a first aider is never questioned, however there is rarely an equivalent to this role for mental health in the workplace.
• Mental health is perceived as the arena of specialists, and therefore not something that general medical and clinical staff—or even the general public—need to have a knowledge of. The general public doesn’t seem to know enough about mental health to challenge misconceptions or incorrect statements made about mental ill health in the way that they do about physical ill health; an issue which stems back to the lack of education about mental health.

8. Local Leadership
• The new focus on local leadership gives CCGs, local authorities and Health and Wellbeing Boards an opportunity to champion mental health in their areas. All aspects of leadership on a local level need mental health champions: people dedicated to furthering the cause for mental health.
• The devolution of leadership has also provided opportunities for local leaders to take control of their services, and mental health should be an important part of this. However mental health providers are not represented on all Health and Wellbeing Boards, which further promotes the case for local mental health champions. It is not a statutory requirement to include mental health providers, and as CCG regulations are also vague about who to include, mental health is often relegated to being a Cinderella service.

9. Early intervention: perinatal health
• It is important to reinvest away from late intervention, and invest instead in early intervention. This leads to the question: how early is early intervention? Perinatal health (the period immediately before and after birth, for both mother and child) is an important aspect of early mental health intervention.
• Between 6-18 months a child undergoes significant cognitive development, which is linked to mental wellness and resilience. Unfortunately, infant mental health is not recognized by either the Department for Education or the Department for Health. This further promotes the need for joined-up thinking across government; approximately £75-100bn is lost to the economy due to poor mental health.
• Early intervention is critical, as it will help reduce the need for ‘firefighting’ services for mental health concerns.

10. Research
• The mental health cause would benefit from more research, particularly patient studies. Poor mental health affects more people than cancer, but the funding gap between the two is enormous. Research is needed to make progress in treatment, and one element of this research should focus on patients, and what helps them deal with mental ill health. This approach would require substantiation with a more scientific evidence base to support the patients’ recommendations.
• Healthcare professionals should be made aware of any new research as it comes out, so that GPs have an awareness of what they can recommend for patients before referring them for specialist diagnosis and treatment.

11. Economics and Investment
• Payment by Results (PbR) is not always the right system; block contracts can be a problem, as institutions often receive large amounts of money regardless of performance. It's important that in rectifying this through a system of PbR, the focus needs to be on results (quality and outcomes improvement) not just on levels of activity and all the perverse incentives to which that can lead. However, Payment by Results can simply seem to be an ineffective ‘box ticking’ exercise.
• The economic value of innovative mental health treatments or plans must be highlighted when discussing how to improve mental health provision. Mental wellness is not high on everyone’s agenda, and therefore the argument often, particularly in times of recession, comes back to money. Decision makers will always consider an economic argument, and therefore the economics of mental health provision should not be neglected.

ATTENDEES

1. Julia Manning, Chief Executive, 2020health
2. Gail Beer, Director of Operations, 2020health
3. Andrea Leadsom. South Northamptonshire, Conservative MP
4. Charles Walker, Broxbourne, Conservative MP
5. Vicki Nash, Head of Policy and Campaigns, MIND
6. Andy Bell, Deputy CEO, Centre for Mental Health
7. Matilda MacAttram, Director, Black Mental Health UK
8. Dr Hugh Griffiths, National clinical director for Mental Health, Department of Health
9. Lucie Russell, Director of Policy, Campaigns and Participation, YoungMinds
10. Simon Lawton-Smith, Head of Policy, Mental Health Foundation
11. Michael Bell, Chairman, London Mental Health & Employment Partnership
12. David Beyt, Health Policy and Projects Officer, Greater London Authority
13. Maeve O’Callaghan-Harrington, Deputy Director of Operations, Head of Site and Emergency planning, North West London Hospitals NHS Trust
14. Shaun Hare, Deputy Director of Psychological Medicine, Central and North West London NHS Foundation Trust
15. Beverley Perera-Anderson, International Associate, 2020health
16. Ruth Cartwright, RSW Manager, British Association of Social Workers, England
17. Professor Clair Chilvers, Trustee, Mental Health Research UK
18. Marjorie Wallace CBE, Chief Executive, SANE
19. William Pickering, Public Affairs Manager, Royal College of Psychiatrists