There has been a lot of talk about mental health and the need to combat stigma, but this has done little to improve the experience of people using services.
That, at least, is the concern some have expressed. I want to offer another perspective.
The need for bold, decisive action to improve the lot of people with lived experience of mental health issues is illustrated by an analysis published by health and social care services in Sussex and east Surrey, the area where I work as an NHS chief executive. This shows that people using mental health services in our area are likely to live up to 20 years less than the general population; are two to four times more likely to die of cancer, circulatory or respiratory disease; and account for about 20% of all A&E attendances and emergency admissions, despite making up only 7% of the overall population.
What are we doing about it? Part of the answer comes through our sustainability and transformation partnership (STP), an alliance of 24 different agencies across Sussex and east Surrey.
While our local STP is facing many challenges, the partnership has identified mental health as one of its priorities. Our partners have agreed to and funded a review of how mental health services on our patch are commissioned, funded and delivered. This sends an important message that the issue of mental health is the responsibility of the whole health and social care system, not just the sole preserve of mental health providers and campaigners.
Health and social care leaders talk about the looming pressures of winter – in mental health, winter comes early and the demands are increasing. One area in particular where more funding is needed is 24/7 mental health crisis support.
The issue of delayed discharges from mental health inpatient services provides another stark illustration of the pressure within the system. Helping people leave hospital when they are ready is a crucial part of promoting recovery. But, too often, the need to arrange suitable accommodation, social care and follow-up support can get in the way. Solutions can only come from the health and social care system working together, rather than in silos.
We’re not simply waiting for the review (published in the autumn) to tell us what to do. We’ve got to think differently about how we provide services, the way we address workforce shortages, make bold decisions and take risks; applying traditional solutions to today’s challenges will get us nowhere very fast.
At Sussex partnership NHS foundation trust, we’re doing more work on employing people with lived experience of mental health to work with us in delivering services. Our recovery college programme involves people with lived experience of mental health working with clinicians as equal partners in designing and delivering courses to promote mental health and wellbeing – on everything from understanding depression to sea swimming for recovery. Our evaluation has shown recovery college students spent fewer days in hospital; were admitted less to hospital and had fewer admissions under the Mental Health Act; and needed less support from community mental health services.
This isn’t about cutting mainstream services or stopping people trying to use them. It’s about designing services around the needs of people who use them, rather than expecting them to fit in with traditional models of care.
It’s exactly the kind of thing we need to do more of. We’re now one of only two centres in the country offering the same opportunities to children and young people (aged 12 – 21) through our discovery college.
We are also doing more to support staff health and wellbeing. Our Sussex mindfulness centre is working with our own staff and local NHS organisations. Now, more than ever, we need to pay attention to the wellbeing of those delivering care.
I make the point not to bang the drum with a sense of self-satisfaction, but to demonstrate that solutions are possible if we think radically. It just isn’t good enough for mental health providers to shroud wave about the need for more money. At the same time, it simply isn’t realistic, desirable or sustainable to expect our hard-pressed health and social care staff to continue absorbing and managing the sustained pressure being experienced by mental health clinical services.
It’s good to raise awareness of mental health issues. It’s important to highlight where improvements are needed. But it’s vital for health and social care services to work in partnership with service users, patients and families to do something about it. This is what the Five Year Forward View for Mental Health sets out – it is our collective responsibility to deliver it.
By: Sam Allen