Tag: politics

Voting for mental health

In this post I underestimated the number of charities which specifically fund mental health research. Last week Hugh McKenna sent a message to members of Mental Health Nurse Academics UK alerting us to the Alliance of Mental Health Research Funders, and particularly to this group’s Prioritising Mental Health Research manifesto produced ahead of next year’s general election.

I count 13 members of the Alliance, and read this from the about section of the organisation’s website:

We are a group of charities and foundations that support mental health research. We meet regularly to share progress and generate new ideas for improving mental health research in the UK. We believe that more and better research is urgently needed to find ways of promoting good mental health, treating mental health problems, and supporting the wellbeing of individuals, families and communities. Research can help people with mental health problems, and those around them such as family members or friends, practitioners and leaders of organisations, to find solutions so individuals can enjoy better health and longer, more fulfilling lives.

In its 2015 manifesto the AMHRF says:

We all know someone with a mental health problem and can see how lives would be improved with better treatments and support and less stigma. Mental health research saves lives, relieves significant distress
and improves quality of life. It also benefits the whole of our society by generating social and economic benefits that contribute to thriving communities built upon resilience, reduced levels of mental ill-health and less stigma and discrimination.

Yet mental health research is underfunded and under-prioritised by government. We are missing opportunities to achieve breakthroughs seen in other areas of healthcare that could transform people’s lives and enhance wellbeing.

The 2015 General Election is a landmark opportunity for political parties to build on growing public awareness of mental health and the value of all health and social care research.

The Alliance is right about a growing public awareness of mental health issues, and its message on underfunding is an important one which deserves to be heeded. The LibDems have promised to include a commitment to increasing mental health research in their 2015 manifesto, and other parties (including those with a chance of forming a government) might consider following suit. Personally I would like to see this wrapped up in a more overarching promise to invest properly in mental health across the board, including in services. Elsewhere this week announcements have been made of extra funds to reduce waiting times for mental health care in England. This is a good thing, but needs to be seen in the context of persistent cuts to the mental health system over the lifetime of this government which have  had serious implications for people left in need.

Closing the Gap?

Earlier this week, over the border in England Deputy Prime Minister Nick Clegg put his name to a new policy document titled Closing the Gap: Priorities for essential change in mental health. The foreword to this includes the line that ‘Mental health is moving up the policy agenda across government’. This is a welcome assertion. It is also one which deserves to be examined alongside evidence of recent cuts in funding and retractions in services at a time of rising demand (see here and here for my earlier posts on mental health in an era of austerity).

This is a document listing 25 areas for change in four areas: increasing access to mental health services; integrating physical and mental health care; starting early to promote mental wellbeing and prevent mental health problems; and improving the quality of life of people with mental health problems. It closes with the maxim that mental health is everybody’s business. Initial coverage in The Guardian included a fairly straightforward description of the document’s content, and particularly its promise of increased choice for people using services and the introduction of waiting time targets. In The Independent, Paul Jenkins (from the organisation Rethink Mental Illness) was more searching, contrasting Closing the Gap‘s aspiration with what we know about frontline services:

[…] historically, mental health has always had a raw deal when it comes to NHS spending and accounts for 22% of illness in this country, but only gets 11% of the NHS budget. On top of this, over the last two years, we’ve seen a 2% cut in mental health spending despite increasing demand. Services which were already struggling are being squeezed even further. So how can the Government now make real inroads into significantly improving care and introducing choice when the services simply aren’t there? People are waiting months, even years for treatment.

If politicians really want to improve the lives of people with mental illness, we need to see investment in mental health services – in the very least services should not be cut. We should also be making sure that people who are too ill to work are properly supported with the benefits there are entitled to and with services that respond when and where they are needed. And when we see an action plan, it needs to set out specific commitments on how things are going to change and by when.

Well said. Personally I am minded to think, again, about the mental health field’s wicked problems, and how large-scale policy always contains just one version of what a system’s most pressing challenges (and their solutions) might be. Closing the Gap has plenty to say on what ought to be happening at local level (better preparation of commissioners of mental health services, more mental health training for primary care workers, more psychological therapies, and so on). What it does not unequivocally say is that ‘the problem’ may also be one of underfunding relative to levels of need.

I am also reminded of how local service change in response to national policy can lead to unintended consequences (something I have written about at length here). Here’s a speculative example to illustrate this point. Typically, mental health teams have responsibilities to respond in timely fashion to new requests for help (from colleagues in primary care, for example) whilst simultaneously providing care to people already using their services. Who knows, then, what the wider system effects might be when waiting limits for mental health services are introduced next year, as Closing the Gap promises they will? At local level, will redoubled efforts to respond to new referrals mean that the delivery of ongoing care and treatment will suffer? Will NHS organisations be tempted to establish new types of service specifically to reduce waiting times? If so, how will these find their feet in systems which are already organisationally complex? None of this is to say, of course, that waiting periods are problems which do not deserve to be tackled, but it is to say that actions to address perceived deficiencies always reverberate.

NPNR 2013 conference review

Health and health services are political. I therefore applaud those who selected the ‘personal and the political’ as the theme for this year’s Network for Psychiatric Nursing Research conference.

A word on the keynotes:

Kate Pickett‘s Thursday morning opener pressed home how disastrous inequalities are, for all of us. For those not there to hear Kate speak there’s plenty of compelling evidence available via The Equality Trust website, and indeed in The Spirit Level (which I now realise I must read).

Simon Duffy, in his keynote yesterday, challenged mental health nurses to act collectively and assertively to improve welfare. I believe he was correct in pointing out that public services are often experienced as fragmented, bureaucratic and impersonal. Check out the Centre for Welfare Reform website for more in this area.

Charles Walker, Conservative MP for Broxbourne, has spoken openly about his personal experiences of obsessive compulsive disorder and until recently was Chair of the All Party Parliamentary Group for Mental Health. His Thursday afternoon conversation with the NPNR audience was stylishly done, and whilst I can’t bring myself to vote for his party (not now, not ever) I do appreciate what he has done to challenge discrimination.

Len Bowers used his Thursday keynote to share, for the first time anywhere, results from his Safewards trial. Len is a genuinely world leading researcher, and Safewards is a big and important study with seriously major implications for policy, services, education and practice. Take note, inpatient mental health nurses: the findings from this one are coming your way.

Rounding off the whole event yesterday afternoon was Fiona Nolan, sharing results from her pilot study of the use of protected engagement time (PET) by inpatient mental health nurses. Fiona’s was another great presentation, and her and her colleagues’ findings are important because (despite the push from policymakers) they suggest PET offers no additional benefits to service users.

Other items of news: warm congratulations to Joy Duxbury, who will be delivering the Eileen Skellern Lecture for 2014, and to Hugh McKenna, who will be receiving the Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award. Two fine people, and worthy winners both.

The concurrent sessions I had the chance to participate in were of uniformly high-quality, and there was plenty of discussion and debate to be had. I’d also like to think that this year’s event maintained the NPNR’s reputation for combining quality with informality and collegiality. For the record, my view is that nothing of great consequence was lost in moving the conference, for the first time ever, away from Oxford. Warwick worked well, and as others have said via their post-event tweets, it’s the people not the place which matter.

See you next year.