Mental health: a quiet revolution?

Source: NHE July/August 2018

According to Mind, approximately one in four people experience a mental health problem in the UK each year. After attending a selection of mental health events at Confed18, NHE’s Daniel Broadley asks: why don’t we give mental health as much attention as physical health?

During his talk at Confed18, Paul Jenkins OBE, chief executive of Tavistock and Portman NHS FT, asked the packed auditorium to raise their hands if they had ever suffered mental health issues at work, or knew someone who had. Almost every hand in the crowd went up, thus raising the question: why is mental health not treated as seriously as physical health?

Although there has been what Mind CEO Paul Farmer called a “quiet revolution” in people’s attitudes towards mental health, there still seems to be some way to go in achieving parity between physical and mental health in the UK. After all, the two are inevitably intertwined – and often come at a great human and financial cost.

At Confed18, Farmer pointed out that more people with lived experience are willing to stand up and talk, that there’s more positive media coverage, and that mental health has become a greater political priority. All of this is great, but when you see that only four in 10 people get any help at all for mental health problems, it’s obvious there’s still a long way to go.

Through all the mental health events at Confed18, there seemed to be one underlying thread that ran throughout: we need to change the narrative. Conversation is needed at a national, local, family and workplace level. What good is investment if no one is willing to talk about it? Or, for that matter, listen? How often, when we ask people if they’re ok, do we want the real answer? How often are we prepared to be honest?

The cost

During his talk, Farmer revealed that mental health problems cost the UK economy an estimated £99bn a year (through such things as lost output and employer and NHS cost) and roughly 300,000 people leave work every year because of a mental health condition. Within the NHS, it costs an average of £2,000-

£2,200 per NHS worker annually – higher than any other part of the public sector.

More shocking than the financial cost of mental health issues within the  NHS  is  the uncomfortable  question  that  follows  it: how can patients be looked after if we can’t even care for our NHS staff’s mental wellbeing?

Luckily, there is the NHS Health and Wellbeing Framework, which sets out the approach of the NHS’s recommendations and translates them into reality. The interactive document echoes the sentiments of the twopronged approach to mental health: the financial and performance case, and the social and clinical case.

It seems a little cynical to raise the issue of financial cost alongside the human cost, but in the era of austerity and cuts it seems to be all the more important. Farmer summed it up as: “Behind every one of these figures are lives that are suspended, ruined or, in the worst cases, lives lost.”

Sharing stories

Nigel Jones, chair of City Mental Health Alliance, told the story of a senior banker and his experience of suffering mental health problems. It had devastating effects on his family and work, but he also spoke of the amazing care he received. Jones revealed that by telling his story openly, he was given the job at his next interview rather than discriminated against. He went on to become, and still is, a leading member of the UK banking industry.

In light of that example, Jones outlined three vital points for mental wellbeing for city workers, again echoing the sentiments of speakers from Confed18: leadership from the very top; collaboration instead of competition; and the power of stories. Senior people telling their stories openly can be hugely influential – couple that with grassroots actions, and we could be on the cusp of something more than a quiet revolution.

Turning people into happy, productive employees can be seen as an investment that makes sense, Jones said. But if you ask me, employers should be looking out for their workers’ mental wellbeing out of human compassion rather than financial incentive.

Marsha McAdam, a service user champion in Greater Manchester, shared her story as a sufferer of borderline personality disorder. She felt that carers faced far too much bureaucracy, so much so that it led to the breakdown of a therapeutic relationship with one of her previous CPMs because he was being “passed from pillar to post” by management.

After being on the mental health circuit for three years, McAdam highlighted one recurring theme she saw constantly: burnout. She also cited a study which rated poor mental health as the second biggest health problem in the UK after cancer.

“I, as a patient, don’t understand why there’s an endless cash cow for physical health,” she said, “but for mental health, it’s always talked about how commissioners are hard up. Why?”

Working models

So what can the UK do to not only improve its mental health services, but alleviate pressure on them and encourage conversation? Despite showing that there’s still much to do, Confed18 also showcased working models from around the world, and some closer to home, that are innovating the way we deal with mental health.

Professor Tim Kendall, clinical director for mental health at NHS England, announced that the Royal Horticultural  Society  will be donating three gardens to NHS mental health trusts and that, by the end of the year, the UK will have 100% coverage for perinatal care. He also spoke of the work being done with NICE in exploring ways to use digital technology to enhance therapy.

Rebecca Cotton, director of policy at the NHS Confederation Mental Health Network, said that mental health is yet to have its “Uber moment” as the rest of the world goes through a digital revolution. A crisis text line in the US, for example, collects data to support better mental health services by improving the way it targets specific demographics.

eheadspace – an online counselling and support network for young people aged 12 to 25 in Australia – has 24-hour coverage and offers 30to 60-minute counselling sessions on an accessible, online platform. Young people don’t always want to go see a doctor, Cotton noted, as this often means going through parents. And, now that pretty much everyone is connected to the internet, this could be the way forward for counselling and support.

Dr Jennifer Kilcoyne, deputy chief clinical information officer at Mersey Care NHS FT, spoke about her trust’s use of predictive analysis and machine learning technology to assess suicide risk, a system she said is “better than humans at predicting suicide and selfharm risks.”

It goes without saying that there will be challenges, both financially and clinically, when it comes to improving our mental health services.

It’s encouraging to see the global innovation that’s taking place and the hard work frontline staff put in – but ultimately, there must be greater investment from central government to achieve parity between physical and mental health services, to ensure NHS staff’s wellbeing is taken care of, and education on the importance of having that often difficult conversation.


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