Archive | January, 2015

The politics of mental health: Taskforces and commissions, manifestos and madwash

19 Jan

Manifesto for Better Mental Health

Mind Manifesto at a glanceMental health waiting times

Your vote has value. People with an interest in mental health – whether people with lived experience or carers or professionals – are viewed as one of the many niche markets that political parties will be trying to tempt in the run up to the 2015 general election with the aim of encouraging us to vote for them. So what tempting tidbits have been offered so far?

  • October 2012 – The opposition Labour party launched its mental health taskforce. This was an exciting development, as I wrote at the time. Over two years later, however, and it seems less of a priority. The taskforce was due to report in spring 2014, so shadow mental health minister Luciana Berger told me in April. However, in June I was emailed by the Labour party to say it would be summer, with the report published online giving the public the opportunity to comment and help formulate policy. No report. Other deadlines have passed and still no report.  Apparently it is due to report later today. I don’t know whether that means the public consultation aspect has been dropped.
  • January 2014 – Nick Clegg MP, Liberal Democrat deputy prime minster, launched the coalition government’s mental health action plan (Closing the gap: priorities for essential change in mental health). This sets out the top 25 areas for immediate action to ensure equality for mental health and increase access to the best possible support and treatment. (Here’s Mind on the action plan.)
  • August 2014 – Norman Lamb MP, Liberal Democrat minister for care announced he was establishing a task force into children’s mental health services. We know some of the answers to the questions already. Do we really need to gather more data? Without announcing a plan of action at the same time as announcing a taskforce, announcing a taskforce simply kicks the need to take action into the long grass.
  • September 2014 – Prospective Labour party candidate for London mayor David Lammy MP announced he was launching a London mental health commission. (I haven’t seen any details yet.)
  • October 2014Nick Clegg made mental health a central part of his speech to the Liberal Democrat annual conference. The first ever mental health waiting time standards were announced.
  • November 2014Nick Clegg announces a cross-government taskforce on mental health services. It is to examine how to improve mental health crisis care and services for young people, and the large numbers of people with severe mental health problems who end up in police cells and prisons. The taskforce will be chaired by Nick Clegg and include senior ministers from across the coalition, such as Theresa May (Home Office), Jeremy Hunt (Health) and Vince Cable (Business).

(For earlier government policy documents, see here.)

Are these developments substantial? Or are they merely what I call “mad wash”: inspired by the term “green wash”, I define this as window dressing to give the appearance that mental health matters. In other words, a veneer of sympathy or parity of esteem used to hide a festering nest of stigmatisation or inactivity around mental health issues. Here are some more musings on mental health taskforces.

On the other hand, we have had several manifestos launched in advance of the election. These include:

Summaries of these manifestos are set out below. What impact will these manifestos have? And what results will the various taskforces and commissions bring? Watch this space to see if they are any more than mere ‘mad wash’.

And finally, everyone loves a taskforce!

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Mind’s manifesto

Take action for better mental health – Our manifesto for the General Election 2015 (June 2014)

What the next government must do in its first 100 days

1. Commit to reducing mental health stigma and discrimination and to supporting the Time to Change campaign to sustain its work.

2. Mandate that the NHS in England offer a full range of evidence based psychological therapies to everyone who needs them within 28 days of requesting a referral.

What the next government must do in its first year

3. Commit to ensuring everybody has safe and speedy access to quality crisis care 24 hours a day, 7 days a week, whatever the circumstances in which they first need help, regardless of where they turn to first.

4. Transform the support offered to people who are out of work because of their mental health and create a system that really helps people to overcome the barriers they face.

What the next government must achieve by the end of its five year term

5. Increase the overall NHS mental health budget by a minimum of 10 per cent in real terms.

6. Develop, consult on, fund and implement a national strategy for wellbeing and resilience.

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The Mental Health Policy Group

Joint manifesto by the Centre for Mental Health, Mental Health Foundation, Mental Health Network, Mind, Rethink Mental Illness and the Royal College of Psychiatrists

A manifesto for better mental health – The Mental Health Policy Group – General Election 2015 (August 2014)

13 commitments are asked for, grouped under the following 6 headings:

  1. Fair funding for mental health – Commit to real terms increases in funding for mental health services for both adults and children in each year of the next Parliament.
  2. Give children a good start in life – Ensure all women have access to mental health support during and after pregnancy. Raise awareness of mental health by putting it on the national curriculum and training teachers and school nurses. Invest in parenting programmes across England.
  3. Improve physical health care for people with mental health problems – Ensure Government targets for smoking reduction apply equally to people with mental health problems. Create a national target to stop people with mental illness dying early, due to preventable physical health problems.
  4. Improve the lives of people with mental health problems – Continue to fund the Time to Change anti stigma campaign. Offer integrated health and employment support to people with mental health conditions who are out of work.
  5. Better access to mental health services – Introduce maximum waiting times for mental health care and support, including psychological therapies. Commit to continued improvements in mental health crisis care, including liaison psychiatry services in all hospitals. Continue to fund liaison and diversion mental health services, working with police and the courts.

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Royal College of Psychiatrists manifesto

Making parity a reality – Six asks for the next government to improve the nation’s mental health (September 2014)

The ‘six asks’ are:

  1. Tackle the mental health beds crisis – Everyone who requires a mental health bed should be able to access one in their local NHS Trust area, unless they need specialist care and treatment.  If specialist care is required, then this should be provided within a reasonable distance of where the patient lives.
  2. Introduce maximum waiting times – No-one should wait longer than 18 weeks to receive treatment for a mental health problem, if the treatment has been recommended by NICE guidelines and the patient’s doctor.
  3. Improve crisis care – Everyone experiencing a mental health crisis, including children and young people, should have safe and speedy access to quality care, 24 hours a day, 7 days a week.  The use of police cells as ‘places of safety’ for children should be eliminated by 2016, and by the end of the next Parliament occur only in exceptional circumstances for adults.
  4. Improve liaison psychiatry services – Every acute hospital should have a liaison psychiatry service which is available seven days a week, for at least 12 hours per day.  This service should be available to patients across all ages. Emergency referrals should be seen within one hour, and urgent referrals within five working hours.
  5. Introduce a minimum unit price for alcohol – A minimum price for alcohol of 50p per unit should be introduced. This will reduce the physical, psychological and social harm associated with problem drinking, and will only have a negligible impact on those who drink in moderation.
  6. Invest in parenting programmes – There should be national investment in evidence-based parenting programmes, in order to improve the life chances of children and the well-being of families.

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The King’s Fund

Transforming mental health – A plan of action for London (September 2014)

The plan, though developed for London, is said to be applicable to the whole country. The key steps identified as being necessary are:
  1. Developing a process of collaborative commissioning to facilitate change
  2. Driving change through collective systems leadership
  3. Ensuring that service users and clinicians are at the core of provision
  4. Using contracting systems to support integration
  5. Building a public health approach to mental wellbeing
  6. Developing pan-London solutions to increase impact
  7. Improving the availability of meaningful outcomes data
  8. Utilising London’s academic infrastructure to disseminate best practice
  9. Creating a new narrative for mental health

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Alliance of Mental Health Research Funders

Prioritising mental health researc – General election manifesto (October 2014)

The Alliance of Mental Health Research Funders is a national coalition of charities working to further research into mental health. They call on all UK political parties to:
  1. Champion mental health research funding in General Election manifestos – The government can redress the current imbalance in publicly funded health research, influence other funders and lead the way in tackling the stigma that hinders mental health research funding.
  2. Seek to remove current blockages to mental health research – We cannot improve mental health and wellbeing without better quality data and information. To unblock research we need better access to high quality data about mental and physical health, improved coordination of data sharing between government departments (for example between Health, Justice and Education) and more mental health knowledge among the wider public service workforce.
  3. Give priority to research that will make the biggest difference to people’s lives – The biggest gaps include research into children’s mental health, prevention and promotion of mental wellbeing and the links between mental and physical health. Setting research priorities should begin with the knowledge andexperience of people with mental health problems.

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Labour MP David Lammy’s London mental health task force

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Labour’s mental health task force:

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What you need is a nice little rest …

18 Jan
A Doctor Who yeti fliming on location in Snowdonia in 1967

A Doctor Who yeti fliming on location in Snowdonia in 1967

I remember years ago, when I was travelling round Australia with a friend who began to experience troubling mental health symptoms, going with her to a psychiatric clinic. I recall the kindly nurse, Sister Ooui, taking us to see her colleague, Dr Yeti. And I remember, as my friend went in to the assessment with Dr Yeti, him saying to her, in the most curious accent, “What you need is a nice little rest“. Remembering that phrase, with its comic pronunciation and enunciation, almost in the manner of a Sigmund Freud caricature, still makes me smile.

I’ve been thinking this week that I might need a nice little rest myself. What I’ve been preoccupied with recently is taking a permanent holiday but I thought, what the heck, why not go for a sunny little trip first? Why not walk away from everything and head for somewhere warmer? Perhaps, I’ve been thinking, I’ll feel renewed and reinvigorated and better able to face the challenges ahead (and I do face some tricky ones) after a nice little rest. Or perhaps I’ll just never come back, one way or the other.

Here are some thoughts on why I’ve been feeling this way. (It’s not happy reading.) I may write them up into a blog post at some point. Or I may, as seems to be the case at the moment, find I’m not able to. Tweets ‘R’ Us.

After Dr Yeti took my friend into his office, I recall waiting in the half-lit clinic which seemed to take up a whole floor several floors up in the large hospital building. After a while, I decided to stretch my legs. I wandered round the floor, which was divided into glass-walled rooms. All of a sudden, I noticed a room full of half-finished little baskets. A basket weaving workshop.

I was hit with a jolt of fear. I still remember being stopped in my tracks, standing there, at the sight of those baskets and what it might mean for my friend. Like many people, my only previous knowledge of psychiatric wards or clinics was what I’d seen on that historical US film Cuckoo’s Nest. For some reason, those baskets represented for me all that was worst about psychiatric care as portrayed in that dramatisation. I remember my eyes widening and my pace quickening as I completed the circuit of the floor and reached the exit to find it was … locked.

How had I not noticed? As Sister Yeti had brought us to see Dr Yeti, we’d been let in through double locked doors – a sort of airlock – by another nurse. The realisation rose up in me that there was my friend, being assessed by a psychiatrist, on a locked floor, with a basket weaving workshop.

I cannot tell you the fear I felt for my friend – and how relieved I was when she emerged, shortly afterwards and we were able to leave. We left quickly, my friend somewhat reassured (though not entirely convinced) that she’d just been experiencing the ancient after-effects of previous illicit drug-taking; and me, determined to ‘rescue’ her from a potentially horrible fate as quickly as possible without alarming her too much.

My friend flew back home to England shortly afterwards, but that’s another story. And I did end up on a locked psychiatric ward myself, many years later. But there were no basket weaving workshops.  And it wasn’t a ‘nice little rest’ by any means, which was what I really needed at the time. And that really is another story.

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Some reflections by a retired nurse on asylums old and new

8 Jan

Vintage psychiatric nurse novels 4

 

Earlier this evening, I had a fascinating conversation with a relative who’d trained as a learning disability nurse in the 1960s. She shared her memories as a nurse, visitor and  patient at Coldeast Mental Deficiency Colony, Littlemore Asylum, Digby, Langdon, Tone Vale and other hospitals.She had some interesting observations on the differences between the old asylums and modern psychiatric hospitals.  It was hard to tell if it was pensioner nostalgia or if things really were, on balance, much better in the old asylums. But that was her clear view.

She spoke about the old asylums, on the outskirts of town, each having a home farm where patients would work, have a purpose, be outside and contribute to the life of the institution. Of patients cleaning the wards, nurses helping too, of real hands-on nursing, of vocation, of the matron closely supervising the ward, of strict hygiene standards that meant, for instance, never sitting on a patient’s bed. Of food cooked on the wards, and nurses trained in cooking too in case there was no one else there to do it. Of the value of good routine, of having to boil the needles and bandages, of having to manage patients without drugs, of highly-trained staff.

She spoke of parents being persuaded to abandon their ‘mentally retarded’ children, to leave them behind and get on with their lives. Of how wrong that was and of how people could contribute so much to society if they had routine jobs. That seemed her one regret from those times.

She spoke of nurses needing to get at least two years’ experience before they could go on the wards with the more difficult patients. Of how patients would be matched to particular nurses, as some patients could be violent from time to time and you had to know how to relate to them. Of how the experienced staff, strict routine and a pride in their work created a secure and stable environment for patients and staff alike.

And she spoke of how things had started to ‘go down the pan’ in the 1970s when, for the first time, staff could use drugs to ‘keep patients quiet’. Of how younger staff were recruited, how routine slipped, how patients were left to do as they wanted, neglected and ‘drugged up to their eyeballs’. Of seeing the nurses’ pride in their job dwindling, of staff having affairs with each other, of hygiene standards slipping. She’d seen this in residential and nursing homes too: residents drugged to keep them quiet, one perhaps two staff on overnight, and little care.

And then she compared her time working in the old institutions with her recent experience of care in a brand new psychiatric hospital. She said, when she was a patient herself, the staff were ignorant about mental health, and some nurses were ‘really nasty’. Staff congregated in cliques or in the staff room. They didn’t mix – ie care for – patients. At night, nurses would be on their smart phones and would brush her away when she tried to talk to them. Of how the ward phone was kept locked in the nurses’ office, so patients couldn’t contact the outside world except with staff permission. (That’s a recipe for abuse behind closed doors, if ever there was one.)

She spoke of there being no facilities for exercise – and, when she went in, she was used to walking miles. How she got fatter & fatter. That there was a small internal courtyard but she wasn’t allowed in it in case she ‘climbed over the wall’ and escaped. How she was finally, after several weeks, allowed into the courtyard and would then walk round and round and round. How there was a swimming pool and gym elsewhere on the hospital site, but the nurses wouldn’t take her there. How she badly missed activity. How she came out of hospital far more unhealthy than when she went in, physically.

How nursing had become more technical, and nurses had more status now, but had lost the basic hands-on skills. How nurses nowadays had lower hygiene standards and no idea about cross-infection control. How hospitals needed highly-trained staff but how the staff who’d treated her didn’t have sufficient training. How nursing was just a job now, not a vocation.

It was fascinating listening to her experiences as staff, visitor and laterly patient starting in the 1960s and running right through to the present day, and the comparisons she made.

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Should we be worried about the rise of antidepressants? #PillShaming

6 Jan

Another post where I’ve set out my thoughts in tweets and hope to write it up into a blog post but, in the meantime, here are the tweets:

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When is an emergency not an emergency? When it’s a mental health ’emergency’

1 Jan

Mental health ’emergencies’

In which an otherwise shocking story about the numbers of people in mental health crisis being treated in A&E reaching record proportions – 1 million in 2014 – is overshadowed by the use of rogue apostrophies indicating a mental health emergency isn’t a real emergency. And then the headline was edited to refer to admissions instead. From ’emergencies’ to admissions.

And here are my tweets on the story itself – which highlights serious concerns (as do the comments underneath the story).

Themes:

– Failure demand spilling into A&E as it does every year, especially in winter, bringing increased calls to “choose wisely” and stay away from A&E: but that’s where mental health patients are told they must go in a crisis, because no other services are commissioned.

– Emergency doctors distancing themselves from caring for mental health patients (one is quoted in the article as saying neither police stations nor A&E is suitable – given a choice of the two, a hospital bed, even a hospital waiting room, is better than a police cell).

– The stigma and discrimination around mental health problems meaning they aren’t viewed as real illnesses (even many psychologists refer to the “idea of illness”, as if the brain were somehow immune from becoming unwell, unlike any other part of the body) encapsulated in the Guardian article’s use of apostrophes around mental health ’emergencies’.

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(I’m attempting to get over my ongoing difficulty with writing blog posts by returning to my twitter roots – twitter is, after all, a micro-blogging site. I hope to later write the tweets up into a blog post but, in the meantime, here are the tweets.)

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