Don’t talk about mental health

noose

“What is the leading cause of death for men under the age of 49?”

This is the question we asked our class of paramedics receiving their mental health training the other day…

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A number of good suggestions came forward; a heart attack, cancer perhaps, maybe a stroke or, thinking outside of physical health, road traffic accidents. Like the paramedics you may be surprised to know the answer is suicide, by a long way, hanging being the most common method.

To give you an idea of scale, there are approximately 1713 deaths by road traffic accidents per year (male & female) while 4287 men lose their life each year by suicide.
Three-quarters of all suicides in the UK are male – Office for National Statistics, (ONS) Statistical bulletin for the year 2016.

Why is this? Because we do not talk about mental health enough, men particularly, nor does society talk about suicide very readily.

Rays of hope; The times they are a changing – a recent masculinity audit shows men now view their mental health as more important than their physical health, with 46% of young men aged 18-29 saying they consider mental health to be very important.

In 2016 the suicide rates fell by 3.1% for men and 9.4% for women (ONS).

Perhaps we are ready to talk about it…

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Mental health & deaths in custody

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                       “Take nothing on its looks, take everything on evidence.                             There is no better rule”   Charles Dickens

On 23 July 2015 the then Home Secretary, the Rt. Hon Theresa May MP announced a major review into deaths and serious incidents in police custody. This has just been published with much accompanying publicity – I have highlighted some key points raised in relation to mental health below:

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Several inquests over many years have highlighted police failure to recognise behaviour as the manifestation of mental ill health.

It notes the need for consistent national training for the police on dealing with mental ill health because it has become a major part of daily policing both with victims and suspects.

Research by the Guardian in January 2016 suggested that ‘UK police are spending as much as 40% of their time dealing with incidents triggered by some kind of mental health issue’.

In its submission to the HAC on Mental Health and Policing, the following was highlighted – ‘Disturbingly, a recent national custody survey of police inspectors identified that 76% had not received training in dealing with the mentally ill in custody’.

In oral evidence to this review, Michael Brown, the national mental health coordinator for the College of Policing, stated that new police recruits may only get six hours training in mental health awareness before graduation. His recent blog on this review can be found here.

Recommendations from the review include:
• Commitment and responsibility at leadership level is needed across police forces to ensure prioritisation of the issue of mental health and to bring about sustained cultural, organisational and practical changes.

• National, comprehensive, quality assured mental health training consistent with the above is needed for all officers in front-line or custody roles. This should span all new recruits and regular refresher training.

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Thriving at work: part 2

Thriving

“Many employers are already creating healthy, inclusive workplaces, but more needs to be done so that employers provide the support needed for employees with mental health conditions.” – Prime Minister Theresa May, January 2017

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This blog sits alongside Part 1 from a few days ago which celebrated the excellent Thriving at work Stevenson / Farmer review of mental health and employers, commissioned by the prime minister, published last week on 26th October.
Along with the clear and practical expectations on employers going forward it introduces aspirations:

• Every one of us will have the knowledge, tools and confidence, to understand and look after our own mental health and the mental health of those around us.
• All organisations will be equipped with the awareness and tools to not only address but prevent mental ill health caused or worsened by work
• Be equipped to support individuals with a mental health condition to thrive from recruitment, and throughout the organisation

Deloitte’s analysis which supports the report notes that investments made in improving mental health show a consistently positive return on investment… a finding which is bolstered by a number of academic meta-studies which demonstrate the same.

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Thriving at work: part 1

915_630_1__147621509002434_ThrivingatWork2017MAIN“Mom always tells me to celebrate everyone’s uniqueness.
I like the way that sounds” – Hilary Duff

The excellent ‘Thriving at work’ Stevenson / Farmer review of mental health and employers, commissioned by the prime minister, made the headlines when published a few days ago 26th October.

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It does a great job of recognising the alignment of current professional and economic thinking with the political direction of travel (a thing in itself to be celebrated)! It goes beyond an excellent analysis of the current state of the nation to making clear recommendations as to practical steps forward.

It resonates with my earlier blog on Carers and the need to be focussing our efforts and resources upstream. Firstly it needs to be applauded for normalising mental health and recognising it as an issue that affects all of us and underlining the economic importance of our response.

4 impact statistics:
• 300,000 people with a long term mental health problem lose their jobs each year
• Around 15% of people at work have symptoms of an existing mental health condition
• There is a large annual cost to employers of between £33 billion and £42 billion
• The cost of poor mental health to the economy as a whole is between £74 billion and £99 billion per year

Important recommendations:
• The report sets out workplace ‘mental health core standards’ – a framework for a set of actions to implement quickly and include:
o Each organisation to produce, implement and communicate a mental health at work plan & develop mental health awareness among employees

• It also sets out ‘mental health enhanced standards’ to reach 46% of employees of all public sector employers and the 3,500 private sector companies with more than 500 employees which include:
o To provide internal and external reporting on mental health
o Ensure provision of tailored in-house mental health support

I will be returning and celebrating this report in part 2 of this blog shortly, but to finish a thought from the report:

‘The Lancet has published findings from a study in the Australian Fire Service which found that a manager mental health training programme led to a significant reduction in work-related sickness absence, with an associated return on investment of £9.98 for each pound spent on such training’.

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Three pieces of charitable advice worth heeding

ship in a storm

“There is a perfect organisational structure out there, it’s just that since 1948 [NHS] we have not found it; perhaps we are just one more organisational change away!”    Professor Jon Glasby

I am often asked by charities to work alongside their boards and senior teams to help develop their strategy. Reflecting on this here are 3 pithy pieces of advice.

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Retain your sovereignty
The radical cuts to statutory services and the resultant effect on their purse strings, has meant that charities are invited to compete for ever diminishing resources. Too often I have witnessed charities putting together detailed bids for contracts which they should have walked away from on first analysis. The results of gaining an undesirable contract are significant; service failure, financial pain, reputational damage, being pulled out of shape to name but a few – advice:
Question if the contract is desirable
Avoid colluding with a race to the bottom
If it does not stack up don’t be afraid to walk away
Your charity is not a statutory sector dept, put aside any notion that they will look after your interests – retain your sovereignty it is a valuable asset

Take the initiative
Don’t be passive recipients, instead be well informed about the issues.
Engineer creative solutions
Seek to avoid best value bureaucratic processes, instead run pilot schemes, make them work and become irreplaceable

Value your memory
The statutory sector is a political football and as a result it suffers from persistent upheaval as it is charged with implementing untested ideas often without evidence base. This results in continual disorientation of services and those who work within them. Managers come and go at an alarming rate, their job titles change as do their priorities and the organogram pinned to the notice board no longer represents who they should be reporting to.
These large scale changes has served to fracture their understanding of the community they serve and the history of what has gone before. Rather like a ship trying to plot the coastline whilst caught up in a force 8 gale.
Charities have been much more stable entities and as such they have become the holders of the communal memory – advice:
Recognise & value this, don’t be shy to share your insights, do it assertively & become the conduit that joins together statutory sector thinking.

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Carers live in a land called Upstream

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“Treat the future well; it was not given to you by your parents, it was loaned to you by your children”    Adapted from a north American Indian saying

Any sensible review of care; how we provide it and the cost of providing it, will recognise that we need to intervene upstream. This blog takes a view on the lack of support for carers, those 6.5million unpaid friends and family members who day after day provide the care without which our health and social care system would be overrun.

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So what do we mean by upstream?
Looking for the causes of long term health e.g. educating and encouraging healthy eating and exercise helps prevent type 2 diabetes, cardiac disease and a 101 other ailments. Providing early intervention with mental health problems helps to prevent hospital admissions, sex education helps reduce unplanned pregnancies etc.

As Public Health notes, investing upstream in prevention rather than downstream in intervention is often wiser and more effective, or as grandma said “a stitch in time…”

Simple then, so why do we sell off playing fields whilst increasing a focus on the 3 R’s and then act surprised when surrounded by childhood obesity? Why when faced with savage local authority cuts is our attention immediately drawn from prevention to the pressing symptoms and expensive reactive interventions?

So in this extended period of austerity let’s talk about carers,  if carers stopped today the swamped system which would collapse tomorrow – simple. Nothing can be clearer than the upstream contribution carers make to the system.

You may say “well it was always thus” however the UK demographic is changing strikingly, some facts to ponder:

• One in five people aged 50-64 in the UK are carers to an older family member, yet the same number have no children of their own to fulfill this role for them, already one million over 65’s fit into this category and this is forecasted to double by 2030.

• Carers aged 75 and over have increased by 35% since 2001

• There are now more older people in need of care than there are adult children able to provide it.

The 2014 Care Act did provide recognition and provided some rights e.g. to have a carers assessment, but the harsh reality in these times of de-growth is that cash strapped local authorities fail to ‘advertise’ this, have created waiting lists and have then restricted the resources allocated post assessment.

Surely if we cannot get our act together to do anything else upstream, we should be providing much more meaningful resource to the unpaid workforce that lives there, because if they crumble its game over.400dpiLogoCropped

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A cruel irony

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“Do not make important what you can measure, measure what is important”

The CQC are officially part of the drive that causes the outcome they are not going to measure – read on!

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The CQC have just released a report – ‘The State of Mental Health Care’ & Michael Brown in his Mental Health Cop (highly recommended) blog notes from the report:

“There is national concern about the difficulty of finding a bed when a young person requires inpatient care. When a bed is found, it is often a long way from the young person’s home. We do not always detect this unmet need because our assessment focuses on the quality of the care provided to patients who are already on the ward, and not to those that require or are awaiting admission. However, we have received reports of the impact of the unavailability of inpatient care. This includes a letter from an assistant chief constable about a 17-year old who was kept in a police cell for 78 hours because no bed was available. The assistant chief constable commented that “the majority of this time in police custody was unlawful and it amounts to a human rights violation, given that Article 5 of the European Convention on Human Rights prevents detention by the state except in accordance with processes outlined by domestic law”.

He goes on to note that police forces have threatened and started action against the NHS over this issue. If this is not a clear indication of how bad things have got and how community mental health need is being mopped up by the police then I do not know what is!

But can we take this analysis one step further, namely that the source of the problem is the powerful Transforming Care Delivery Board’s (TCDB) overtly stated intention to sharply reduce inpatient beds (in which they are succeeding) it is this that has lead directly to this kind of suffering.

Now the idea that better designed services in the community will be forthcoming is wishful thinking. The scale of the cuts to local authority budgets over the last few years has meant that far from services moving up stream the only thing that has gone up is the threshold criteria to receive services.

However let us just consider a further irony in the system; the CQC are extremely unlikely to drill down on this issue because they formally signed away their neutrality when they signed up as a core member to the TCDB – they are officially part of the drive that causes the outcome they are not going to measure!

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