Ruby Stockham writes:
At the mental health charity Mind’s conference event yesterday, the newly appointed shadow minister for mental health Luciana Berger described how the good will that UK mental health services have been running on for years is ebbing away.
Since the Health and Social Care Act introduced the concept of ‘parity of esteem’ between mental and physical health care in 2012, there has been a widening gap between the rhetoric and reality of this supposed equality.
This is because the very same legislation also fragmented all aspects of the health service to the point that access to mental health care is, as the panel put it, ‘almost nonexistent’ for many people.
Because there are now so many bodies involved in administrating healthcare, it is difficult for decisions or changes to be made expediently.
The Health and Social Care Act disrupted what is known as the ‘patient pathway’ – the route a patient takes between first GP contact and the completion of their treatment in whichever department they need for their condition.
Because the HSC Act increased competitive tendering in the NHS, providers are more mixed than ever. This has led to the pathway becoming increasingly convoluted and made it difficult to trace accountability.
So while the National Commissioning Board is responsible for commissioning primary care, community and hospital services are commissioned by a variety of clinical commissioning groups (CCGs) supported by a commissioning support service.
Sound confusing? It is, and it is damaging standards of care.
York Central MP Rachel Maskell gave the example yesterday of Bootham Park Psychiatric Hospital in York, which has just been ordered to close.
In 2014 inspectors found a number of serious problems with the facilities, not least a prominent old sign reading ‘Lunatic Asylum’.
Inspectors found ligature points and doors which could be barred, presenting serious suicide risks.
The inspectors ordered urgent improvements but when they returned earlier this month found these had not been made.
According to Maskell this was partly because there are so many different bodies involved in the running of the hospital that the decision-making process slows to a halt.
Fragmentation also means that it is incredibly difficult for someone with a mental health problem to ‘get in’ to the system to begn treatment.
GPs may be unsure which services are available locally, leading patients to ‘fall through’ the gaps, passed off as ‘too severe’, ‘not severe enough’, or not fitting age criteria.
Somebody in crisis – who has attempted suicide, for example, or been hospitalised for an eating disorder – will always be given the emergency treatment they need.
But this will often be followed up by the news that there is a year-long waiting list to see a counsellor.
This is hopeless. It puts people’s lives on hold, leading to relapses, job losses and worse.
The lack of integration of services also means that a patient’s treatment is often left to the discretion of the first point of contact.
Some GPs will put medication at the centre of treatment plans, whereas others will be more likely to prescribe a ‘talking cure’.
There needs to be integration of these services so that nobody misses out on receiving the treatment most suitable for them.
Of course, long waiting lists are also down to a lack of funding.
Under the coalition there was a £50 million cut to children’s mental health services, and a loss of 3,300 specialist mental health nurses and 1,500 mental health beds.
Despite a government pledge to increase spending on mental health, freedom of information requests made by Labour earlier this year suggested that 50 of the 130 CCGs who responded plan to reduce the proportion of the budget they spend on mental health for 2015/16.
The Conservatives have yet to practice the parity of esteem that they preached.
This is an opportunity for Labour to step up and show that they still understand healthcare as a system that prioritises patients, not market competition.
And:
There are alarming ethnic inequalities in mental healthcare in the UK.
Access to quality treatment is inadequate for everyone at the moment, but if you are from a Black or Minority Ethnic (BME) background it’s likely to be even worse.
BME experience in mental health services became a national issue surrounding the 2004 inquiry into the death of David Bennett, a 38-year-old African-Caribbean man suffering from schizophrenia.
The report found that Bennett was, in his sister’s words, treated ‘like a lesser being’ in the series of events that led to his being forcibly restrained for almost 25 minutes.
Research over the last 50 years has repeatedly shown that BME communities have more adverse experiences and worse outcomes within mental health care than the rest of the population.
The Joint Commissioning Panel for Mental Health (JCPMH) says that ‘ethnic differences are apparent in most aspects of mental health care in the UK’ and that different ethnicities report different experiences of access to care and treatment, choice of treatment, length of stay in hospitals and quality of care.
According to the charity Mind, BME people with mental health problems are more likely to present ‘in crisis’, appearing at A&E or being referred by police.
This suggests insufficient access to community support services or home treatment, as well as a reluctance to seek help until the last minute.
This is likely due to fear and mistrust because of differences in the way BME patients are treated.
In 2013 less than 40 per cent of white British and Irish inpatients were subject to detention under the Mental Health Act compared to over 60 per cent of inpatients from BME backgrounds.
The outcomes of treatment are also more likely to be negative.
The latest data from the Health and Social Care Information Centre (HSCIC) showed that among people referred to psychological therapies in the past year, there has been a significantly higher ‘recovery’ rate for white people than for BME people.
Obviously, these inequalities do not only begin when someone enters the healthcare system. BME people across the UK are more likely to be in poverty or suffering from ill health.
An ONS study on subjective wellbeing and happiness found that the groups who reported the lowest average rating out of 10 for ‘life satisfaction’ were the ‘Black/African/Caribbean/Black British’ group (6.7), the ‘Bangladeshi’ group (7.0), the ‘Arab’ group (7.1), and the ‘Mixed/Multiple ethnic’ groups (7.1).
These ratings were all significantly lower than for the ‘White’ group who reported an average of 7.4 out of 10.
So what can be done to reduce ethnic inequalities in mental healthcare?
Jeremy Corbyn’s welcome focus on mental health is an opportunity to develop new strategies for addressing this problem. In both the long and short term, we need to consider:
At the mental health charity Mind’s conference event yesterday, the newly appointed shadow minister for mental health Luciana Berger described how the good will that UK mental health services have been running on for years is ebbing away.
Since the Health and Social Care Act introduced the concept of ‘parity of esteem’ between mental and physical health care in 2012, there has been a widening gap between the rhetoric and reality of this supposed equality.
This is because the very same legislation also fragmented all aspects of the health service to the point that access to mental health care is, as the panel put it, ‘almost nonexistent’ for many people.
Because there are now so many bodies involved in administrating healthcare, it is difficult for decisions or changes to be made expediently.
The Health and Social Care Act disrupted what is known as the ‘patient pathway’ – the route a patient takes between first GP contact and the completion of their treatment in whichever department they need for their condition.
Because the HSC Act increased competitive tendering in the NHS, providers are more mixed than ever. This has led to the pathway becoming increasingly convoluted and made it difficult to trace accountability.
So while the National Commissioning Board is responsible for commissioning primary care, community and hospital services are commissioned by a variety of clinical commissioning groups (CCGs) supported by a commissioning support service.
Sound confusing? It is, and it is damaging standards of care.
York Central MP Rachel Maskell gave the example yesterday of Bootham Park Psychiatric Hospital in York, which has just been ordered to close.
In 2014 inspectors found a number of serious problems with the facilities, not least a prominent old sign reading ‘Lunatic Asylum’.
Inspectors found ligature points and doors which could be barred, presenting serious suicide risks.
The inspectors ordered urgent improvements but when they returned earlier this month found these had not been made.
According to Maskell this was partly because there are so many different bodies involved in the running of the hospital that the decision-making process slows to a halt.
Fragmentation also means that it is incredibly difficult for someone with a mental health problem to ‘get in’ to the system to begn treatment.
GPs may be unsure which services are available locally, leading patients to ‘fall through’ the gaps, passed off as ‘too severe’, ‘not severe enough’, or not fitting age criteria.
Somebody in crisis – who has attempted suicide, for example, or been hospitalised for an eating disorder – will always be given the emergency treatment they need.
But this will often be followed up by the news that there is a year-long waiting list to see a counsellor.
This is hopeless. It puts people’s lives on hold, leading to relapses, job losses and worse.
The lack of integration of services also means that a patient’s treatment is often left to the discretion of the first point of contact.
Some GPs will put medication at the centre of treatment plans, whereas others will be more likely to prescribe a ‘talking cure’.
There needs to be integration of these services so that nobody misses out on receiving the treatment most suitable for them.
Of course, long waiting lists are also down to a lack of funding.
Under the coalition there was a £50 million cut to children’s mental health services, and a loss of 3,300 specialist mental health nurses and 1,500 mental health beds.
Despite a government pledge to increase spending on mental health, freedom of information requests made by Labour earlier this year suggested that 50 of the 130 CCGs who responded plan to reduce the proportion of the budget they spend on mental health for 2015/16.
The Conservatives have yet to practice the parity of esteem that they preached.
This is an opportunity for Labour to step up and show that they still understand healthcare as a system that prioritises patients, not market competition.
And:
There are alarming ethnic inequalities in mental healthcare in the UK.
Access to quality treatment is inadequate for everyone at the moment, but if you are from a Black or Minority Ethnic (BME) background it’s likely to be even worse.
BME experience in mental health services became a national issue surrounding the 2004 inquiry into the death of David Bennett, a 38-year-old African-Caribbean man suffering from schizophrenia.
The report found that Bennett was, in his sister’s words, treated ‘like a lesser being’ in the series of events that led to his being forcibly restrained for almost 25 minutes.
Research over the last 50 years has repeatedly shown that BME communities have more adverse experiences and worse outcomes within mental health care than the rest of the population.
The Joint Commissioning Panel for Mental Health (JCPMH) says that ‘ethnic differences are apparent in most aspects of mental health care in the UK’ and that different ethnicities report different experiences of access to care and treatment, choice of treatment, length of stay in hospitals and quality of care.
According to the charity Mind, BME people with mental health problems are more likely to present ‘in crisis’, appearing at A&E or being referred by police.
This suggests insufficient access to community support services or home treatment, as well as a reluctance to seek help until the last minute.
This is likely due to fear and mistrust because of differences in the way BME patients are treated.
In 2013 less than 40 per cent of white British and Irish inpatients were subject to detention under the Mental Health Act compared to over 60 per cent of inpatients from BME backgrounds.
The outcomes of treatment are also more likely to be negative.
The latest data from the Health and Social Care Information Centre (HSCIC) showed that among people referred to psychological therapies in the past year, there has been a significantly higher ‘recovery’ rate for white people than for BME people.
Obviously, these inequalities do not only begin when someone enters the healthcare system. BME people across the UK are more likely to be in poverty or suffering from ill health.
An ONS study on subjective wellbeing and happiness found that the groups who reported the lowest average rating out of 10 for ‘life satisfaction’ were the ‘Black/African/Caribbean/Black British’ group (6.7), the ‘Bangladeshi’ group (7.0), the ‘Arab’ group (7.1), and the ‘Mixed/Multiple ethnic’ groups (7.1).
These ratings were all significantly lower than for the ‘White’ group who reported an average of 7.4 out of 10.
So what can be done to reduce ethnic inequalities in mental healthcare?
Jeremy Corbyn’s welcome focus on mental health is an opportunity to develop new strategies for addressing this problem. In both the long and short term, we need to consider:
- That lack of appropriate understanding of racism that exists within the mental healthcare system perpetuates the problem. Put simply, if a young black man with a mental health problem expects to be treated like a criminal by staff he will be unlikely to seek help. Experience of racism in wider society may exacerbate this problem. (David Bennett’s problems were repeatedly blamed on marijuana use).
- Conducting an inquiry into higher rates of compulsory detention among BME inpatients and developing systems to better ensure that use of detention, and use of force, are always appropriate. Noone should ever be afraid to approach the health service.
- That lack of information about mental health may prevent people from BME communities from seeking help. Different cultural frames of reference may affect how a person with mental illness is viewed in their community. Better education in schools with high BME populations would be one way to reduce the stigma surrounding mental illness and encourage understanding.
- Psychological distress and complex emotions often need mother tongue communication. It is important that enough health professionals within BME communities are trained to offer support in patients’ own language. A mental health worker should be able to support a patient in what Mind calls ‘the context of their whole life’ which may point to specific cultural or religious components. Peer or survivor-led groups could be one way to approach this.
- Recording and measuring the experiences of service users should be routine.
Of course, much of this is dependent on better funding, but costs could be reduced if there was more focus on prevention, with educational and community initiatives intervening before people end up in A&E.
Mental health costs the economy as much as £70m a year – the status-quo is not working economically any more than it is working for vulnerable people.
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