In this blog, Mary Frances Trust Patron, Bernie Muir, shares her views on this year’s theme for World Mental Health Day: “Mental Health for All – Greater Investment – Greater Access. Everyone, everywhere” as well as highlights the many opportunities that arise from investing in mental health in every aspect of our lives, especially in light of the recent pandemic.
Bernie is Surrey County Councillor for Epsom West as well as Epsom & Ewell Borough Councillor for Stamford Ward and Chair of Surrey County Council’s Adults and Health Select Committee.
“This is a huge subject which touches on EVERY aspect of life so this blog is by no means an exhaustive look at the subject in the round. I have taken an overview of some areas of change, especially those that have arisen since the COVID-19 Pandemic.
Early intervention and tailored support
Clearly, mental health issues that arise in childhood, if unaddressed, run through to adulthood which can have far reaching consequences for the next generation and can indeed impact society as a whole. Provision of children’s mental health services varies hugely across the country in terms of access, wait times, consistency of service and constancy of staff. At Surrey County Council, we embarked on a massive transformation programme in children services which is underway, and within that will be new approaches to provision for mental health and learning difficulties. Whilst always striving to prevent the need for mental health provision, many children do need significant support for a host of reasons, for example, difficult circumstance, personal challenges, tragedies or incredible pressures such as being young carers to mention but a few.
Diverse communities have diverse needs and the need to tailor appropriate support is also key. Again, there are thousands of organisations seeking to address individual needs and recent work has shown that often appropriate signposting can be an issue to getting the right individual to the right support. Support is not universally available and different authorities and organisation are not singing off the same song sheet.
Navigating the justice system for those with mental health issues can also be challenging. Again, mental health provision is not available 24/7 and from the custody suite through to the courts and detention can be extremely difficult for perpetrators with mental health condition and victims of crime and much more.
The aforementioned examples are just a few that show the need to build a strong base foundation for good mental health practices nationwide from the get-go. I have been involved, one way or another, with mental health support for decades. I’m currently a member of a mental health task group which is just about to report on its initial Phase 1 high level findings. As Chair of Surrey County Council’s Adults and Health Select Committee, I have introduced two more regular attendees at our select committee meetings – one seat for a representative of mental health service providers and the other to represent mental health service users as I believe that mental health should be built in from the get-go into everything we do.
Mental health as front and centre
Quite simply Mental Health belongs, front and centre of policy creation and should receive increased funding. It is a false economy not to. From those that are vulnerable, needing lifelong support, to those who have had a brief experience of poor mental health from which they recover, the list of those needing support at some point is a long one. One in four people will experience mental health issues and many more are impacted as a result. Almost everything that we do should be considered from a mental health perspective and all of us should at the very least receive mental health first aid training.
Mental and physical health are inextricably linked, yet mental health rarely seems to be at the core of policy, strategy and planning and, in general, is not a priority. Training in relation to mental health has yet to be as ubiquitous as it should be given the prevalence of mental health issues.
Even in seemingly disconnected areas such as house building, town planning, employment, transport, and retail, there is the potential to plan in good mental health or inadvertently build in poor mental health.
When people experience significant challenges, in many cases whilst they may receive practical help, there is a tendency for the mental health implications to be overlooked. Failure to pre-empt mental health problems resulting from, say bereavement, victims of crime, homelessness, unemployment, abuse, is almost certainly going to set in train much worse down the line. Having spoken to those who have faced life changing events, it is clear that we should be aware of the link between circumstance, practical help and awareness of the impacts on BOTH physical and mental health.
The importance of shining the spotlight on what makes good mental health is key to raising the bar.
What makes good mental health
It is time that mental health was front and centre of everything we do from our actions as individuals, our behaviours towards each other, health provision at all levels, organisation, institutions, business, social groups, charities, community groups, sport, media, technology, local authorities, providers of services, Government policy and much more.
Prevention, early intervention, ongoing mental health services, social prescription, mental health facilities, consultants and third sector providers are part of the equation. One issue is that early diagnosis often leads to people falling between two stools – not being quite ill enough for one service or too ill for another. There is a lot of work being done to address this and to provide more streamlined services.
In Surrey, there has been a pilot to introduce GPimhs (General Practice Integrated Mental Health Service) in three areas – a very innovative project in which Mary Frances Trust plays an important part. GPimhs is indeed a new community mental health service designed to improve access to a wide range of specialist support by having mental health practitioners based at GP surgeries who can signpost patients. It seems to have been well received by practitioners and service users and it is therefore being rolled out to a total of 11 sites. It will be interesting to see how this service develops.
One underlying problem is that not enough nurses and medical students are choosing to be mental health specialists. Sadly, those choosing not to specialise get minimal mental health training during their studies and, thereafter, further mental health training is largely voluntary. Given that identifying mental health is vital for early intervention and outcomes, I think the time has come to give much great prevalence to mental health training from the get-go and there should be regular and obligatory mental health refreshers and top up training for the majority of practitioners across medial services.
The role of the third sector
In addition to needing more specialists, councillors, psychiatrists and psychologists there is no doubt that mental health needs more investment/funding not just to the NHS and Local Authorities, but to the third sector who are, in many cases, best placed to offer what is really needed. Charities often consist of long-established teams, who can adapt easily to provide tailored solutions within the community. They are at the ‘coal face’, the ‘front line’ and therefore should be at the top table as significant contributors in discussions on policy, programmes and strategies.
Examples of just such organisations include Mary Frances Trust, The Old Moat Garden Centre and Catalyst. Mary Frances Trust offers skilled mental health support, social interaction, activities and training for a wide sector of the community to support wellbeing and enablement. They offer an environment where individuals feel safe to talk about their mental health and were targeted programmes are created.
The Richmond Fellowship’s Old Moat Garden Centre provide work-based therapy to help people return to work, start work or gain enough confidence to join mainstream activities. They are part of the wider community and again create an environment where people feel safe to talk about their mental health.
And, Catalyst offers support, guidance and activities to enhance wellbeing. They specialise in offering support to drug and alcohol users and offer support to the individual, families and friends through counselling, group work and much more.
Having spoken to the service providers and service users of these organisations, it is clear how much the support, enablement and tailored programmes transform lives.
There are so many charities, voluntary groups, organisations, activities and opportunities that even mental health professionals and GPs are unaware of the wide scope of offerings, let alone service users. It would therefore be helpful, in order to improve access, that a more efficient information portal could be established detailing mental health services and tools. Whilst several exist, they often only really help if you know what you are looking for yet, generally, we don’t know what we don’t know.
It has been very helpful that celebrities and high-profile figures with huge followings are raising awareness regarding mental health. Their message is making it easier for people to talk about mental health. We now need this new awareness to filter through all aspects of our lives. Along with learning to reach out when we have issues, we also need to learn how to open dialogue, recognise mental health issues in others and learn how to effectively reach out to those around us.
But it’s not just about individuals, we need institutions, organisations and employers to know how to create good environments, integrate good practice and instil culture change to strive for good mental health and to establish strong and appropriate responses when issues arise.
Understanding what good mental health practices look like requires more work. Whilst companies, institutions and organisations say they have a mental health strategy, sadly, all too often the strategies are, at best, reactionary rather than proactively building and promoting good mental health. Some enlightened employers are seeing the benefits of mental health training and/or mental health first aid sessions for everyone in their organisation. I sincerely hope that this will become the norm.
Another area where employers could have a major impact is recruiting people who have challenges such a learning difficulties or Autism, to name but two. We need to encourage employers to recognise the skills of people who have challenges. Many people who have employable skills are overlooked. The Employability scheme has done a great job in this regard, matching individuals with businesses with wonderful outcomes. Recruitment policies are, at times, barriers to those people seeking employment which, of course, has a huge impact on mental health. Addressing this could positively impact hundreds of thousands of people.
We hear a lot about Reskilling Programmes. If employers understood the value in employing people with challenges, then these reskilling programmes could be part of creating a highly appropriately skilled and loyal workforce, selected on a strengths-based approach rather than focusing on challenges which might have no bearing on their ability to do the job.
Opportunities arising from the pandemic
Another recent lifestyle change that could help people with mental health challenges and/or learning difficulties back into employment is agile working. This new approach to work reduces the emphasis on fixed working timetables which, in itself, may present many opportunities. People who have anxiety, for instance, can perhaps find work patterns that better suit them. It eliminates the need for stressful commuting and avoids stressful office dynamics. So, in many ways, employers willing to make this culture shift have the power to make great inroads towards better mental health for all and to create vital opportunities for the thousands desperate to be valued and employed.
More generally, there have been strenuous efforts to reform mental health provision over the last few years. These reforms, some in transition right now, are being sorely tested with the huge impact on mental health of COVID-19 on our shores.
This virus has been extraordinarily hard on many, with the obvious health issues, loss of life and the resultant impact on loved ones, the impact of lockdown, home-schooling and shielding, isolation, practical struggles, impacts on work and businesses, personal relationship and the resulting financial, physical, social and mental health implications.
Indeed, a report, that appeared in European Psychiatry written by Andrea Fiorillo and Philip Gorwood, concluded that the mental health and psycho-social consequences of the COVID-19 pandemic may be particularly serious for at least four groups of people:
1. Those who have been directly or indirectly in contact with the virus;
2. Those who are already vulnerable to biological or psycho-social stressors (including people affected by mental health problems);
3. health professionals (because of the higher level of exposure); and
4. even people who are following the news through numerous media channels.
Clearly, we have huge challenges ahead. The pandemic is still firmly here and we have by no means felt the full force of the impact on employment, the economy and our ability to support those who will be most impacted.
However, some changes may deliver some unexpected benefits and may, if harnessed, help to forge stronger communities. Two such changes include (1) the huge increase in volunteers and community engagement which has had a profound effect on many, and (2) agile working which may deliver the ‘15-minute neighbourhood’ where people live, work, socialise and shop within a short distance of their home. This, in some cases, could be a great boost to locality. Agile working means people are available to engage because they are at home, not wasting time commuting and may actually need to get out into their community to engage, participate, volunteer or even initiate new community initiatives. If we plan for this, then we may see much more potential for integration, interaction and the greater take up of local initiatives. All of this can help to enhance the mental health of the wider community.
The collaboration of thousands of volunteers, discovering for the first time the joy of getting involved with charity and community organisations has shown just what a powerful force they can be.
The ripples from this are far reaching. Significant numbers are taking these lessons back into their own lives and recognising what can be done and what should be done.
Another lesson from the pandemic is the lowering of barriers and unwieldy practices. During this pandemic many organisations, both large and small, reacted swiftly, often enabled by the removal of barriers and employing more agile ways of operating services. More responsive partnerships should be encouraged, planned for and enabled. In recent months, we have seen huge efforts to strengthen existing partnerships between local government and community organisations, the third sector and individuals striving, at breakneck speed, establishing new pathways and moving away from restrictive silos to achieve significant outcomes. As we move forward, it is important that we work actively to nurture the relationships that have been developed and foster the community engagement that has been achieved.
Another lesson from this pandemic is the innovative use of technology and social media. This has delivered some remarkable solutions to reach out to people needing support. However, in embracing these achievements we also need to empower people against the worst excesses of social media which can be highly damaging to mental health. We need to help social media users to recognise the issues, scams and to avoid those who set out to harm.
On the positive side, technology can really help to reach those that need support, offering activities, classes, connections, counselling and vital mental health services during this pandemic. This access has proved popular and we can develop these capabilities still further.
The pandemic has seen a far greater cohort of people fixed up with these new means of communication. However, many do not have the means to access these lifelines and we must actively strive to level the technology playing field to help both young and old alike. Local Authorities, NHS, business and charities are all working to redress this balance providing IT advice/training, equipment, connections to the internet and more. But we still need to do more. I sincerely hope that we can do this quickly. I have just funded a pilot scheme that grew out of needs that became evident during the COVID-19 lockdown. I attended the first session of this Covid-compliant pilot study and was astounded at the positive impact. We had Tech Angels offering advice and equipment, the Surrey Coalition of Disabled People were finding simple and practical solutions to issues that were severely hampering those with recent catastrophic life changes. The change in demeanour, in just a couple of hours, was astounding. There was no doubt that this creative six-week social and enablement programme was money well spent.
I saw for myself how this programme and the virtual sessions offered by the mental health charities made such a difference. Service users told me they wanted to continue with hybrid arrangements when Covid-19 is more under control, wishing to access a combination of face-to-face sessions with virtual opportunities. I think we are only just beginning to realise the potential of these new avenues.
Building the future
Housing, or the lack of it, is another pressing issue. Crucially, we need to rethink how we go about delivering the social and affordable housing that is so badly needed. I strongly believe that the built environment has a major impact on mental health and behaviours. In my view, it is absolutely possible to build housing that facilitates good mental health as well as physical health. We need inspired local plans, good designs, realistic housing targets, all of which should be viewed through the mental health prism. Space and community-centric facilities should be a requirement. Good form and design, in keeping with the local vernacular, develops a sense of identity, belonging and pride, key component towards good mental health and social cohesion. Given the likelihood of people living, working and playing in their locality, this will be even more important.
Another area that greatly reduces the opportunities for people experiencing mental health issues, anxiety or panic attacks is public transport. Do transport planners have mental health advisers involved at the inception of their plans? And, are mental health friendly initiatives built into their budgets? Much could be done to create less anxiety. One such example is the need to provide toilet facilities on all trains and at all stations. The lack of toilets means that those who are prone to anxiety and panic attacks often are excluded from making journeys which limits employment options and can curtail social inclusion.
When building new communities in the future, we must build in strategies to promote good mental health, making it easier for people to reach out. And we must be better equipped to support those within our communities, considering mental health at every turn and in every decision.
With the re-engagement of volunteers, community groups, charities and Local Authorities, we have the chance to provide facilities and activities to develop the very best in social prescription. Active and diverse local communities go some way to contributing towards tackling inequalities, social isolation, loneliness and mental health issues.
As we move forward, we have a real chance to find a new balance in which we embrace the power of stronger communities, embrace better ways of working, new supportive ways of living and achieving greener environments.
Real integration generates so much – reducing misunderstandings, reducing isolation, providing opportunities – and is ultimately capable of enabling many, supporting others and transforming lives. We cannot miss this opportunity. We need to galvanise those who are now engaging. We need to actively evaluate the potential of the changes that have taken place, both positive and negative, so that ultimately, we can build viable, strong, inclusive and diverse communities to, amongst other benefits, promote good mental health and to provide real opportunities that those with mental health challenges deserve.
Mental Health needs to be given a high priority, right from what we do as individuals to Government’s approach to mental health. It needs parity with physical health. The scales are tipping gradually towards that, but this needs to speed up. In the meantime, we can all help create awareness, create supportive environments and ensure that we get mental health at the heart of everything we do.
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