Last Thursday, I prepared myself to attend what looked to be an interesting event. I had no idea what to expect but being a free event and relevant to my field and work I couldn’t help myself and jumped at the opportunity to mingle and learn more.

The stage was set by Councillor Sue Anderson of Birmingham who introduced us to the speakers, programme but more importantly gave us a preview of the stats and current public mental health scene. Some information to contemplate included:

  • 1:6 people will experience mental illness symptoms at some point in their lives (1:4 is a more frequently used and widely accepted)
  • Mental health costs the economy £105bln per year
  • There are distinct connections between mental health, housing, employment and criminal justice (whilst this may seem obvious, this relationship is rarely referred to or reflected upon within treatment or accessing services in each of these areas. Multi-agency interaction is poor and lacks linking up and communication. [My opinion])
  • Current models of care are unsustainable in the current economic climate
  • An estimated 90% of people with a mental health condition are unemployed

These are all pieces of information that had the desired effect of making people sit up and listen. But what really struck home is the current need to “Do more with less money. Doing things differently in a cost effective way for better outcomes. How can we meet what the individual needs in our cost envelope?

And YET AGAIN… the conclusion that we heard echoed (over time as well as geographical space) was PREVENTION.

Dr Neil Deuchar (Medical Director of West Midlands Health Authority) started us off with a very informative presentation that gave a fantastic background to existing white papers concerning mental health and what the current plans are for approaching mental illness in the community. He gave a succinct and much appreciated (by me at least!) summary of “No Health, Without Mental Health“, the government strategy that supersedes “New Horizons” but importantly highlighted the need for prevention stating that “tackling poor mental health could reduce our overall disease burden by nearly a quarter”. The positive economic impact this would have does not require a genius to realise!

Dr Deuchar went on to mention the “Foresight Report: Mental Capital Wellbeing” published in 2008 by the GOS and the resulting “Five Ways to Wellbeing” published by the New Economics Foundation this year. Documents that are going to the top of my reading list.

Interestingly and more importantly, Dr Deuchar brought to our attention possible prevention approaches that might be adopted by “the powers that be” in order to address mental health issues in society:

  • Universal Approach – mental health promotion via e.g. schools, parents (the approach was compared to vaccination programmes in schools)
  • Targeted Approach – Primary prevention aimed at sub-populations who might be at risk e.g. women at risk of Post Natal Depression (PND)
  • Screening Approach – Secondary prevention targeted to individuals with early signs of certain conditions
All valid approaches that have their value! But the key is clear – PREVENTION.
My radar went off when I heard WEMWBS. WEMWBS stands for the Warwick-Edinburgh Mental Well-being Scale and measures psychological resilience. One of the issues many professionals face these days is the measurement of mental health conditions but as importantly the impact various treatments and approaches have on an individual’s mental health and well-being. There are a number of scales recognised within the field which also include CORE and EQ-5D but the question is always which is the most recognised, effective and accepted measurement scale. I have been contemplating which scale to use if any if measuring my own practices/ approach and WEMWBS does keep cropping up as well as within NHS settings.
Dr Khesh Sidhu continued from where Dr Deuchar had left off, starting out by reminding us of mental health and comorbidity (the presence of one or more disorders/ diseases in addition to a primary disease or disorder or the effect of such additional disorders). It is quite sobering to consider that, for example, people with diabetes are twice as likely to experience a mental health problem.
Equally valuable was the reminder that inequality is a key determinant of well-being. Ultimately those who are more at risk are the children of parents who have endured mental health problems, children of parents who are unemployed, looked after children, people who have experienced abuse and those with disabilities. Seems logical to me. And what seems even more logical is that to have an impact on adult mental health you need to prevent it from emerging or reduce its likelihood or impact in the first place. That means starting at the beginning – childhood.
We are not taught in school how to become emotionally resilient, intelligent or how to deal with the rollercoasters life throws at us. Is it any wonder then that we are then unable to cope or struggle to manage?
The most important thing (as much as we’d like to deny it) in society today is “Is it worth my investment?”. Dr Sidhu presented us with some examples of how cost benefit analysis strategies might be applied – through schools based social and emotional learning programmes, anti-bullying programmes, universal health visitor PND screening and by promoting well-being in the workplace. (At this point I found myself nodding furiously with such vigour I thought my head might roll across the floor…) Cost benefit analysis strategies for primary prevention might include counselling and practices such as befriending older adults, parenting interventions, early intervention of psychosis, Brief GP/ Primary care counselling, workplace CBT and collaborative care.
Again “prevention” echoed around the room with Jon Tomlinson’s presentation (Director of Joint Commissioning). Much of what was said, has admittedly been said before (as was the case with much of what was presented at the event), but now more than ever are we “feeling the pinch” and seeing the need not only for positive impact but value for money and as Councillor Anderson said “doing more with less money. Doing things differently in a cost effective way for better outcomes”. Mr Tomlinson reminded us of the key drivers for change – that we’re in a new world, with new challenges, with new rules, customer expectations, delivering more and different services, reducing budgets, partnership working [and yet again] prevention. The familiar echo of “we need to move from the medical model to the social model” resounded through the hall and I thought someone had hit replay…
Mr Tomlinson told us that Birmingham has built good foundations with £180mln for mental health in Birmingham (there remains some uncertainty regarding this figure and I am trying to find confirmation for this figure. Especially as this is nigh on £19mln more than the most recent lottery winners won!), has pooled budget arrangements, a new and changing governance and is piloting new approaches. However, targets are ambiguous, there have been significant changes to spending, the market is reshaping, individual budgets have been created (offering service user choice [my italics]), there is a more joined up response and there is more control for people and communities.
Jim McManus gave a fantastic presentation introducing those of us who weren’t already familiar with it, to Birmingham’s existing Joint Strategic Needs Assessment (JSNA). He very skillfully turned the stats, graphs and charts (which were difficult to see at a distance anyhow!) into an understandable and meaningful context. Whilst Mr McManus confirmed the statistics we’d already heard (e.g. that being in fuel poverty will double your risk of depression & people with mental health problems have an increased risk of comorbidity) he also presented us with a variety of reasons and ways of interpreting the data and statistics, for example, are more people identified or being categorised as having a mental health illness due to a rise in mental illness or an improvement in identifying symptoms?
Similar priorities were highlighted by Mr McManus –
  • to develop an integrated approach to tackle mental health conditions
  • to redesign services to address demand and diversity
  • to optimise resources
  • to create an integrated health check for people with mental health conditions
More sobering statistics accompanied us within Nicola Benge’s (Director of Public Health, Health Inequalities Theme Lead) presentation
  • mental health is the single largest cause of disability in the UK contributing up to 22.8% of the total burden
  • the annual cost of inequality in England is estimated at £56-69bln

Ms Benge also re-introduced us to the NEF’s “5Ways to Well-being” report, highlighted the need for mental health awareness training and that there should be a focus upon early intervention services dealing with psychoses and early identification and referral with particular regard to those in high risk groups where “access is disproportionate to prevalence”.

Despite the repetitious nature of some of what was being said, I cannot stress how I appreciate that everything mentioned, highlighted and proposed is of immense importance and crucial if we are to make positive changes to our existing mental health services and improve the lives of those who need these changes the most – those within those services. Those in the “system”. And those who need to access these services.
Food for thought.