Let’s be more aware, take stock and celebrate best practice

NHS England’s National Clinical Director for Mental Health marks the start of Mental Health Awareness Week with a look at how messages are getting across:

While the nation has been swept up in the drama of the election, backstage the NHS has continued with business as usual.

And so this week’s Mental Health Awareness Week #MHAW15 is a chance for us to reflect on how the growing awareness about mental health has reached the hearts and minds of millions and is influencing decision makers in many sectors of our society.

In the past year, the appetite for information about mental health has reached unprecedented levels. Every day, across the country and indeed the world, there are newspaper and magazine articles, radio and TV programmes, thought pieces, new facts and figures, and live narrative stories.

The thoughtful and compassionate nature of this very welcome media attention is a far cry from the past, where stories based on ignorance, fear, stigma, and misinformation was common. Today the public and media are increasingly sophisticated in their ‘awareness’ of the impacts on individuals, communities, wider society and healthcare.

Let me give you some examples of some of the most far reaching developments: first, people want to be more aware of their own mental health.

More and more individuals and parents want to understand and develop their own, and their children’s positive mental health and prevent illness developing.

One of the most popular website hits on Google is our NHS Choices mental health webpages, developed in response to the common questions people are asking, which include: ‘How do I develop my mental health? What influences make me the person I am? Can I work on building good mental health like I do for my physical health? Can I change my behaviours and thinking to make better choices about my lifestyle and relationships? Can I really be a better parent, sister, grandma, neighbour, and friend?’

Particularly popular are the self-assessment questionnaires on depression and anxiety. The appetite for learning and self-empowerment is growing almost as fast as the digital world can provide it!

Second, awareness that mental ill health can be prevented is finally landing!

As a clinician, it’s so often been heart breaking to read the referral letters to my services and see, over and over again, the same tragic stories, the many missed opportunities for prevention, and for the earlier recognition and treatments that would have totally changed the person’s life chances, and prevented their lifelong need for services.

The scientific developments from many disciplines and powerful patient narratives are leading to a growing international consensus on the causes, triggers and the ‘science’ of mental health. They have raised awareness about the complex interplay between a person’s genetics, biochemistry, brain development and formative life experiences.

The great myths of ignorance – that mental illness has no scientific basis, has no cost effective, evidence based effective treatments, and that all conditions are inevitably long term – have been debunked.

Seventy per cent of all mental illness starts in childhood and adolescence and before the age of 24, and local community leaders and decision makers now have major opportunities to prevent the impacts of adverse and causal early life experiences, and to ensure early intervention at the acute stages of illnesses. This thinking is changing lives.

Across the country we are seeing innovations in prevention with inputs from NHS England and its partners. Among these are: the movement for zero childhood physical, sexual and emotional abuse, and for support for parenting and relationship developments; schools with mental health awareness and resilience trained school nurses, form tutors and governors; creative use of the pupils premium to provide rapid access to effective support for pupils and their families; colleges and universities providing mindfulness and building resilience programmes; employers putting in place ‘win win’ productive healthy life places and much more.

Third, the beginning of the end of the curious division of people into ‘mind’ and ‘body’ parts.

Across England we are seeing an explosion in innovations that will deliver the Five-year Forward View integrations: integration of physical and mental health care, primary and specialist pathways and health and social care. The evidence that seeing people as either just  ‘body’ or just ‘mind’ parts, rather than as a whole person, results in poor outcomes for patient and poor value for commissioners is there.

Unassessed and untreated mental ill health leads to physical ill health and long-term conditions. For example, people suffering untreated depression and anxiety, are significantly more likely to develop heart and lung diseases, diabetes, cancer, die up to 20 years prematurely, more often use crisis services and have repeated hospital admissions.

Likewise unassessed and untreated physical illness in people with severe mental illness results in early deaths, great distress and low quality of life. The wholesale changes to clinical assessments, treatments and care pathways, workforce training, commissioning and provision will take time but there are great signs of change.

Primary care mental health and integrated care innovations are growing at pace.

There is a new army of primary care mental health leaders and CCG commissioners. They are hungry for new mental health knowledge and training and professional bodies are working at pace to better equip the workforce of the future.

Our Improving Access to Psychological Therapies (IAPT) programmes  means that over two million people have experienced the benefits of treatments.

Our London Strategic clinical network has published 72 prime examples of integrated care. Many initiatives are the result of discussions with patients and families, and straight talking and partnership to change care pathways.

The culture is changing from the passive patient recipient, to ‘educating to’, living well with ‘coaching for’ partnership between professionals and patients. Evaluations are progressing, and there will be much learning.

This week I want to take the opportunity to showcase just a few of the programmes and initiatives which are really thriving in our communities and providing fantastic support to service users and their families up and down the country.

One example is a scheme running in Bradford which is changing the lives of thousands of people thanks to a new system to ensure patients get physical health checks alongside their mental health check. This is just one illustration of change which is helping us to implement the parity of esteem agenda bringing mental health care onto a par with physical health care.

Kate Dale, mental health nurse and physical health project lead for Bradford District Care Trust (BDCT) which is behind the Bradford scheme, has described their results and some of the challenges they faced. Read about the Bradford scheme here and look out on the NHS England website each day this week for similar illustrations in other areas.

So what’s next on the awareness agenda? The Five Year Forward View partners have launched the Mental Health Taskforce which will be another major force for building awareness, not just about mental health per say but, importantly, about the actions that individuals, communities and organisations can take in response. I very much look forward to another dynamic, progressive year in mental health awareness.


Dr Geraldine Strathdee OBE,

Dr Geraldine Strathdee, OBE, MRCPsych, is the National Clinical Director for Mental Health, NHS England, a consultant psychiatrist in Oxleas NHS FT, and Visiting Professor, Integrated mental health education programme at UCL Partners.

For over 20 years she has held senior roles in mental health policy, regulation and clinical management, at national and London regional levels, and advises internationally on mental health service design and quality improvement, while working as a practising clinician. She has been involved in transformational large scale service development programmes, moving services from hospital based, to 24/7 home care and primary care models, in roles which have included: the Trust Director of Clinical services in Oxleas NHS FT (2005-2007), Director of Service development at the Sainsbury Centre for Mental Health and Senior Lecturer, UMDS ( 1995-1998). She was the National Professional Adviser in mental health to the Healthcare Commission and the Care Quality Commission (2005-2012).

Her particular commitment is to the translation of policy and best practice evidence into front line routine clinical practice, empowering service users to reach their potential, and staff to maximise their time to care. She is passionate about the development of leadership competencies and using information to enable informed decision-making.

As London SHA Associate Medical Director (2009-2013), with responsibility for mental health, she led transformational change through the development of clinical networks for dementia and primary care mental health CCG leaders, developed ground breaking commissioning support care pathway profiling informatics tools, and high impact educational programmes. She was awarded the prestigious RCpsych Psychiatrist of the Year award in 2012.

Clinically, she has worked in a wide range of primary care, inpatient and community services, and latterly with people with complex and multiple needs, as a Consultant Psychiatrist for the Bromley Assertive Community Treatment team in Oxleas. She is committed to providing services which enable services users to live in their own homes, develop their own personalised care plans and self management expertise to achieve recovery, while at the same time working with community agencies to deliver coordinated, responsive, care pathways.

Service evaluation and research interests: Her teams have won awards for their use of technology in improving care, using patients as experts in staff training and leadership awards for new Ways of Working, the redesign of roles. Her research interests have included the fields of primary care mental health, evaluation of community services and dual diagnosis. Current research interests include the evaluation of competency based leadership programmes and clinical networks to drive transformational improvements, and high impact educational programmes.