It’s time to deliver real improvements

Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, explains why World Mental Health Day is a vital milestone:

The record number of events this World Mental Health Day shows the moment has come to deliver real improvements.

It is another sign that people are impatient for better prevention and more timely access to high quality services. While my professional focus has been on the latter part of the equation I cannot emphasise enough the importance of improving prevention.

We know that neglect, abuse, poverty, work stress, relationship difficulties and lack of timely access to good services all contribute to poor mental health. Whole communities need to recognise these factors and work together to reduce the causes, and intervene early, to give people the best evidence-based education and support.

Parents and children, in particular, need to learn how look after each other and themselves better – but everyone could do with help to manage the difficulties life throws at us.

If I want to learn Mandarin or advanced driving skills I can find a course round the corner but I would struggle to find one on improving my relationships, parenting skills or coping with emotional difficulties.

More adult education opportunities and support at work is needed so people can learn how to get the most out of life and not let stress turn into mental health distress. Not only is preventing ill health a good aim in itself but, if we are successful, it would give our services a greater opportunity to provide earlier, higher quality care to those who need it.

A third of all GP visits are by people with a mental health condition, and it is in primary care that more than 80 per cent of people with these conditions are looked after. Despite these demands we’ve had very little focus on supporting primary care to deliver the best mental health services.

Currently less than a third of GPs and fewer than half of practice nurses get up to date training in mental health care. This lack of knowledge and a lack of timely access to the best treatment lead to poor outcomes including greatly reduced life expectancy for people with serious mental illness.

NHS England is now supporting every GP and practice nurse with training to improve the physical health care of people with mental health problems.

In addition NHS England is now training for clinical commissioning group mental health leads to develop their leadership skills, understand best practice and use information about their area’s needs to commission the most effective services.

To provide that information NHS England has worked with Public Health England to create the Mental Health Intelligence Network. This pools all the information we have about the mental health system and makes it easy for anyone to understand what is happening in their area, enabling commissioners to make well informed decisions.

Part of the change we need to see to maintain progress is the end of the myth that, inevitably, mental illness is always a ‘long-term condition’. With the right, timely intervention there is no need for that to be the case and we can transform outcomes in mental health just as they have been transformed for many physical conditions.

In the past many cancers were recognised and treated very late which resulted in poor outcomes. In that regard mental health is in the same place that cancer was 15 years ago, and we need to make the same sort of changes in terms of early diagnosis and treatment times.

Instead of looking at mental illnesses, depression, eating disorders, anxiety conditions, alcohol addiction, and psychosis etcetera as long-term conditions, we should view them as a set of acute conditions that, just like acute physical conditions, require rapid access to the best evidence-based treatments.

Research shows that if people do get treatment early, they can recover, get into employment and lead a life they and their families enjoy.

The mandate from Government to NHS England is to introduce clear waiting time and access standards for people with mental ill health in the same way as we do in physical health, and the work to make that a reality has commenced this year.

With common mental health conditions like depression and anxiety we know that you get the best outcomes with rapid access to psychological therapy. In some parts of the country people are waiting a year, or even two years, for that therapy. Without timely access to evidence based services those people are more likely to get more ill and develop secondary problems like eating disorders, alcohol dependency, employment and relationship problems. For those individuals, and for taxpayers, it obviously makes sense to get them the treatment they need when they need it.

Providing timely access to evidence based treatment requires resources but it is a genuine investment that will pay for itself several times over through reduced pressure on GPs, A&E, acute hospitals, psychiatric services, social care, and the criminal justice and welfare systems.

All those agencies need to learn about mental health and to break down the barriers between the treatment of psychological and physical conditions. Acute hospitals with psychiatric liaison teams have been shown to dramatically cut their A&E waiting times, reduce admissions, increase home treatment and improve the outcomes of patients.

Those better outcomes are repeated when the teams go on to the wards and are able to diagnose other patients with a range of physical conditions who also need mental health support and treatment.

Every acute hospital should have such arrangements and NHS England is exploring how to make that a reality and incentivise trusts to deliver what we need.

Specialist mental health services have already gone through the great deinstitutionalisation process to help more people get their care at home. That process has plateaued and we now need to reach the next stage by talking to partners in housing, employment support services and local authorities to ensure that many more people get their care safely, at home and as active members of their local communities.

We also need to reach out and communicate better. If we are to make real progress we need to drop the jargon and talk to and listen to our patients and communities more effectively because when we have informed and influential service users, who know through experience what works and what doesn’t, then we get real improvements.

In my job I am lucky enough to see amazing, innovative, high quality care and support in every part of the country. Our challenge is to make these standards the norm, with whole communities working together to prevent ill health and treat illness in an effectively and timely way. I am convinced we will have made real progress in meeting that challenge by next year’s World Mental Health Day.

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.

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