A defining moment in mental health care

The introduction of the access and waiting time standards for mental health marks the start of a new era in England’s mental health services and in its healthcare system.

It is the start of the end of the low levels of access to effective care and treatments for so many people who live their lives in distress and despair.

It is an indication of a society, and healthcare system that now recognises that a great deal of mental ill health can be prevented. That access to care at the early stage of illness offers real opportunities for recovery. That our treatments are effective. That people with mental ill health, deserve and benefit from excellent care that enables them to develop their potential, live with hope, and contribute to their communities with the insights gained from the experience of illness and recovery.

Mental ill-health is very common. It affects one in four people in the course of their lives. The impacts start early as the onset of mental ill heath often starts in childhood, adolescence and young adulthood. But access to skilled assessment and excellent treatments is limited. The majority go untreated as on average just 30 per cent of those with ill health access care.

The questions often posed are: Isn’t most of it caused by poor lifestyle choices? Are rates of treatment so low because there is no evidence for effective treatments? Is it because all mental illnesses are inevitably long term and, as such, a poor investment for taxpayers?

The answers to all these ‘myths’ about mental ill health is a resounding, evidence based ‘No’.

The definition of mental health in the national ‘No Health without Mental Health’ policy is that it is a positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment. Levels of mental health are influenced by the conditions people are born into, grow up in, live and work in.

In order to address each of the common myths about mental ill health, it is important to examine the wealth of scientific evidence, and listen to the lived experience of those who have developed, lived with and have recovered from mental illness.

Mental ill health, like physical ill health, often has its roots in the interaction between the individual’s genetic, biological, neurodevelopmental and other fundamental attributes. Like so many healthcare conditions, it is the complex interaction between the individual and the environment in which she or he grows up, works in, lives in, that can protect against, or trigger, the development of mental illness.

For our children and young people, the bed rock to positive mental health is growing up in a stable, secure, loving home, in a safe, supportive community, where parents, family, friends, schools and the community can provide access to the opportunities needed to enable the person to reach their physical health, academic, creative, and positive mental health and resilience potential, and feel a sense of belonging and contribution to their communities.

Mental ill health is often triggered by adverse abuse experiences, including physical, emotional and sexual abuse, by bullying at school or by gangs, by a learning environment that does not recognise or support learning difficulties and emotional distress, by a community that does not have a sense of identity that means it can offer a sense of cohesion and opportunity.

The opportunities for prevention are therefore great, and increasingly recognised.

For adults, employment is a source of good mental health if that environment is supportive. There is a well-established, proven evidence based public health guideline which sets out how positive employment practice can improve both the physically and mentally health of employees and their families, and also productivity, and reduced sickness absence for employers.

Mental health treatments are well researched and are successful but, like cancer, diabetes and other common conditions, they work best when there is early identification, diagnosis and treatment.

In addition to the lifelong impacts on individuals, the economic costs of failure to provide parity of access for mental health as for physical health conditions is very high and runs into billions of pounds annually.

The illnesses do not just disappear. The impacts of lack of prevention and untreated mental ill health reverberate across all agencies and wider society.

Robust economic evaluations have led to our understanding of many of these costs, which include: Children are excluded from school. School environments can be disrupted. Young people end up in costly institutions, whether care homes, prisons, youth offender facilities, acute and forensic mental health wards. Families are devastated by suicide of their loved ones. Employers face sickness absence and loss of productivity. Colleges and universities see loss of potential and achievement.

Fire chiefs, police, community safety agencies see the millions of pounds of impact of untreated illnesses on crime, unrest, fires, domestic accidents, traffic accidents, tragic loss of life through suicide on the transport system. Alcohol alone accounts for a minimum of 20 per cent of the work of so many community agencies.

The new standards start the journey for access to treatments for the common sixteen areas of mental ill health, and a better value investment that will rapidly bring wide benefits.

The announcement today is of access standards for people with psychosis and access to psychological therapies for common mental health conditions. The implementation of access to evidence based therapeutic care for young adolescents and adults with psychosis beginning this year will fundamentally change their lives over the next five years.

They will no longer face an almost inevitable future of 20 years premature mortality from poor physical and mental health, years of delay in accessing the right psychological therapies and medicines, exclusion from training and employment, and a lack of support for them and their families.

Making this a reality requires the commitment of commissioners and providers, community leaders, and workforce education bodies. The new standards are not only good for patients and their families They are also important to reduce avoidable admissions, and detentions under the mental health act.

Across the country, our networks and partners are mobilising for implementation and detailed plans are being made!

Access to liaison mental health care in acute hospitals will be a major step forward in the Five Year forward view commitment to integrating physical and mental health care. These services will support patients in mental health crisis who come to Accident & Emergency departments; patients admitted to acute wards and those with long-term conditions who attend outpatient clinics.

They will provide expert, skilled mental health assessment and treatments, and mental health training and support to acute trust staff.

In A&E they will undertake expert assessments rapidly, and reduce the waiting times and many avoidable admissions to hospital beds and to care homes.

They will particularly support patients presenting with dementia, young people with depression and self-harm, people with psychosis and those with long term physical illnesses such as chronic pain, cancer, heart disease, liver conditions and others, who develop depression and anxiety, and also those with alcohol related conditions.

They will provide NICE evidence based care for people with long term conditions  as an integral part of the treatment programmes, and this will reduce avoidable crises, expensive investigations and admissions.

The outcomes for our children and adolescents and young adults with eating disorders will change fundamentally as the plans for introduction of the new access standards develop.

The journey to better access to effective modern care starts today.

With the continuing commitment of the very many courageous patients who have spoken out and reached the hearts of decision makers, of their families and advocates who have worked tirelessly to educate and reduce stigma, of the commissioners and providers of services who are dedicated to provide excellent care, of the new army of mental health champions in all community agencies, we look forward to this great new journey for mental health in our country.

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.