Esteem for people with mental health issues

Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, lays down a marker for World Mental Health Day.

It is exciting to be in this role at a time when we have the national strategy of “No health without mental health”, and an NHS Mandate that makes an historic commitment to deliver “parity” of esteem.

So what is it that we, in NHS England with our partners across government and across the mental health leadership community, want to change?

We want to play our part in creating a society where mental well-being and building strong, psychologically resilient people and communities is seen as essential, exciting and transformational.

We want good psychological health to be as achievable as good physical health.

We want to support employers to create healthy workplaces, and parents and schools to support our young people learn how to achieve great psychological health, as well as academic success.

We want local community leaders and commissioners to act on the knowledge that over half of all mental ill health starts before the age of fourteen, so it’s important to intervene early.

We want to stop the unnecessary and shaming premature mortality of those with mental illness.

We want to stop the scandal of lack of access to the very effective, and cost effective, treatments we now have in mental health.

So what actions are we taking and what do we plan?

NHS England has got off to a flying start! We have set up an organisation where the culture is about collaboration, and the focus is on achieving parity and outcomes.

We have acted at pace on three fundamental building blocks:  We have connected with leaders across all sectors. We are building a powerful communication and information system to arm these leaders with the facts they need to communicate to achieve ‘parity’. We have been thrilled to identify so much front line innovation and excellence in every part of the country and in every type of services.

In our first six months we have started many programmes. Some of the major ones include:

  • People who suffer mental ill health scandalously die up to two decades younger than their counterparts, from the five major killer diseases. NHS England is launching a formidable programme to reduce premature mortality, and people with mental ill health will be included at the heart of these plans.
  • People, who have conditions such as stroke, heart and lung disease, cancer, diabetes, liver, commonly suffer mental ill health as a consequence.  Unless they are treated, they also die earlier. NHS England’s integrated care pathway programme is tackling this head on. Across the country care has started to transform!  Access to highly effective psychological therapies is being provided in primary care and acute care settings, moving from a ‘cared for’ approach to a ‘How to live well with’ empowering, educational, care model.
  • Care in crisis for vulnerable people, including those in mental health need, is at the heart of an ethical society. NHS England has launched its acute and unplanned care review, engaging literally thousands of stakeholders in designing a system that is responsive to local populations. For the first time in my lifetime, mental health crisis is included and the mental health clinical commissioners and partners mental health providers are exploring and evaluating innovation in single access points, tele health and tele triage, twenty four hour community and mental health liaison care models, aiming to provide personalised, home based care where possible.

Across the country our strategic clinical networks have launched, with upwards of 2,500 leaders from many sectors engaging.  They are working with Clinical Commissioners on plans that will improve lives and build sustainable leaders for mental health.

Building on the success of the mental health CCG leadership course delivered to 32 leaders in London last year, NHS England has announced the roll out of this leadership programme for all 211 CCGs across the country. Experts by experience, expert clinicians and commissioners will shape the launch for spring 2014.

Primary care mental health is finding a strong voice and, innovative services, collaborative models, and real integration of physical and mental health is gathering an unstoppable pace!

I want to thank all the wonderful experts by experience, carers, commissioning and provider leaders and partners that are working with us in the journey towards parity that England has now started.

We can make it happen and I very much look forward to working with you all.

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.

One comment

  1. Catherine Clarke says:

    Greater psychological and physical health will be achieved when genotyping takes place prior to psychiatric medication prescribing. Antidepressants and antipsychotics are predominantly metabolised through the CYP450 2D6. Variants in this enzyme may cause toxicity and ADRs, both psychological and physical. These ADRs are subsequently treated with additional psychiatric medications or general medications which may be metabolised though the same enzyme. This causes drug- drug interactions, which poses increasing difficulties for service users. And their carers.
    Bearing in mind 60% of patients diagnosed with schizophrenia have poor outcomes, which require on going and increasing costs to the NHS for many years, compared with £30 for a one off genotyping test, this is a mere fraction of the cost without genotyping.

    For those who are concerned about outcome without intensive pharmaceutical interventions, there is a history of using psychological interventions that have greater effectiveness and outcomes. See: Successful Non-Neuroleptic Treatments for “Schizophrenia”
    Pre therapy is another psychological approach which is used increasingly in other countries when patients are difficult to engage. This intervention is efficacious and results in reduced amount of antipsychotic doses. See: Pre Therapy –