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Mental health: times they are a changing
In the latest of a series of blogs introducing a number of senior appointments within NHS England, the newly appointed National Clinical Director for Mental Health looks at what he sees as his main challenges:
I have been a consultant psychiatrist since 1992 and working in mental health since 1984. It has been a fascinating period of enormous change.
When I started as an SHO, the old Asylums were still in existence and I spent some of my training based in the old Asylum in Sheffield. Having been one of the best students in my year at medical school, I recall a number of physicians and surgeons advising me against specialising in psychiatry because there were no treatments and most probably not much of a career in mental health. Not only were the patients subject to stigma, so were the doctors and nurses who chose to work in mental health.
Thankfully the times have changed! The asylums have now gone and most treatment and care is now provided within the community.
For the last 13 years or so I have been medical director in Sheffield and have led the reconfiguration of acute and rehabilitation care within our trust, moving further away from institutional care wherever we can and re-providing services within the community.
Over this time we have reduced our acute bed base for a population of nearly 600,000 from 147 to 92, and down to 72 by the end of this year. We have mothballed beds, shut wards and eliminated out of area treatments caused by lack of capacity. We have developed new early intervention services for people with psychosis in the community, set up a crisis house with Rethink, provided rapid response teams for people with dementia, developed ultra-intensive community treatment for people coming out of locked rehab services and are now setting up new, evidence-based community services for people with personality disorder. And although stigma has reduced considerably, we all still feel it to some extent.
In 2001 I chaired the first NICE guideline on schizophrenia. Finding and analysing all the evidence worldwide to develop the very first NICE guideline and to do this first for a mental health problem, before any other NICE guideline had been produced, was both challenging and really exciting. It felt like we were at the heart of something very new. And so it proved to be.
As Director of the National Collaborating Centre for Mental Health (NCCMH) I have led the development of more than 30 NICE guidelines on mental health, proving beyond doubt that psychiatry and mental health now have as good an evidence-base as most other parts of medicine.
Our (NICE) guidelines have become the envy of the world, certainly in mental health, and I believe that helping people to see the enormous range of evidence-based treatments that can help people with mental health problems has helped to raise the profile of mental health both in society and within medicine.
We really can help people with schizophrenia, with depression, with ADHD and conduct problems.
With the many other fantastic contributions over the last decade, from patients, from carers, from other professionals – and even politicians – we have perhaps contributed to making mental health so much more important than it used to be!
So, what an exciting time for me to join NHS England to help lead mental health over the next few years. Never before has mental health had such focus across government and across the NHS. And with the new Access and Waiting Times Standards for mental health about to be introduced for the first time in the NHS, mental health really is the ‘place to be’. But now the work starts! We have an unprecedented opportunity to ensure parity between mental health and physical health.
To do this, we not only have to ensure timely access to evidence based treatments for mental health problems, we also have to find ways to reconfigure the NHS and to integrate mental and physical healthcare throughout primary and secondary care.
So many people with physical health problems also experience mental health problems, which also makes their physical health worse; and a large proportion of people with mental health problems have physical health problems and many die much too young as a result.
We have to boldly change the delivery of physical and mental healthcare to ensure everyone has timely access to appropriate mental healthcare where and when they need it. No small challenge! So, it is with excitement, if not more than a little trepidation, that I start my new role as National Clinical Director for Mental Health in England. Any help, gratefully received…