Thursday, 19 February 2015

Norman Lamb at Brecon & District Mind

Roger Williams MP, Norman Lamb MP and Val Walker, Service Director of Brecon & District Mind
Last Thursday Brecon and District Mind hosted an Open Forum on Mental Health with Norman Lamb MP – Minister of State for Care and Support. The session was facilitated by Roger Williams MP for Brecon & Radnorshire. During the hour-long session many important issues were covered, including changing the health system to put mental health on a parity with physical health, the failings of the system for children and young people, concern around funding for vital third sector services in the community such as Brecon Mind, and the needs of carers. Norman’s talk was followed by a Q&A session with Brecon Mind members.

There is not space to cover the entirety of the Open Forum here in one blog post, so we have highlighted some of the points that Norman made during his visit. 

Disparity between services for mental and physical health

I wanted to say something briefly about my complete passion for mental health. 1 in 4 of us at some stage in our life will experience some form of mental ill health. It may be mild depression or anxiety or it may be something more enduring. Most families are touched by it in some way. Our family very much is. What I talk about is not just because I happen to have a job as the Minister for State responsible for mental health. It is something I really care about. The thing that is quite shocking is the disparity between how people with mental ill health are treated by the system despite the great work of people working within the services. But the system, in my view, discriminates against people with mental ill health. I can talk primarily about my experience in England but I suspect it is not much different to here.

In England if you have suspected cancer and are referred by your GP you have a right to see a specialist within two weeks and a right to start treatment within a month of diagnosis. If you suffer from mental ill health, if you perhaps are a youngster who experiences a first episode of psychosis, you have no such right. There is no such entitlement to access treatment on a timely basis. And I just don’t see how that is right. We know there is a wealth of evidence that if you intervene quickly with a youngster who suffers a first episode of psychosis, you can often rescue that person, you can stop the deterioration of condition and give that person the chance of a good life. 

The Open Forum on mental health
So how unacceptable is it that those people don’t have any right to access evidence-based treatment which we know gives the person the chance of recovery. Particularly in mental health the quicker you intervene the greater chance you have of achieving a good result for that individual and potentially rescue someone from a lifetime of a pretty miserable experience for very many people - out of work on benefits, not enjoying things that the rest of us take forgranted. It costs a fortune to deal with the damage and the effects of negligence on that person. So the moral and economic case for proper investment in mental health is overwhelming. If you make the investment you ultimately end up saving money further down the track as a result. That is the central message that I have been trying to get into government, NHS England and also to apply the moral pressure on organisations locally to take mental health more seriously.

I am on a mission to try and change this (the disparity between physical and mental ill health). So in England we are introducing the first ever waiting time standards for mental health so that if you experience a first episode of psychosis the standard will be that you start your treatment in two weeks from referral by your doctor. We start by saying that 50% of youngsters should be seen within two weeks, and then progressively in subsequent years we want to increase the percentage, but you have to increase the capacity in mental health services to be able to do this.

Increasing Access to Psychological Therapies

Kirsty Williams, Assemby Minister Brecon & Radnorshire 
and Harold Proctor of Powys teaching Health Board
We have also got in England the IAPT programme – Increasing Access to Psychological Therapies. It is fantastic for mental health. For the first time we have rich data, information, evidence about how many people are waiting, how long they waiting and whether they are recovering as a result of their treatment. We can monitor the programme to understand which providers are performing well and which are failing people, where access is very poor. The result of this is that in 2010 300,000 got access to psychological therapies. This year it will hit about 900,000, an increase of three times, so it’s a big advance and a programme that is delivering massive results for people. There are thousands of people that have recovered from depression and anxiety. The evidence is very strong; not only of recovery but that if you invest money you achieve a saving in the long-run. You get people off benefits, you get them back into work, you give people a good life with the chance for self-respect and some dignity.

Crisis care

Crisis care is where the disparity between physical and mental health is probably at its greatest. If you suffer from a physical health problem the system may be under pressure but an ambulance will arrive and you will be taken to an Accident & Emergency department and you will have access to a specialist who understands your condition. If you have a mental health crisis it is completely haphazard what happens to you. And you could end up in a police cell. This is intolerable in a civilised society.

So last February we published the Crisis Care Concordat. We got twenty national organisations to sign up to it. It is the first set of standards for crisis care in mental health that we have ever had. It tells you there that there should be a 24/7 helpline available so you can get access to support any time of day and night. There should be proper liaison psychiatry in hospitals, and in A&E if your problem is a mental health problem you will get access to a specialist. It critically says we should end completely the practice of putting under 18s in police cells and halve the number of adults who end up in in police cells this year compared to two years ago. In my view it should become a “never” event. Parts of England have demonstrated it is possible. They don’t get more money, they have just organised themselves better.

The role of carers and the Open Dialogue approach

I am acutely aware (mental ill health) affects the whole family. It can have a massive impact on other people’s lives. Providing support for the whole family is critically important. There is a very interesting development called Open Dialogue. It is the approach they use in Finland. The whole idea is that it is a recognition that mental health is crucially related to relationships with other people, and to try and deal with someone’s mental ill health in isolation is a mistake. Their whole approach is that when crisis occurs you get the whole family engaged straight away.

It’s absolutely the case that a family trying to cope with mental ill health very often has no idea how to handle it, whether what they do has an adverse or positive effect, whether to be tough with the person or gentle and understanding. Getting the balance right is so often incredibly difficult, so to involve the whole family seems a very attractive approach. There are now four trusts in England that have taken this approach and pooled some money between them to train psychiatrists and other health workers to develop the model in this country and critically to evaluate as they go through.

Transition from children’s to adult services

We have a massive issue with this cliff edge at 18. You get to 18 and are then told children’s services come to an end. You’re suddenly told you’re in adult services. 18 years old is a very difficult age for many people. They are going through real transitions in their own lives, maybe going to university, maybe leaving school, it may be all sorts of teenage angst that you are trying to cope with in your own mind, and to suddenly force a complete change of service seems completely daft. I’m trying to force a move away from a one size fits all date for transition. It’s often “abandonment” to be honest. A service needs to stick with someone if that’s the appropriate thing to do. There are several areas, my own county of Norfolk, where they have a youth service that takes you through to 25. Because it is a youth service it is more attuned to what might be more appropriate for you at that point in your life.

I also think third sector organisations working collaboratively with statutory sector organisations are more subtle and pliable in getting the right response for a youngster. So I think a collaboration between statutory and voluntary sector services works more effectively.

Janet Pardue-Wood, Acting Director of Mind Cymru, meets 
Kirsty Williams AM and Roger Williams MP.
Voluntary sector

My view is that the voluntary sector plays a crucial role. When I was at Gofal earlier they were talking about how they had entered collaborations with some of the health boards around Wales. We have this awful problem of people being put into out-of-area placements, often a long way from home. There is no ambition to give them a better life, they are just hidden away from view at enormous cost to the tax payer, it is an extraordinary outrage really. Their role can be to identify these people and find a mechanism to get them back into community and rebuild their life.

Gofal gave a wonderful example of a woman who was a serious alcoholic whose life was in a complete mess, she had been in secure accommodation. She is now living back in her own home and working in a charity shop three days a week. She contributes to local community efforts, she has a life. It’s fantastic. Three or four years ago no one assumed she was capable of that, she would just have been locked up as a risk or threat to everybody. It does not have to be like that.

Roger Williams rounded off the session by complimenting Brecon & District Mind on the work that they do in their community and thanked them for hosting the Open Forum.

Thank you to Freda Lacey and Brecon & District Mind for providing photographs from the day.

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