“Right Here, Right Now” – a timely report into the quality of Mental Health Crisis Care.

Last week, the Care Quality Commission (CQC) published a report into the quality of care given to people who experience a mental health crisis. The report, “Right Here, Right Now”, focussed on the following three areas:

  • Help, care and support in the community;
  • Going to A&E for help and support;
  • Experiences of detention under section 136 of the Mental Health Act.

The evidence was gathered through data reviews, local area inspections and evidence provided by people who have used crisis care services. The outcome reported that:

  • Only 14% of people who have experienced a crisis felt the care received provided them with the right response and helped them to resolve their crisis;
  • 65% of local organisations felt that out of hours care was not of an equal standard to the care provided at other times of the day;
  • Nearly 50% of people reported that they did not feel confident that they would receive a timely or helpful response if they experienced a future crisis.

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In writing the report, CQC have identified a significant difference between the reported experiences of people who had accessed a charity based service to the statutory Community Mental Health team or A&E. 74% of respondents who accessed a charity reported that they felt they received the help they needed in a timely way, compared to only 35% reporting the same feelings when they accessed the Community Mental Health team;

            “It is encouraging that a professional working outside of specialist services can get it right and this should act as a challenge to those working in the health service to do the same.”

The report concluded with the following recommendations:

  • To ensure that all pathways into crisis care are focussed on providing accessible, available and timely support for all who require it;
  • To hold commissioners to account for commissioning crisis services the deliver a quality of care based on evidence-based good practice;
  • To engage with local, regional and national partners to ensure innovative approaches to improving experiences of those in crisis are shared within and across local areas.

http://www.cqc.org.uk/content/new-report-looking-peoples-experience-care-during-mental-health-crisis

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Learning to Quit: Lessons from Bristol

As an appendix to the post on this blog, “Learning to Quit: No Smoking Day 2015”, the below visual has been produced by the Office of National Statistics (ONS) for Bristol.

pwbsmokinggraphic_tcm77-382718This demonstrates the wellbeing outcomes for people who are non-smokers or quit smoking. This is measured by the 4 questions asked by the ONS to measure general wellbeing:

1. What is your level of overall life satisfaction?

2. Do you feel that your life is worthwhile?

3. What is your level of happiness?

4. What is your level of anxiety?

The ONS was tasked with measuring the UK’s levels of General Wellbeing (GWB) as a measure of progress, national wealth and prosperity, after David Cameron’s speech in 2006:

“Improving our society’s sense of wellbeing is, I believe, the central political challenge of our times.”

http://whatworkswellbeing.org/wellbeing-2/wellbeing-data/ons-three-year-dataset-20112014-smoking-and-personal-well-being-in-bristol/

Learning to Quit: No Smoking Day 2015

Last Wednesday, March 11th 2015, was National No Smoking Day. Run by the British Heart Foundation since 1983, it is claimed that the day has helped over 1.5 million smokers to quit for good in the last 32 years. This year’s campaign was entitled “I’m proud to be a quitter”:

NSD_ProudToBeAQuitter_l24F300px_focus-none_width-500

Mental health and smoking have a complex, chicken-and-egg relationship. Statistics tell us that:

  • 42% of all tobacco smoked is smoked by people who have diagnosed mental health difficulties[i];
  • the number of people who smoke who have been diagnosed with depression is double the number of adults who smoke who are not diagnosed with depression[ii];
  • Stopping smoking is likely to improve a smoker’s mental health, especially if they have diagnosed mental health difficulties[iii].

Smokers often report that they find that smoking alleviates symptoms of depression and anxiety, although research evidences that smoking is likely to worsen symptoms of depression and anxiety over time[iv]:

Depression

Nicotine in cigarettes causes the brain to release the hormone dopamine which helps regulate emotional responses to situations. However, over a prolonged period of time, nicotine reduces the brain’s ability to produce dopamine itself, therefore increasing the symptoms of depression.

Anxiety

Nicotine provides an immediate release from tension and anxiety, giving a sense of relaxation for the smoker. However, these sensations are only temporary and the withdrawal symptoms experienced by the brain as the nicotine wears off will increase the symptoms of anxiety and stress.

Whilst the process of stopping smoking may be difficult to begin with, the benefits of quitting, especially for people with diagnosed mental health difficulties, are numerous[v]:

  • Increased feelings of wellbeing and increased physical health;
  • Increased lung capacity, whiter teeth, younger looking skin;
  • Smelling and looking fresher, cleaner and healthier;
  • Reduced feelings of stress, anxiety and depression;
  • Increased enjoyment of sex and increased chances of fertility;
  • Possible reduction in medication, including some anti-depressants.

People who quit smoking before they are over 35 years old have a life expectancy that is the same as a non-smokers, whilst smokers on average lose over 10 years of their life by dying early from smoking-related illnesses[vi].

For more information and help on quitting smoking, please visit:

https://quitnow.smokefree.nhs.uk/

https://nosmokingday.org.uk/

http://www.nhs.uk/Livewell/smoking/Pages/Getmotivated.aspx

http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/smokingandmentalhealth.aspx

References:

[i] http://www.rcpsych.ac.uk/pdf/APPG%20on%20Mental%20Health-%20Parity%20in%20Progress.pdf

[ii] http://www.mentalhealth.org.uk/help-information/mental-health-a-z/s/smoking/

[iii] http://www.bmj.com/content/348/bmj.g1151

[iv] http://www.mentalhealth.org.uk/help-information/mental-health-a-z/s/smoking/

[v] http://www.nhs.uk/Livewell/smoking/Pages/Betterlives.aspx

[vi] http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/smokingandmentalhealth.aspx

Parallel Pathways?

How far down the road towards achieving Parity of Esteem are we really?

This month, the All Party Parliamentary Group for Mental Health have published a report investigating the true extent to which parity of esteem between mental and physical health has been achieved in the UK.

The outcomes of the report demonstrate that, whilst some progress has been made, there are still significant inequalities in how mental health services and physical health services are funded, provided and viewed in the public health arena.

The report focussed on three main areas for improvement:

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The report explored the impacts of the limited availability of health checks for people taking ant-psychotic medication, and the limited, easily accessible information about the side effects of this medication. It highlighted smoking as a key cause of increased mortality amongst people experiencing mental health problems, who are reported to smoke 42% of all tobacco. To compound the impacts of increased smoking levels amongst people experiencing mental health problems, the report also found that these people are less likely to be offered smoking cessation programmes.

Mental health crisis services were examined in detail in the report. It looked at the difficulties presented by the limited spaces for holding people experiencing mental health crisis which has lead to a large number of people being held in police cells whilst awaiting an assessment with a mental health professional.

Finally, the report focussed on the significant shortfall in the funding that is allocated to the promotion of mental health. This amounts to only 0.03% of the NHS’ budget for Mental Health. It also emphasised the dangers of under investing in mental health support for children and adolescents. The report argues for standardised mental health provision in schools and across the curriculum, as well as evidence-based parenting programmes to reduce the prevalence of mental health problems in children, who are then more likely to sustain and experience mental health problems in adulthood.

Recommendations

Access the report here: http://www.rethink.org/media/1307442/APPG%20parity%20in%20progress%20-%20FINAL.pdf

Parity of Esteem between Mental and Physical Health

“Parity of esteem” is the latest buzz-phrase when talking about Mental Health. The Government and NHS England have identified that achieving equality in terms of funding, access and outcomes for people with mental health problems and people with physical health problems is a central area of focus for the next 5 years[1].

“In its most simple form, parity of esteem is defined as mental health having ‘equal value’ to physical health… taking a holistic view of an individual’s health (seeking the interdependencies between their physical and mental health needs.”[2]

 

Research has evidenced that mental health problems are the single largest cause of disability in the UK, and represent 23% of all causes of disability[3]. In addition, it has been evidenced that people with diagnosed physical health conditions are more likely to experience mental health problems, and alongside this, that people with mental health problems are less likely to recover from physical health problems.

The issue is cyclical, and is costing the NHS over £105 billion per year. However, as the parity of esteem agenda has identified, NHS funding allocated to mental health is significantly below the level of need. Despite mental health problems accounting for 23% of the total impact of ill health in the UK, only 13% of the NHS budget is allocated to promoting, preventing, treating and monitoring mental health throughout the country[4].

imbalance-500x248

[1] http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

[2] http://www.rethink.org/media/1307442/APPG%20parity%20in%20progress%20-%20FINAL.pdf

[3] http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf

[4] http://www.rethink.org/media/1307442/APPG%20parity%20in%20progress%20-%20FINAL.pdf

“The Mandate” and Mental Health Service Provision

In December 2014, the Department of Health published The Mandate[1] for the work of NHS England from April 2015 to March 2016. The document encompasses the whole of health care provision in the United Kingdom – so what is the role of The Mandate in Mental Health services in the future?

The objectives of The Mandate are broken down as follows:

  • Preventing people from dying prematurely
  • Enhancing quality of live for people with long term conditions
  • Helping people to recover from episodes of ill health or following injury
  • Ensuring that people have a positive experience of care
  • Treating and caring for people in a safe environment and protecting them from avoidable harm
  • Freeing the NHS to innovate
  • The broader role of the NHS in society
  • Finance
  • Assessing progress and providing stability

Mental health is identified in The Mandate as the first area where there needs to be additional focus for the NHS. As an area in itself, mental health is not separated out in the document. This is the first sign of the importance of driving home the message of achieving parity of esteem between mental and physical health in service provision – the first step of which is to meet the newly published access and waiting times for mental health services:

Within Improving Access to Psychological Therapies (IAPT) services, the standards of at least 15% of people have access to services (with an expansion of the programme focussed on children and young people and people currently out of work), and that 50% of those completing treatment will experience recovery will be maintained.

In addition, waiting times targets will be introduced: these will specify that 75% of people referred to an IAPT service will be in treatment within six weeks from referral and 95% of people will be in treatment within 18 weeks from referral (NHS England and the Department of Health will be revising these targets from March 2016 onwards).

There is also a focus in The Mandate on the development of crisis services, through collaborative working with a variety of stakeholders, including the police. In line with the World Health Organisation’s Preventing Suicide report[2], and the National Suicide Prevention Strategy from the Department of Health[3], the NHS is being actively encouraged to identify groups of people who are at high risk of suicide, and to work with commissioners and services to reduce the numbers of suicides and instances of self harm.

Recognising perhaps the reports over the last twelve months of NHS staff burnout and stretch, The Mandate also requires the NHS to lead by example as an employer, and to invest on the physical and mental wellbeing of it’s workforce. NHS staff will then be in a better position to promote healthy lifestyles and good health to their patients.

The Department of Health’s The Mandate to NHS England crucially addresses the issues of parity of esteem between mental and physical health, as well as setting key targets for provision of Mental Health services. It paints a promising, if realistic, future. It does however come with the caveat that it can be changed in exceptional circumstances – including, of course, the event of a General Election.

[1] https://www.gov.uk/government/publications/nhs-mandate-2015-to-2016

[2] http://www.who.int/mental_health/suicide-prevention/en/

[3] https://www.gov.uk/government/publications/suicide-prevention-strategy-launched