Monday, 9 January 2017

"A Shared Society Must Value A Person's Right To Be An Individual": My response to Theresa May's Mental Health Speech

Theresa May has delivered her promised vision for Mental Health reform by mentioning the need to #EndTheStigma during the annual Charity Commission lecture this morning. The Government has decided to accept all 58 recommendations made in the Five Year Forward View For Mental Health For The NHS in England, that was published in February 2016 by the NHS Mental Taskforce. I am pleased that Mrs May has decided to do this, rather than relying on vague platitudes or focussing on funding alone as a solution. There needs to be a comprehensive approach to tackling the root causes of mental health issues and May's speech may have helped start the ball rolling with a national conversation on what needs to be done by employers, charities/voluntary organisations, the medical profession and faith leaders to help reduce instances of mental health, especially in our young people. It is absolutely imperative we get a grip. 1 in 4 people have a common mental health disorder and mental health issues affect young people the most, with 50% starting before the age of 14 and 75% by the age of 18. Facing peer pressure at school to fit in with gender stereotyping, studying long hours with little sleep to help pass GCSE and A Level exams to help get students to universities, colleges or apprenticeships of their choice as well as family based pressures can all contribute to the onset of mental health disorders. Action is desperately needed to help young people when they need it the most.

Nobody can deny that the Government can play a central part in helping to shape new positive approaches to tackling mental health. Even Jeremy Corbyn's most ardent supporters have to admit that any Government should use its power "as a force for good" and to do it "right across society and at every stage of life".  May seems to be suggesting an interventionist approach rather than a traditional "laissez-faire/ultra personal responsibility" approach and has suggested a number of actions the Government will take which I discuss below:

  • It's great that every secondary school in the UK will be offered mental health first aid training; teachers should be equipped with the knowledge they need to spot the signs of depression, anxiety that may be symptomatic of other mental health illnesses too, such as bipolar disorder or eating disorders such as anorexia. The training will be rolled out to 1/3 of secondary schools in 2017 with the remainder of schools being given training within the next two years. The training will be delivered by Mental Health First Aid UK on behalf of the Government.
  • I approve of May's proposal to set up new trials between schools and mental health professionals at local NHS trusts to help improve communication channels between them. Once symptoms may have been picked up by teachers, it is vital to make sure the student involved is diagnosed so they can begin treatment ASAP.
  • It's important to carry out a review of children and adolescent mental health services across the UK, headed by the Care Quality Commission (CQC) to ensure that the services are fit for purpose. A green paper on children and young people's health is then to be created which looks at transforming services in schools, universities and for families too. As long as this doesn't involve reduction in the number of mental health centres, professionals or unnecessary centralisation of services, this should be a good idea.
  • Employers need to be more sympathetic and tactful to employees who are going through mental illness whilst employed by them. I'm glad that May has appointed Lord Dennis Stevenson, a tireless mental health campaigner and Paul Farmer, CBE, CEO of Mind to undertake a review into working practices. Yes they should definitely be adopting best HR practices from trailblazing companies and getting those HR professionals to go and work with the public sector and SMEs to develop policies that work for the HR department and for employees. There needs to be more understanding shown towards employees who take sick leave due to suffering from mental illness and consideration should be given to allow employees to attend hospital appointments whenever they need to do so. I shall look forward to any recommendations made from their review into discrimination legislation on the grounds of mental health and hope they will add it as a protected characteristic to the Equality Act, 2010 to bring tougher sentences against those employers who discriminate against any worker with a mental illness.
  • It's a good idea to try and support mental health patients within the community, as an alternative to going to hospital. Seeing a GP or attending A&E really isn't the answer so I hope the Government will honour its promise to build on the £15 million investment in mental health services by funding initiatives such as crisis cafes and community clinics. The £15 investment has led to 88 places of safety and they say they will spend another £15 million to build on this success. The worry is that this funding may not be seen in rural counties such as Lincolnshire which have sparse areas of population and need support centres to be on public transport routes.
  • Digital mental health services can help alleviate symptoms of some patients but they cannot replace entirely face-to-face diagnosis and meetings. The Government plans to invest £67.7 million so people can check their symptoms online if they feel stressed or anxious and then access digital therapy immediately (I hope that will be the case) with further follow up face-to-face sessions provided when needed. Treating mental health patients differentially is vital because we are all individuals and would respond to different treatments more successfully than others.
  • The mental health form filled in by GPs to prove to employers/Job centre advisors that a person is going through mental illness should be free. It shouldn't cost £300. Those suffering from stress, anxiety or severe depression as a result of getting themselves into long term debt should not have to pay out even more money to get the help they need. A review by the Department of Health isn't should be phased out immediately.
  • I'm glad that Theresa May has committed the Department of Health to work towards ending the cruel practice of providing inappropriate placements for inpatient beds for children and young people which often leads to parents having to take time off from work to look after and visit them, incurring costs which they cannot afford to keep paying if they are not earning their usual income. The practice is due to end by 2021.
I do think May has missed out a few points of interest in her speech:
  • Mental health service provision should never become subject to a "one size fits all" approach. As Jacqui Dyer, vice chair of the NHS's mental health taskforce has commented "people from BAME (Black, Asian and minority ethnic) backgrounds and/or who are LGBTQ get a raw deal" and can have barriers to accessing mental health services. For example, a mental health service provider needs to make sure all of their professionals value the gender identity choice of a trans person and recognise that non-binary people cannot have their identity choices dismissed as part of their mental health condition. Being transgender or non-binary or queer does not automatically mean you are suffering from a mental health condition- in fact the cause could be to do with stress over exams or peer pressure based self body shaming issues.
  • Better interfacing between Domestic Violence support service providers and local NHS mental health service professionals would be a great idea. The digital therapy may form part of a survivor's treatment but to have a mental health professional they can trust will help them recover the strength they need to start rebuilding their lives after the physical scars have healed. This sort of collaboration needs to be properly funded, with professionals being able to deliver treatment within shelters wherever possible.
  • I do remain sceptical when it comes to the Conservatives' record of implementing positive reforms to the NHS. Funding remains an important issue, with Labour's shadow minister for mental health, Barbara Keeley, questioning why funding for children's' mental health services hasn't already been ring-fenced by the Government. After all, funding fell by 8% between 2010 and 2015 and there are now 6,600 fewer mental health nurses than in 2010.  We can't hope to deliver effective mental health care if there aren't enough resources or staff to do it. 1400 more people are accessing mental health services each week but we don't know whether that's because they have more knowledge about services or because they are more willing to seek help or whether it's because Government policies have increased the number of people suffering from stress. If you are a young professional struggling to get by on the NLW and having to make choices between paying the rent for your flat or feeding yourself, that could lead to a breakdown in your mental health, especially over a sustained period. May needs to continue to evolve housing policy to look at ways of reducing rents. May also needs to scrap further austerity measures and focus instead on raising the NLW further so that young professionals do not need to make such stark choices between eating and paying rent or take on large amounts of unsecured debt on credit cards and personal loans just to make ends meet at the end of the month.
  • Benefit sanctions could tip some jobseekers over the edge, especially if they are already battling drug or alcohol addictions or are in a severe amount of unsecured debt. Jobseekers have literally died after being declared "fit to work" after a work capability assessment (WCA) (2,380 between December 2011 and February 2014).  If we are meant to be part of a "shared society" where the Government helps everyone to aspire to a healthier life, and gets us all to support each other as citizens, as Theresa May is suggesting then I believe there needs to be a review into the benefit sanctions system to make sure it is fit for purpose or is abolished altogether as SNP MP Mhairi Black has suggested. WCA programmes need to be fair and take into account a claimant's mental health as well as physical health. I do think that outsourcing of such assessments needs to be curbed, as Maximus and Atos seem to have not been fair in their assessments of ESA claimants. I doubt Mrs May is bold enough to make such changes to the benefits system, which is unfortunate. Jeremy Corbyn wishes to scrap the WCA, because it has "caused immense stress and suffering for thousands of disabled claimants". Perhaps Labour, led by Corbyn would deliver on more funding for mental health services and make additional recommendations to safeguard ESA claimants as well as making sure services are accessible to BAME and LGBT people. The proof will be in the delivery, after all.