The days when we could put mental illness in a straightjacket and treat it well out of sight, in an isolated asylum, are thankfully long gone. In the UK, the ‘Care in the Community Programme’ saw people transferred out of institutions in the 80s and 90s and our mental health bed numbers have plummeted from 76,000 then, to under 20,000 today.
However, the current picture is by no means rosy. Our mental health services are under intense pressure and NHS Trusts are very busy improving their community-facing services in response. The most intense pressures are in cities, where the population is set to expand by 25% over the next 50 years. The incidence of common mental health conditions, such as anxiety and depression, is significantly higher amongst city dwellers when compared to the rural population, so the need to address this problem will only intensify with time.
We are also at the start of a paradigm shift in the way we look at and treat mental health conditions; recovery, enablement and empowerment of the individual being the triple aim. There is immense value, therapeutically and financially, in supporting people with mental health conditions to remain at home and actively participate in their local community. Austerity measures mean this treatment and support has to be delivered out of existing budgets, so going forward, things will have to be done differently. Let’s look at the drivers and the emerging responses:
- ‘Health: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’, World Health Organisation
- The ‘NHS Five Year Forward View’ suggests a twofold problem: ‘the NHS need a far more proactive and preventative approach for people experiencing mental health problems and their families, and to reduce costs for the NHS and emergency services.’
- The widely adopted ‘Recovery Model of Care’ empowers people and encourages those with mental health challenges to self-manage with well signposted readily available support. This is where there is a huge gap at the moment, both in the quantity of services, support available and in the way it is signposted.
The Emerging Responses
Sustainability and Transformation Programmes (STPs): The new NHS and Local Authority landscape of STPs aim to bring us better, cheaper, integrated health and social care. If the roll-out of the plan is successful, we will see mental health support in schools and offices, sports centres and libraries as well as in traditional primary care centres and in the next generation of ‘wellbeing centres’.
City Intelligence Centres: Meanwhile, in a completely different arena, there are cities, such as Bristol in the UK, where a citywide re-think about how to deliver services in the future has led to the development of the new Bristol Smart City Operations Centre, which co-locates wellbeing, mobility and security hubs. Staff will be cross trained to respond to requests across traditional service boundaries and there will be a clearly signposted place to go for your health and social care needs.
Healthy New Towns: Another example of how to do things differently is NHS England’s Healthy New Towns programme, which takes an ambitious look at improving health through the built environment in 10 demonstrator sites. Under consideration is: health and health services, travel and transport, digital smart cities, inclusive design, and dementia. Using the public health profile of the population, which measures for example the incidence of dementia, depression, diabetes and serious mental illness, they will be able to measure the effect of their evidence-based interventions on population health.
Local Initiatives: At a more local level, a specially formed group ‘‘Like Minded’ is seeing service users, carers, clinicians, and the third sector working on the co-design of a strategy to improve health and wellbeing across North West London. Initiatives like this often start with a single point of contact telephone and web service for self-referral, bypassing the GP as the gatekeeper to services. Several community based places that are independent of NHS services are also emerging, often having a connection with a mental health charity or a local community group. One such group is the ‘Mental Fight Club’ in South London, where people self-refer or simply attend and enjoy the busy café or the very varied programme of classes and activities.
Technology: The use of technology is another way in which evidence-based psychological therapies are being delivered directly into peoples’ homes. Some providers such as the ‘Big White Wall’ or ‘Healios’ have area based NHS contracts. Access is via a live video interview with a clinician who will recommend either online mental health services, web-cam consultations, audio or instant messaging services for patients and their carers.
Recovery Colleges: Another community based initiative that has developed apace over the last five years is the Recovery College. This was born out of the proposition by the Mental Health Network and the Centre for Mental Health, which said that offering education alongside treatment for individuals would change the relationship between services and those that use them. It would also identify new peer workers to join the workforce empowering service users. Recovery Colleges are open to the public, service users, professionals and families alike with people choosing the courses they would like to attend from a prospectus.
This short but wide ranging overview into some of the initiatives already taking place in our cities and towns, shows that the response to meeting the mental health needs of people living in them is beginning to change. We are entering a new age of empowerment where there is an emphasis on better education, on how to keep well, and better signposted access to a wider range of services in any number of community locations.
It’s still early days. Over the next few years, area based public health measurements will reveal to what extent these new initiatives are helping people with mental health conditions to keep well. My hunch is that the results will be very positive.