Leadership in Mental Health
All posts from: June 2011
The much talked-about Health and Social Care Bill has now returned to Parliament with some very significant government amendments after its two-month ‘pause’. The bill’s lasting impact on the NHS has been the subject of heated debate and disagreement and will doubtless continue to be throughout its passage through Parliament.
What matters most about the bill, though, has at times been obscured or at least debated only at the margins. Changes to the way the NHS works are not, and should never be, ends in themselves. They are the means by which taxpayers’ investment in our national health service achieves the greatest possible impact on our health, wellbeing and quality of life.
The NHS was created as a key component of the post-war welfare state. It was seen as an economic as well as social good; a way of achieving the best possible value for money in the way health care is paid for and organised. And it was inextricably linked to the other pillars of the Welfare State, such as housing, social security and National Assistance (the forerunner of social care).
The Health and Social Care Bill will likewise have a big impact not just on the NHS but on the lives of the people who rely on it. And it will affect a range of other public services: not just social care but also employment, housing and criminal justice among others.
The importance of integration was one of the central ideas of the Future Forum report. The government’s amendments to the bill thus seek to enhance integration in the new health system. But they do so as if health and social care exists in a bubble.
Integration within health and social care is of course vital. This is not just the case for older people and those with long-term conditions but for people who fall between service silos, such as those with a ‘dual diagnosis’ of mental health and substance use problems whose care is too often anything but integrated.
But integration can apply successfully beyond health and social care. Good, safe and if needs be supported housing is often the key to hospital discharges, for everyone from frail older people to patients in secure mental health wards. Links between housing and health are just as important as those with social care. Yet Health and Wellbeing Boards are in danger of being constituted without their active involvement.
Health and Wellbeing Boards have huge potential to act as the ‘glue’ to bring together a range of local agencies to promote good health and support the most vulnerable and disadvantaged. But without genuine cross-agency involvement they may find it hard to break down the silos that prevent services working together to meet commons goals.
As clinical commissioning groups begin to form and local authorities take on their extended roles in promoting public health, it is vital that they take the opportunity to build effective relationships with other public services. Tackling the determinants of ill health, intervening early when people become unwell and supporting those with the greatest needs remain big challenges for the health system. Yet they are also where it has the most potential to contribute towards the wellbeing of society as a whole: its fundamental purpose.
While the bill gets debated in Parliament and eventually implemented in the world outside, it is vital that we stay focused on ends, not means, and on how best the NHS and its many partners can make a difference to people’s lives.
Earlier this month, the NHS Information Centre published the latest survey of public attitudes to mental illness in England.
In many ways, the results were encouraging. They showed that public understanding about mental illness and attitudes towards people with mental health problems in recent years are improving.
Over three quarters of respondents, for example, agreed that ‘mental illness is an illness like any other’ while 72 per cent agreed that someone with a mental illness should have the same rights to a job as anyone else.
The survey has now been running since 1994. Between then and 2003, there was a noticeable hardening of attitudes towards people with a mental illness. High profile cases of homicide involving people who had been in contact with mental health services, coupled intense political debate about how dangerousness should be managed, have been widely blamed for this trend.
Since that time, there have been gradual improvements in attitudes, with answers to most questions showing greater acceptance of people with mental health problems as citizens with the same entitlements as everyone else in our society.
The upward trend is a great tribute to the efforts of campaigners who in recent years have sought to demystify mental ill health and tackle the prejudice and ignorance that have a huge impact on the lives of people with mental health problems.
But underlying the positive trend is a worrying truth: that fear of people with mental health problems and ignorance about mental illness are still widespread across our society. One person in six agrees that ‘locating mental health facilities in a residential area downgrades the neighbourhood’. This kind of fear is too often translated into action, bedevilling efforts to build new community services.
One in eight, meanwhile, agreed that ‘one of the main causes of mental illness is a lack of self-discipline and will-power’. Such myths translate all too easily into hostility towards people claiming incapacity benefits.
Even the fact that 72 per cent agree about a right to a job shows that over a quarter do not. And attitudes can be seen to harden the ‘closer to home’ questions are: only 25 per cent said they would trust a woman who had been in a ‘mental hospital’ as a babysitter.
These are not merely the views of a tiny minority of intolerant people. They are mainstream social attitudes with a long history. And they are not confined to older generations, either. A survey by YoungMinds last year showed that myths and misperceptions were just as prevalent among children and young adults. They found that mental illness is widely associated with violence and that half of young people are subject to verbal abuse when they are distressed.
The need for continued action to tackle these entrenched and ingrained prejudices and fears clearly remains. The Time to Change campaign has begun to bring about the kind of social change that will take more than one generation to bear fruit. That work will need to be sustained for some time to come, and with people of all ages, to achieve its full potential.
The government’s mental health strategy, meanwhile, rightly includes reduced stigma and discrimination as one its key objectives. Action to put that policy into practice should begin now. Restrictions on people with mental health problems serving on juries or sitting in Parliament need to be lifted as a matter of urgency. These symbolic acts of discrimination have no place in twenty-first century Britain.
Tackling stigma remains key to achieving so much more to improve the life chances of people with mental health problems. Concerted action at every level continues to be necessary to banish the blights of bullying and discrimination from people’s lives.