Claire Murdoch - mental health: from rhetoric to reality?

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Featuring:

Claire Murdoch

Claire Murdoch, Chief Executive of Central and North West London NHS Foundation Trust, speaks at our event on moving conversations around mental health from rhetoric to reality, part of our breakfast series on the big election questions.

Transcript

We have come a long way. There is some great evidence-based practice. I think of all of the sectors in healthcare the whole spectrum of peer support, user engagement, work across housing, local authorities, partnerships into primary care and so on and so forth are amazing. The trouble is they are not good enough. And we have probably got just as far to go again in the next...I wouldn’t say 30 years, I think we need to truncate that and say the next five. We need another revolution. So we have all got mental health. There is not a single person in this room that doesn’t have mental health. And at least one in four of us will at some point in our lives expect to experience some mental health problems/crisis. 

We provide liaison services into four major inner London A&Es. In the four A&Es I looked at the figure of referrals from those acute Trusts in our liaison services for the month of November. We had 1200 referrals. That is a lot of people who have needed mental health intervention at a point of crisis in our acute hospitals. 25 per cent of acute admissions will have co-morbid mental health problems. 80 per cent of bed days will be occupied in acute hospitals by people with physical and mental health co-morbidities and complexities.

One of the top five reasons for medical emergencies in acute hospitals is deliberate self-harm. In one borough alone (and we provide CAMHS services in many London boroughs and in Milton Keynes) we are getting 40 referrals a week, CAMHS referrals a week. If you ask parents, 92 per cent of parents will say their top concern about their children is their mental health. We are closing beds yet acute admissions have gone up, length of stay is getting shorter. 

In London in 2014 we had 4,335 section 136s. This is the police arresting people under a section 136 in the midst of some kind of an emergency. A figure I am really proud of, really proud of, having worked with police colleagues and chief exec colleagues across London over the last two years is that only 20 of those 4,335 individuals in crisis requiring care, only 20 of them ended up in police cells in London. I think that is a staggering success story. And that is because front line healthcare workers and police have devised new ways of working in this most complex and challenging of cities, only 20. We want to declare it a never event, we think it is something that should never happen. So let’s see what the following year brings.

I could go on and on about why mental health is important and I have chosen CRISIS and what goes on in acute hospitals really because it is what most people understand about mental health. But of course many people with mental health problems never quite reach the state of CRISIS, it is the tip of an iceberg. So this is why it is important. Why do I get really irritated? I feel like I have had 30 years of being...I am the Victoria Meldrew I think of the NHS. I spend so much of my time cross and grumpy. 

And I am going to give you a list of things that just make me cross and grumpy about mental health. And my first story started when I was on my very first ward as a trainee student nurse at Friern Hospital and talking to a junior doctor who said, ‘God you have got...’ he was asking me about where I had come...I didn’t go into it until I was 23, what was my background and where had I been educated blah blah? And he went, ‘You have got A levels, good A levels, why are you doing mental health?’ And then subsequently as a ward sister when I did a part time degree, I did four years and got a first class honours degree, I was congratulated by the then very senior manager in the hospital for this achievement and he went, ‘You now can get a job in acute care, you do realise that don’t you? You have got a first class honours degree, you can get a proper job.’ These things make me so angry, that presumption that if you were any good at what you did you would always choose to work in physical healthcare for example, so that makes me grumpy.

Stigma, the stigma that still surrounds mental illness is a shock. And I looked up stigma last night in the dictionary, never done it before. And it is a mark of disgrace or infamy, a stain or a reproach, and that is what so many people live with who are living with mental health problems, it is a shocker.

The factor in commissioning which we created only a few short years ago is a disgrace. We all said if you do this, if you separate out specialised commissioning from CCG commissioning, local commissioning, what will happen for example CAMHS tier four is that we will end up not investing downstream in prevention and intensive community support at points of crisis in young people’s eyes because the CCG will say ‘well we have been top sliced, the money has gone to NHS England’. And you will have this separation ‘we fund beds, you fund prevention’. At least a 2 per cent disinvestment in mental health nationally.

In all other recessions I am told, mental health has been hit first and hardest in terms of where the money goes in health. And here we are in 2014 and we have let it happen again. It is a disgrace in my opinion. There has been real termed disinvestment in mental health whilst spend in acute and other areas has gone up, has risen. I sit in so many meetings where we talk about NHS performance or come to seminars and breakfast where people talk about the NHS and they never once mention mental health. That makes me grumpy.

I am coming to the end of it. To be honest quite a lot makes me really cross about mental health and we still talk about it in such a limited way. I do want to, though, end by talking a bit about where we are in the future. So I do want to commend actually Charles Walker and Kevin Jones who in 2012 stood up in the house and talked about having a mental illness. I thought that was amazing, I heard that on the radio, it did bring a tear to my eye. 

What do I think should happen? Well in terms of all of the furore yesterday and should we be preventing suicide, should we be investing in early intervention for younger people, should we be doing a whole host of other things? I would like to say of all of the political parties and not only because we are in the run up to a general election, they are all right. We should be doing all of that. There needs to be a proper mental health strategy that runs all the way through from health and wellbeing looking at things like housing and employment and recovery and prevention, certainly a focus on IAPT and talking therapies in primary care. Currently we have got, well we think 15 per cent coverage for people who need talking therapies. 

But we do need to invest in younger people, we do need to. I have talked about my 40 referrals a week in one borough. We do need to set these access times have been set for first episode psychosis. I think it was a disgrace that we didn’t have access targets sooner for people in urgent crisis. I was saying earlier if you had substituted the word cancer for mental health nobody would have questioned whether or not we could afford a two week waiting time from GP referral to specialist for people in mental health crisis or urgent. So I really welcome that. 

So I feel full of hope about the future. We have a golden opportunity given the strength of mental health provision in this country now and with the knowledge of mistakes made elsewhere to weave mental health into all future whole systems working and integration. I am very worried with the election looming that the answer to integration will be to put mental health all in one big organisation with physical health care. That has been tried before, it doesn’t work. The answer is not big structural reorganisation in my opinion it is about developing pathways of care that are truly integrated.

So I look forward hopefully. I think there are some risks along the way and thank you for letting me get a few things off my chest. Thank you.

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