Dr Geraldine Strathdee, National Clinical Director for Mental Health at NHS England, presents an overview of implementing the NHS five year forward view for mental health care. This presentation was filmed on 8 September 2015 at the Increasing access to mental health care conference.
So in terms of the five year forward view we’re thinking about it in terms of life-span, so across the life-span from the very beginning to the very end of life we want to think about what would increasing access mean and then access to what? We understand a lot more about how all of us might develop a mental health problem. We know about the kind of genetics, the biochemistry, the hormones, the way our brains develop, the hard and soft wiring and absolutely critically we know about the environment in which we are born, grow up, work, have relationships, grow old and of end of life care.
In this country we know there’s an enormous amount of money spent on mental health, the only problem is it’s spent on dealing with the adverse consequences of not having given access early to effective interventions.
In going forwards we have four main strands of our work. One is building positive literacy in mental health. Secondly prevention of mental health. Thirdly lots more communication about building your own psychological literacy and health. And then obviously what we want to start this journey that you’ll hear more about today about increasing access to evidence based interventions for anybody with a new problem coming into the system.
What’s my evidence that more people want to build their mental health literacy? Well it’s good news. We’ve had more people talking about busting the five big myths of mental health. The myths that mentally ill people are weak people and you can't learn to develop your mental health, absolute rubbish. Secondly we’ve seen major changes, fantastic campaigns like the Time to Change campaign which I hugely celebrate.
I’d like to also pay tribute to the media, if there’s any media in the room because I think three years ago there was an automatic link in the media with mental health violence and bad things happening, and I think the media have really really come with us.
So what about prevention? If we look at what would some of the very high impact prevent strategies be, it’s around abuse, it’s around in every pregnancy can we support people around parenting? Schools, absolutely vital. So what we are introducing is increasing access to standards which started with children and young people, because that feels absolutely morally and ethically the totally right thing to do. For young adults, so I suppose the people that I have had the huge privilege to work with as a clinician, for people with psychosis that’s next because I think how with psychosis in this country are treated, sometimes my description is it’s a bit like how people were treated with leprosy 30 years ago and we’ve got to break down, that’s absolutely to me one of the greatest ethical things we have to do is to change how people in this country talk about and think about psychosis, it’s really important for these young people.
The way we’re introducing every one of our standards for early intervention psychosis, for peri-natal mental health, for liaison services, for crisis services and we’d then like to go on to people with complex emotional trauma otherwise called PD, medically unexplained symptoms, people with alcohol conditions, people with neuro development mental conditions like ADHD and ASD is as follows.
We get together from across the whole country, experts by experience, good academics, good clinicians, good managers, good commissioners who come together in expert reference groups, develop commissioning guidance, we the have worked incredibly closely with both the NHS Benchmarking Club and the Improvement Unit at the Royal College of Psychiatrists which is a multi-disciplinary, multi-agency unit to do a baseline audit.
So we now know for some of these across the country what’s the gap between what we need and where we’ve got to go to. How can we develop, how can we implement the standards? These are not targets, these are standards. We’re obviously strengthening what we do by working with the five arms-length bodies. Everything we do for these standards will be embedded in making sure that we get our share in mental health of new science money and new big data and new innovations.
So first of all it’s about working with people in a kind, compassionate, coaching, it’s got to be a coaching not a doing unto, a coaching model of kind of care. And it’s got to be about thinking about the basics, so the basics are have you got access to the right information to give people? Information is power. It’s about the right physical health care. I think we in mental health, and I put my own hands up, have been just as guilty as the physical health world of saying, “Well you can look after the body but the mind won't work”. 20,000 people a year are dying because we are not doing the right physical health care of people with particularly psychosis, 20,000 a year. Every single one of these is evidence based, I can give you 3,500 references per line, I won't I promise. It’s the right information, the right physical health, the right medication if you need it in the lowest possible dose with the right monitoring and the right choice, the right psychological therapy is absolutely critical, the right access to recovery, rehabilitation, employment and absolutely probably one of the most important things is access to communities that are welcoming and kind.
I hope that gives you just a flavour of the way we’re thinking. And the reason I always start with the population is it’s when the people say, “This is important” that’s when everybody listens. So the whole bit about the public campaign, making knowledge accessible, is absolutely fundamental to all of us being able to come back to this room next year and kind of celebrate another year where despite the economic situation we are making huge progress in mental health.