Mental health network

Time for bold decisions in mental health | Dr Rick Fraser

Dr Rick Fraser

People with mental health problems in Sussex and East Surrey live up to 20 years less than the general population, new research has found. To turn the tide, the local sustainability and transformation partnership has put its money where its mouth is, explains Dr Rick Fraser. 

Times are tough for mental health services. But there are grounds for optimism…aren’t there?

It feels like there’s more political public and media attention being given to mental health than ever before. And there’s no doubt that public understanding and awareness has improved in recent years. Yes, my clinical colleagues working in operational services are under massive pressure. But no one could describe us as the ‘Cinderella service’ any more (or, at least, Cinderella has come to the ball).

So why am I worried?

One very good reason is analysis we’ve published today (1 August) that shows you’re likely to live about 20 years less than the general population if you use mental health services where I work in Sussex. But that’s not the half of it. Here’s just a taster of what today’s statistics, published by Sussex and East Surrey Sustainability and Transformation Partnership (STP), tell us:

  • If you use mental health services in our area, you’re two to four times more likely to die of cancer, circulatory or respiratory disease than the rest of the population
  • Mental health service users attend A&E more than three times as often as the rest of the population.
  • There’s a life expectancy gap of around 20.5 years for men and 15.5 years for women between those who use mental health services and those that don’t.

The second reason to worry is that none of this is really news to clinicians working in mental health. Variations of the life expectancy statistic have actually been kicking around for quite a few years now. But we’re not really seeing an improvement in the situation, despite the increased awareness of mental health I just mentioned.

I can’t think of a single other area of healthcare where statistics like this would be acceptable in today’s society. But I do think there’s a chink of light on the horizon.

The STP concept hasn’t exactly enthused the public and patients (and I wonder how many of my clinical colleagues have a good understanding of what it means). It doesn’t help that it’s a pretty uninspiring name. And I don’t think anyone will find it a startling revelation for me to say that the health and care system hasn’t exactly covered itself in glory trying to explain the idea, and the value of it, to the public.

But here’s the thing. Our local STP hasn’t just decided that mental health is a priority, it’s put its money where its mouth is to look at how we do something about it. That starts with drilling down into how mental health services are funded and commissioned locally.

But what has to go hand in hand with that is for those of us working in mental health to look really long and hard at what we do – and to start making some bold decisions about doing things differently. In particular…

The recruitment crisis isn’t going to magically disappear any time soon…so let’s think about how we can create new roles and get more people with lived experience of mental health working alongside clinicians as equal partners.

The pressure on services shows no signs whatsoever of easing…so let’s really embrace the recovery model as a way of helping people maintain their own mental health and wellbeing, getting away from the idea of traditional mainstream mental health services as the only option.

Our staff are working constantly under huge stress…so let’s pay serious attention, rather than lip service, to their wellbeing.

The health service, frankly, has done a pretty shocking job of looking out for the physical health needs of people with mental health problems…so let’s get our act together and start translating ‘integrated care’ and ‘partnership working’ from a fuzzy ideal into tangible action.

We’re starting to do all of those things at Sussex Partnership NHS Foundation Trust. But we need to do more of it, much more. And we need to be doing it shoulder to shoulder with people who use services, their families and the rest of the health and social care system.

I’m beginning to feel there’s a genuine appetite to do this, not least because we’re fast approaching the point of running out of alternative options.  I’ll take that as a reason to be optimistic.

Dr Rick Fraser is chief medical officer at Sussex Partnership NHS Foundation Trust, a member of the Mental Health Network.  Follow the trust on Twitter @withoutstigma

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