Dr Andrew Mayers
PhD, MBPsS, FRSA
My work frequently attracts the attention of local and national media. Please click here to see an overview of radio, TV, and other media appearances.
October 1st 2017
Why we still need mental health campaigns
This blog was written for Mind Republic http://mindrepublic.mozello.co.uk/
On September 21st, the BMJ interviewed Sir Simon Wessely, President of the Royal Society of Medicine (formerly President of the Royal College of Psychiatrists). The central message of that interview suggested that we should stop raising awareness about mental health. The argument was that we do not have the resources to cater for those seeking help. Raising more awareness would, the article argues, only serve to put more pressure to an already over-stretched system.
In this blog, I will argue that we need more investment in those services; not fewer awareness campaigns. At the same time, we need to ensure that those campaigns are realistic, safe and appropriate.
I would like to start by stating my utter respect for Sir Simon. He has often spoken out for the need for better support for people with mental health problems. That is perhaps why I was so surprised when I read the BMJ article. A few of us took to Twitter to (I hope politely) challenge the arguments put forward. In his defence, Sir Simon stated that a short interview can only capture a small part of what he was trying to say. Nonetheless, what was said could potentially do a great deal of damage to people with a range of mental health difficulties. Perhaps there’s an argument there for writing one’s own press releases; I often do.
In one quote, Sir Simon said “We don’t need people to be more aware. We can’t deal with the ones who already are aware.” For me, mental health awareness campaigns are not about making people aware that they may have certain conditions. Most people, unless they lack insight or have a complex personality disorder, are aware that there are unwell; they just lack the confidence to seek help, or they fear stigma and judgement. Instead, campaigns should be about a whole raft of other factors – including persuading governments and commissioners that we need to invest in services, reducing social stigma, helping people not to feel guilty, and making it OK not to be OK.
I have been part of several campaigns that have influenced the Government. Through the Maternal Mental Health Alliance (Everyone’s Business) campaign and the 1001 Critical Days initiative, we have seen commitment to investment that would not have occurred without the awareness campaigns. The Time to Change campaigns have raised awareness across all areas of society reducing stigma and getting people talk positively about mental health. All of these campaigns have probably saved lives.
I agree that, by successfully raising awareness about mental health, we have been the victims of our own success. More people are coming forward to potentially seek help. That is indeed putting greater strain on services. However, that should not be a reason to stop. It’s the investment that’s wrong. Reducing awareness and failing to tackle stigma will not make that problem go away. All it will do is make people less likely to seek support, which would put their lives at even greater risk. Not raising awareness will not reduce depression, bipolar disorders, or psychoses. Any more than diabetes will go away if we stop raising awareness about that. The conditions will still be there; they just will not be diagnosed and properly treated. Reducing awareness might place less burden on services, but it would be wrong and indefensible.
Furthermore, those coming forward to seek support need not be a burden on NHS services. We need to radically rethink how we deal with mental health. With the right investment, the charity and voluntary centre can play a big part too. During the interview Sir Simon said “We should stop the awareness now. In fact, if anything we might be getting too aware. One wonders what’s happening when you have 78% of students telling their union they have mental health problems—you have to think, ‘Well, this seems unlikely.’”. Of course, it’s unlikely that three-quarters of students have a diagnosable condition. But, there’s a lot more to mental health support than primary and secondary care. At my own university, we have a whole range of support services, where students are, essentially, triaged. It’s a question of signposting to the right support. Many may need no more than simply directing towards activities that might tackle low mood and anxiety. Others may need counselling support. A few may need something more intensive. We frequently run awareness events, and wouldn’t stop those for fear of overwhelming demand. Without awareness, they might not seek help at all (and the problem could escalate). We have responsibility to support our students and adapt to what we can offer or signpost to.
In any case, mental health awareness is not just about making people aware about mental illness. Far from it. Campaigns can also teach people about how to lead better mentally health lives. We can show the importance of exercise, diet, sleep, and work-life balance, for example. We can also use campaigns to educate those with life-long conditions about tool kits that can help them stay well and reduce relapse. There are many excellent programmes across the UK doing just that. These very same people can be trained to be peer supporters, using lived experience to help others. We need to use public awareness campaigns to illustrate the benefit of peer support – to those who give the support as well as those being supported. Investment in those services, typically provided by charities, can help with prevention of relapse, or escalation of mild mental ill health into something more serious. It could save a great deal of money in future spending and, more importantly it can save lives.
Sir Simon was cautious about promises made by the Government about mental health investment, especially on the recruitment of mental health staff. I share his concerns. But that should not stop the awareness campaigns. Instead, we must use these campaigns to show that the Government still does not ‘get it’. I said as much in a blog I wrote in August. We need a revolution in the way we see mental health. Our awareness campaigns should focus on how we can foster a mentally healthy population (through positive lifestyles). Mental health education in schools can teach young people about emotional wellbeing, and how to seek help if they become unwell (as well as look out for friends and family). Early intervention could prevent a lifetime of mental illness – and that intervention, if early enough, need not be expensive either.
I also agree with Sir Simon about the need for integrated physical and mental health services. Much of what he says in the latter part of the article (which many readers could not see without a subscription to BMJ) was applaudable. Sadly, the message about mental awareness campaigns, which pervaded the opening paragraphs, might have done more damage than Sir Simon might have imagined. Sure, many of these campaigns are not perfect. In fact, we have a duty to make sure that campaigns are realistic, safe, and appropriate. A campaign that is not underpinned by networks that can, at the very least, signpost to support is dangerous. But having fewer mental health campaigns is also dangerous. We run the risk of undoing all the work that has been done over the last few years.
I will continue to campaign and raise awareness, but I will also continue to lobby Parliament for more investment (partly through my political work) and to be a critical voice in mental health services (I am a Public Governor for Dorset Healthcare University NHS Foundation Trust). I will also continue to advocate the role that charities can play in providing services (I hold trustee and ambassadorial roles to several local and national mental health charities, including Dorset Mind). We can all play a role in putting mental health at the heart of everyday living. It is a public health priority.
August 1st 2017
Jeremy Hunt announces ‘major’ recruitment in mental health: A new dawn or just the same old day?
Yesterday, Jeremy Hunt (Health Secretary) announced plans to recruit almost 10,000 staff to mental health posts over the next 4 years. The money would be drawn from the £1.3bn 'committed' to improve mental services (with the aim to bring services in parity with physical health). As a mental health campaigner, I was initially encouraged by the headlines that greeted me when I awoke on Monday morning. But does it all add up?
I have been campaigning for better mental health support for several years, especially for young people and for mothers (and fathers) experiencing mental health problems in the perinatal period. I am an academic psychologist at Bournemouth University, specialising in mental health. Through my external commitments and professional practice, I belong to a number of campaign groups (such as the Maternal Mental Health Alliance and I contribute to the All Party Parliamentary Group for perinatal and infant mental health group, 1001 Critical Days. I was driven to join these groups because of the chronic underfunding in mental health for decades (or probably ‘forever’, as Paul Farmer, CEO Mind Charity, put it yesterday). Through my work with local and national mental charities (such as Dorset Mind), I have seen the impact of cuts to services, reduction in public health and local authority funding, and the effect of austerity on communities. I was also compelled to tackle public stigma towards mental health, which ostracises sections of our society and discourages seeking help.
Let’s not forget that 1 in 4 of us will experience some mental health difficulty at some stage of our life. If you have not encountered problems, you no doubt know someone who has. Some conditions, such as depression, are a major burden to health services, and yet mental health only receives a fraction of the overall health budget. So, surely, I should welcome the promised investment and the commitment to recruiting the workforce to sustain that? Well, it’s a little more complex than that. Partly as a result of our campaigning, we have seen some encouraging funding pledges, especially in perinatal mental health. But there needs to be more. The promised £1.3bn investment in mental health needs to be put into context. Some might say that this funding only partially replaces what has been lost over the last decades. Where pledges have been made (even recently), the actual funds have failed to reach front line services. But let's say we give Mr Hunt the benefit of the doubt this time. He claims, to properly invest in mental health, we need a strong workforce to implement that. Hence the call to recruit thousands of new workers. That's OK, in theory, but what is the reality?
Part of the recruitment drive is to employ a further 2000 nurses by 2021. Surely that has to be a good thing? Well, it depends. To ensure that these nurses are in post, fully-trained, by that time, they would need to start their undergraduate courses by September this year. And yet, we are seeing a reduction in the numbers of applicants for nursing posts following the introduction of fees. There is little incentive for people to enter nursing, with the prospect of high debts to pay for the fees, and then years of chronically low pay. Why not waive the fees? Why should future nurses be paying to get the training needed to benefit society? Then there's nurses pay itself. While the pay rise cap remains, where is the reward for hard work (especially in the highly demanding and stressful role of mental health nursing). When questioned on this yesterday, Mr Hunt sidestepped the issue, focusing instead on praising how hard nurses work without addressing the problem with low pay. Hunt says that he is confident that they will recruit the nurses. But how convenient it would be, should the recruitment fail, to use that as an excuse not to spend the £1.3bn pledged. We might hear "well, we made the commitment, but no one took us up on it, so we will spend the money elsewhere".
It's not just about the pay either, or just nurses. All mental health staff have incredibly stressful jobs. Many of those staff enter the profession because they have their own lived experience and want to give something back. That experience is very powerful; I have seen that in the contact that I have with staff and service users. However, very little (until recently) has been done to protect those staff from the impact of working in those challenging conditions. Investment is needed in ensuring that all staff have access to proper clinical supervision. It's also not just about staff working directly in mental health services. All health professionals (GPs, acute hospital staff, practice nurses, community teams, etc.) need mental health training, so that (at the very least) they can properly signpost and/or refer to specialist services.
Of course, most of what I have said to this point applies to 'patients' with chronic or acute mental illness. There are considerably more people with sub-threshold mental health problems who do not qualify for treatment. But many still need support. That's where the third sector comes, especially through local mental charities. In many cases, someone with (say) relatively minor mood or anxiety problems might simply need structured, effective, peer support. Local charities can provide that expert support, especially through peers with lived experience. However, as Patron and Trustee for Dorset Mind, I can attest that our biggest challenge is finding the funds to runs the services. Very little comes from local authority, public health budgets, or local commissioning. A great deal comes from grant funding. Simply by providing these local services, we can prevent so many people escalating into more acute mental illness, and becoming a great burden on NHS budgets. Surely, one answer is to use LA and/or local clinical commissioning to ensure that all areas have access to expert services, away from the NHS.
So, was I happy with Mr Hunt's announcement yesterday? I welcome any funding, and certain applaud a drive to increasing staffing. However, this was not properly thought through. There is a much bigger picture that is being missed, quite probably because those making the decisions simply do not have the understanding about mental health that is needed to truly make the changes that are needed.
June 19th 2017
A blog for International Fathers’ Mental Health Day: Why paternal mental health is so important 2