DESIGN IN MENTAL HEALTH CONFERENCE 2019
people with severe and enduring mental ill health. He said: “It is an immensely impressive service there, led at the time of my visit by a man called Warren Larkin.”
Consultant clinical psychologist Prior to founding Warren Larkin Associates in 2017, Warren Larkin spent 24 years in the NHS, working predominantly with individuals and families experiencing serious mental health difficulties – first as an assistant working on the long-stay psychiatric wards at Prestwich Hospital, and then as Clinical Psychologist in Manchester, working in a service created to provide and research the impact of CBT and Family Interventions for people experiencing psychosis.
He went on to lead one of the two national IAPT SMI demonstration sites for psychosis – chosen to share and disseminate innovative practice in first episode psychosis services (FEP). This initiative contributed to the case for change which led to increased funding and the introduction of the two-week referral to treatment time in FEP services in England.
He then spent five years as Clinical Network Director, responsible for Children and Families Services across Lancashire, which he said engendered his ‘passion’ for public health and prevention work. A Consultant Clinical Psychologist and Visiting Professor at Sunderland University, he is working there with the Faculty of Health Sciences and Wellbeing, and its research programme, and delivers training for public health and mental health professionals.
Adverse childhood experiences expertise Having recently completed a two-year tenure as the Clinical Lead for the Department of Health’s Adverse Childhood Experiences programme, he is now working with NHS Health Scotland to implement REACh (routine enquiry about adversity in childhood) in a number of GP practices. He has a long-standing interest in the relationships between childhood adversity and outcomes later in life, and has published numerous research articles on adverse childhood experiences, trauma, and psychosis, and an edited book in 2006 (now commissioned for a second edition) exploring this theme.
He was a member of the Children and Young People’s Mental Health Services National Task Force, the NICE expert reference group on first episode psychosis, the ‘Tackling CSE’ advisory group, and a contributing author of the recently published Personality Disorder Consensus Statement.
‘Under incredible pressure’ over CAMHS bed capacity Sir Norman Lamb said of his discussions with Warren Larkin: “As we were heading back to the station in the car after my visit – at a time when we were under incredible
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The DiMHN’s chair, Jenny Gill, introduced Sir Norman Lamb to the stage.
pressure over a lack of CAMHS bed capacity nationally, with awful stories in the media about children and young people being shunted hundreds of miles in search of a bed, and massive pressure to provide more – Warren said: “Don’t just think that the answer to all this pressure is more beds. We need to be thinking much more profoundly about how we stop children and teenagers needing to go into inpatient care in the first place. That really struck me, because I hadn’t previously come across any really solid thinking about how we prevent mental ill health in the first place, and how we prevent a deterioration in mental health. Most of the discussion then was about adding more beds to respond to a growing crisis.”
‘Reformers’ brought together In a second recollection of his time as a Minister, Sir Norman remembered how mental health charity, Rethink Mental Illness, had brought together a number of ‘reformers’ in mental healthcare for a discussion. He said: “I can remember Matthew Patrick (who until July this year, when he stepped down, was CEO of the South London and Maudsley NHS Trust
Don’t just think that the answer to all this pressure is more beds. We need to be thinking much more profoundly about how we stop children and teenagers needing to go into inpatient care in the first place
(SlaM)), a very impressive man, saying: “I envision a time when we will have re- thought the role of the mental health Trust – away from institutional care, towards being much more of a centre of excellence, working collaboratively with organisations in the community. Trusts will still, of course, admit people for people for inpatient care when needed, but will really re-focus on support in the community, rather than providing long-term institutional care. That, again – coming from somebody I admired a lot – really struck home.”
Sister’s death
In 2015, Sir Norman Lamb went on to explain, his older sister, Catherine, took her own life following a period of deep clinical depression after the death of their mother, some months after being discharged from a 10-week stay in an inpatient unit. While there had been ‘no question’ about any lack of sufficient investment in his sister’s care, he did wonder if the money available had been used in the best way to help her in a therapeutic recovery. “I questioned this,” he explained, “because while the unit she was accommodated in was probably not that old – it probably dated back to the 1980s – it was a pretty dismal place, with high fences around it, akin in many ways to a secure prison facility. Inevitably, all the service-users were deeply troubled, and with my sister you had somebody suffering from deep clinical depression. When we met with staff carrying out the internal investigation following her death, I asked whether that was really a fit-for- purpose therapeutic environment for her, or indeed for anyone in that unit, to recover in.”
Physical environment’s importance
The former Minister acknowledged that these ‘various thoughts and experiences’ had had an impact on him and his thinking about how society can best support people experiencing mental ill health. He said: “One of the key lessons I learned was that the physical environment in which people stay when mentally ill is extremely important. While I was Minister, I visited a wonderful new Mersey Care mental health inpatient unit in Aintree, and the CEO there showed me this wonderful new facility with lots of light – modern and attractive, and very different from many other inpatient facilities around the country. The truth is that there has been a disadvantage suffered by mental health compared with physical health in terms of capital investment countrywide over very many years.” In 2017-2018, the speaker noted, mental health Trusts in England received just 9 per cent of public healthcare capital investment, and in the period up to 2022/ 2023, of the £2.6 bn being given to Sustainability and Transformation Plans for capital investment, mental health was getting £300 m. Spending on NHS mental healthcare thus had ‘a lot of catching up to do’.
OCTOBER 2019 | THE NETWORK
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