DESIGN IN MENTAL HEALTH CONFERENCE 2019 Children’s services
Turning to children’s mental health services in England, Sir Norman Lamb noted that the average length of stay in a bed was 72 days for a child or a teenager, compared with just 10 days in Australia. He told the conference: “This sort of data should at least force us to ask: ‘Are we always getting it right for our children and young people?’ I imagine sending a teenage girl 100 miles away from home, for perhaps 10 weeks, we may be doing her long-term damage. Imagine trying to re- integrate with your friends, school, and so forth, after returning home – much more difficult after that length of stay.” The speaker said that over the years, as bed numbers had come down in Adult, but not in Children’s, mental health services, commissioners had tended to take the savings that had been made, and invest them in the local acute hospital, rather than in community services in mental health; the latter had often suffered disinvestment ‘over the years of financial strain’ within the NHS. He said: “Looking at what people were doing all around the country to confront all of these challenges, I saw some very inspiring practice; going back to Tim Kendall, he told me that in Sheffield they had a real problem with out- of-area placements and very high occupancy rates. They thus made a purposeful decision to reduce stay lengths in their units in Sheffield. By doing this, they were able to repatriate back home all the people in out-of-area placements, and additionally close beds, in turn saving money to re-invest in support services in the community. That to me is an inspiring direction of travel, which we should follow very closely.”
A 24-hour triage service The speaker had also worked with a consultant psychologist called Alex Stirzaker, at that time working in Swindon. At Alex Stirzaker’s invitation, he visited a service in Swindon. Patients with a mental health problem, after seeing their GP, were not automatically referred into secondary mental healthcare and a bed, but rather into a ‘24-hour triage service’. Sir Norman Lamb elaborated: “Here they assess whether the individual really does need to go into inpatient care. For a significant proportion of those triaged, they refer the individual to their ‘LIFT Psychology’ primary care-based service. This aims to support people with complex needs, including those with a diagnosis of personality disorder, and keep them out of acute inpatient beds, thus relieving the pressures on inpatient services, and supporting people more effectively in the community.”
‘Stuck for months on end’ Sir Norman Lamb said he had heard from one mental health Trust CEO that individuals diagnosed with personality disorder ‘end up’ in inpatient beds, and that they often ‘get stuck there for months
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Getting mental healthcare ‘into the ‘spotlight’
Tim Kendall, NHS England’s National Clinical director for Mental Health, had told the former Minister that in Sheffield, they had ended the use of facedown restraint, and he felt that ‘if one large mental health Trust can do it, others surely can’.
on end, without any particular therapeutic value’. Keeping them out of hospital, and supporting them in the community, thus ‘seemed to make a lot of sense’ to him. Citing another example of an ‘inspiring’ individual he had come into contact with – a consultant psychiatrist working in east London called Sharad Ahmad – he explained that the psychiatrist’s team was working with complex individuals who would in the past always have ended up in an inpatient bed, but who were now being supported in the community. The MP added: “We subsequently brought all these inspiring reformers within mental health together to draw up a document which we have called Care not containment: Setting a radical vision for transforming mental health support. We have sent this to the Secretary of State for Health, and it was featured on Channel 4 News.”
In essence, he explained, the document’s message was that while politicians, pressure groups, and other policy- influencers, must continue to campaign for more money for mental health services – including investment in capital assets to improve the experience of those needing inpatient care – there also needed to be more of a focus on how money is spent. He said “A shift away from institutional care, which too often breaches human rights, to an emphasis on prevention and intervening early, particularly in childhood and teenage
years.There needs to be increased focus on recovery, and supporting children, families, teenagers, and adults through crisis at home, rather than – as a default position – admitting them into inpatient care.”
Still on the subject of ‘prevention’, Sir Norman Lamb explained that he is chair of the Government’s Science & Technology Committee, and had been pleased, as he put it, to have ‘got mental health onto the agenda of that Committee for the first time’. He elaborated: “We looked at the impact of adversity – trauma, abuse, and neglect, in early years, and the very clear correlation between children experiencing adversity at an early age, and the emergence of mental ill health and mental distress in teenage years and beyond.” The Committee also examined ‘very clear evidence’ of interventions in early years, which were shown to prevent trauma becoming entrenched in particular children, and thus ‘all of those adverse consequences later on’. These, he added, went ‘beyond health’ – to poor educational attainment and ‘worklessness’ in adulthood, ‘at enormous cost to the state’. He said: “The life cost of a child neglected is vast, so if we have the evidence of what we can do to intervene in early years to prevent that trauma becoming a lifelong problem, surely we should be doing it?” He added: “If you go to Manchester, Dr Caroline White leads a brilliant Children and Parent Service where they do exactly that; they apply the evidence – despite stressed finances, – prioritising early intervention in early years, to prevent the deterioration of health later on.”
High percentage had experienced early trauma Jon Wilson, the head of the Youth Mental Health Service in Norfolk, meanwhile, had told the North Norfolk MP that about 70 per cent of the teenagers being looked after in the service there had experienced some form of traumas in their early years, and that what these individuals were going through was ‘a very rational and understandable response’.
“Very depressingly,” Sir Norman Lamb added, “the Government rejected our call for a national strategy to apply the evidence nationwide, just as they do in Manchester, but we will keep campaigning for that change.” He said he would like to close with a simple message: ‘Parity of esteem has now become part of our lexicon’. He elaborated: “Government Ministers talk about it all the time; they demonstrate a commitment to equality between the treatment of people with mental ill health and those with physical health problems. The reality, however, is still a long way from equality or parity for those suffering from mental ill health. Through my own experiences in my family, and no doubt the families represented in this room today, we have to recommit to the fight to ensure equality for those people who suffer from mental ill health.” Thanking the audience for listening, and with this rallying call, Sir Norman Lamb brought a thought-provoking conference presentation to a close.
n OCTOBER 2019 | THE NETWORK
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