DESIGN IN MENTAL HEALTH 2022 KEYNOTES
Sarah Hughes (pictured, left) was introduced to the audience by Chair Emeritus of the Network, Jenny Gill (pictured, right), as ‘a leader in global health, gender equality, and justice, who has been involved in mental health and criminal justice for 30 years’.
Sarah Hughes said: “None of these things entail seeing a psychiatrist every two weeks, so it’s all about our lives, and where and how we exist on a daily basis.” Key risk factors for poor mental health, meanwhile, included trauma, traumatic events – especially for children and young people, abuse and neglect, isolation, bullying, poverty, insecure housing, fear of, and actual, crime, discrimination, and racism – ‘all very well evidence-based influences on our mental health’. The speaker’s experience was that mental health inequality, both in Europe, and around the world, was significant, ‘for a number of reasons’, but with the most vulnerable in society facing the highest risk of poor mental health. She said: “While all of us can experience mental health issues, those who are most vulnerable are the most likely to experience mental distress – people on low incomes, disabled people, people from the LGBTQ+ community, those with long-term illness, neurodiversity, looked-after children, people coming through the criminal justice system, and those in residential care. For those of you that have worked in mental health for any length of time, this will be very clear to you.”
‘Triple barrier’ Sarah Hughes said that, currently, there existed a ‘triple barrier’ – as the Centre for Mental Health dubs it, to mental health quality equality. “So,” she explained, “we have the unequal determinants of mental health – as I’ve just described; unequal access to mental health support, and unequal experience and outcomes. We all know we have a two-week waiting time for urgent referrals for cancer, most of which are still maintained, despite the pandemic. We don’t have any of that parallel for mental illness; maybe you’ll receive early intervention in psychosis, and in some instances when you’re in crisis or at risk of suicide, but even then we do not have a parallel experience in mental health.” For some conditions within that ‘mental health umbrella’, the speaker emphasised, however, ‘we have the worst prognosis’.
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She said: “So if you’ve got personality disorder, and you go into mental health services, you’re likely to have a worse prognosis of recovery than somebody with psychosis, for example, so there are a number of factors that are unequal within the ‘unequalness’ of mental health and its entirety.”
What about the causes? Focusing next on what causes mental health inequality, the speaker said mental health inequalities were ‘social and economic inequalities’; it was thus ‘about wealth, poverty, and economic power, discrimination, racism, misogyny, violence, oppression, and injustice’. While mental health was often
considered a medical / clinical issue, Sarah Hughes said that although the Centre for Mental Health’ understands the medical model’, it doesn’t ‘tell the whole story’. She expanded: “What does is how people are living, how their lives look, and what happens when people are living on the breadline. Fundamentally, their mental health takes a battering; you only need to step outside your front door now to see that it is very real, expressed all over cities and towns countrywide.”
Deprivation’s role Showing two maps, she explained that the one on the right showed areas of deprivation, while shown left was a map of the prevalence of mental illness. The speaker said: “It’s pretty stark; you can pretty much overlay deprivation with mental illness down to very specific geographical boundaries.” Unfortunately, however, despite more clear evidence of the link between deprivation and mental ill health emerging every day, Sarah Hughes said this was not necessarily a clearly held or agreed perspective in government, or among decision-makers necessarily. She said: “There is also huge and stark inequality for people with mental illness around physical health, which we call ‘the stolen years’. So, if you have a serious mental illness, your prognosis of living beyond 75 is vastly reduced, and in fact 20
years behind other people without such an illness. This is also deteriorating at a rate of knots every year. So, again, we’re talking about a specific vulnerable group whose physical needs are not being met. So, life expectancy is shorter, and there are higher rates of physical ill health – like diabetes and heart disease, as a consequence of smoking.”
Changing attitudes Having worked in mental health for 32 years, Sarah Hughes recalled that when she first started, ‘everybody smoked’. “I smoked, service-users smoked, and the psychiatrist smoked,” she recalled. “However, it’s the service-users who are dying, with low rates of cancer screening, but high mortality after diagnosis. So, what we’re seeing is people with serious mental illness not getting diagnosed with cancer until it’s too late, and dying fairly rapidly thereafter. Those with mental health issues also have higher death rates from infectious disease, including from COVID-19. In fact, when the vaccine roll- out happened, we had to fight tooth and nail to get people with serious mental illness on the first tranche to get their vaccines; they were initially left off the list, and of course physical health is linked to poverty and exclusion, so you have a kind of triumvirate of issues.” The Centre for Mental Health has a network, ‘Deeply Well’, which Sarah Hughes explained anybody could join, which ‘focuses very hard on the issue of physical and mental health’.
‘Where inequalities grow’ Moving to ‘how and where mental health inequalities grow’, she said one key factor was ‘early years experience of diversity’, with children aged 0-5 currently ‘gaining profile’ across the country. The Duchess of Cambridge was, she noted, ‘doing a huge amount of work’, as were universities, to ‘raise the profile of these really important years’. She said: “If you’ve experienced adversity in years 0-5, you’re more likely to experience trauma or other adversity later on in life.” Also key to mental health
AUGUST 2022 | THE NETWORK
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