A Mental Health Manifesto: Five Things That Need to Change
The Guardian; Emma Howard and Andy Bell, 12/10/2014
In the UK today, up to a quarter of us will have some kind of mental health problem in any given year. Yet for children and adults alike, only a minority ever receive any help for it. As the issue rises up the political agenda and the general election draws nearer, we asked the Centre for Mental Health to create a manifesto to improve the nation’s mental health.
One of this year’s Guardian and Observer Christmas appeal charities, the Centre for Mental Health is a research and development organisation that links policy with frontline service provision. We asked them to give us five ideas to prevent ill health, aid recovery and save money. Deputy Chief Executive Andy Bell told us what they believe needs to change:
1. Teach mental health in all schools
On average, three children in each classroom is experiencing a mental health problem. Most common are behavioural issues, which can cast a long shadow over a child’s future, increasing the risk of mental illness, poor physical health, drug or alcohol dependency and future imprisonment.
Schools are ideally placed to protect and promote children’s mental health: children are there five days a week for most of eleven years. Every school teaches physical education – so why do we ignore mental health?
Today, teachers’ understanding about mental health is equivalent to sex education a decade ago. Teacher training includes nothing about wellbeing or child development. Some schools have introduced Social and Emotional Learning, a programme about teaching mental health. This needs to become the norm, not the exception.
Teaching alone will not work. Schools also need to introduce screening to help identify children in distress and promote good parenting programmes.
‘We started taking her toys away for bad behaviour, until we realised there were no toys left and there was nothing we could take away.’ The Centre for Mental Health recommends parenting programmes as a method of helping children with mental health problems
2. Create specialist “mother and baby” mental health services
One woman in ten will have a mental health problem during pregnancy or in the year after childbirth. In the worst case scenario, it leads to them taking their own lives; more often they receive no help or require expensive treatment too late. Only a minority are even diagnosed. The impact on their children’s future health can be devastating. This costs £8 billion a year.
In general, GPs, midwives and health visitors do not ask women about their mental health; even if they do, they often lack the knowledge to help them. When health visitors come, physical needs always take precedence.
Women who become seriously unwell after giving birth are sometimes placed in a psychiatric hospital away from their babies. This causes untold distress to everybody. The lucky ones are referred to specialist “mother and baby” units but the system operates like a postcode lottery. When a woman in one London borough discovered that if she lived a few streets away she would have been able to access a unit unavailable to her, she launched Everybody’s Business, a campaign to highlight the issue.
3. Keep people with mental health problems out of custody
Imprisoning somebody is disastrous for their mental health and can increase a person’s risk of re-offending. Poor mental health is both a cause and effect of crime – this is why every police station and court needs to work in tandem with an expert mental health team to identify people at risk of offending and to respond at the point of arrest. 70% of offenders have multiple mental health problems and one in ten have a severe mental illness
Of course, there will always be some people who offend. When they do, we need support for those with mental health problems so they can be referred to hospitals, GPs, drug and alcohol services and counselling. These specialist teams can help find someone a roof over their head and can talk to a school to prevent a young person being excluded. There is also some great preventive work being done by individual projects – such as appeal charity MAC-UK – but there needs to be a national system in place.
4. Employ people with mental health conditions
More than half of people with long-term mental health problems want to work yet less than one in ten are in paid employment. Why is this?
First there is the assumption that people with mental illnesses cannot – or should not – work. Often this can come from health professionals themselves. Then there is the assumption that it is all the fault of bad employers. Of course, some do discriminate and many are still fearful of taking someone on with long term mental health problems. This is why we need good employment support – it takes the fear away.
This can come from the NHS or voluntary sector partners, but at the moment they are mostly not working together. We need support that is tailored for people with mental health problems, which is commissioned through the NHS and works with local employers. When this is done, it is very effective, with some services achieving great results – one NHS trust in London last year got more people with severe mental illness into work than the whole of the government’s national programme.
“Doing a full day of work is very beneficial for your mental health”. The employment programme at the Central and North West London Foundation Trust
5. Help people with long-term physical health conditions
Few people with illnesses like diabetes, cancer and heart disease are asked about their mental health at the point of diagnosis – but we know that about a third have a problem. The extra prescriptions and hospital admissions cost the NHS £10 billion every year.
In Hackney, London, a group of GPs decided to invest in a new psychotherapy service for people with complex mental and physical health needs. It both improved patients’ health and reduced demand on local GPs and hospitals.
Mental and physical health have for too long been treated separately. Some hospitals do have mental health experts available to offer specialised support in a crisis but this is not yet the case everywhere. If there is help in one place, it should be everywhere.