Today I was one of the speakers at DMU’s third ‘Be the Change’ event. Focusing on the research that takes places within the university, the event has speakers throughout the day talking about their work and their contributions to research. During my time I spoke about how mental health training can contribute to a public health approach to mental health care. This post is a summary of what I said.
Mental health is an increasingly prominent social issue. Partially this is because of the social and financial impact of mental health needs. People with mental health needs generally need more treatment for their physical health also. People with schizophrenia and bipolar disorder die up to 20 years earlier than then general population due to physical health conditions. Additionally untreated mental health needs also cause more people to turn to drugs or alcohol to self-medicate, which places further strain on our health service when this causes health problems, or requires emergency care. It is not only health care that struggles to address the extent of mental health needs within society. Up to 40% of police time is spent addressing incidents which are linked to mental health needs. This contributed to an over-representation of mental health needs within the criminal justice system, and an overuse or misuse of section powers by police.
For those who have sought help and been assessed as needing mental health support, accessing care is difficult, with waiting lists as long as a year or more for treatment in some areas. This all amounts to our support services for the whole community being overstretched, and professionals from a variety of areas being expected to understand or offer mental health support in some capacity, without necessarily being trained to do so. As 1 in 4 people will experience some form of mental health need at some point within their lifetime, it is clear that the approach we take to providing mental health care requires improvement.
Policy and funding allocations have a huge impact upon how mental health services and care can be delivered. The current Prime Minister has said that the inadequacy of mental health support is a “burning injustice”, but in speeches her views of mental health care focus on citizens supporting each other, rather than more formalised support. This echoes David Cameron’s ‘big society’, which was generally viewed to be unsuccessful. Additionally framing mental health care as a community based issue effectively minimises the responsibility of government to fund and support mental health services. The “no health without mental health” policy stated that more financial control would be given to local services and local authorities, to ensure that spending was used to meet needs within that area. Additional funding was released to support this also. But front-line services actually saw very little of these funds, and in many areas mental health services have been impacted by cuts.
To properly support the mental health needs of the population, a new approach is needed, which recognises the extent and prevalence of mental health need, and allows people to get support before they reach crisis. Public health models would be a good way to do this. Public health approaches look at problems and offer support on a number of levels. The primary level focuses on universal services, and how they could offer generalised support for a specific problem. This may be schools offering counselling services, or ensuring that police offers understand what a panic attack looks like to allow them to act appropriately. This isn’t a replacement for specialised services, but allows for less serious problems to be addressed in a non-clinical, accessible setting, or referrals to be made for more specialised support. The secondary level would be specialised support for low to mid-level needs. This may be ensuring that GPs can diagnose mental health needs correctly, and that treatments that are shown to be effective are accessible. Currently medication is a common treatment, whereas CBT or talking therapies are difficult to access, despite potentially being more effective for many people. The tertiary level of a public health approach is comprised of highly specialised services, for those with the greatest level of need, such as psychiatric units or long term systemic therapies.
The public health model doesn’t look too different from what we have now, except for the primary level. We don’t offer general mental health support and wait until people reach crisis to offer support, or all issues are addressed by what should be a more specialised service. Developing our primary level mental health care within universal services would be beneficial for everyone and would allow specialised mental health services to work more effectively. We’ve taken public health approaches to a number of issues within the UK, such as smoking, nutrition, heart disease; so why not mental health?
It isn’t necessary to wait for government to apply a public health approach to mental health care to develop and improve primary level services. Ensuring that staff within universal services are aware of mental health needs and have some skills to offer support would be a step towards this. Mental health training is becoming more commonplace, with Mental Health First Aid (MHFA) being a good example. Developed in Australia, MHFA is a two day course delivered to a group of mixed professionals. It covers basic information about common issues such as depression and anxiety, and more serious needs such as psychosis. MHFA also offered practical tips like how to calm someone who is having a panic attack, and how to have a conversation with someone experiencing a delusion. One of the main things MHFA courses deliver is knowledge of what support is available, and how to access it. The receptionist in social services shouldn’t be expected to deliver mental health care, but informing them of who they can call if someone is in distress is helpful.
In my research into MHFA courses, it seems one of the main benefits to people is that they are reassured about what they do in those situations, much of the fear or hesitation in supporting someone with mental health needs seems to stem from uncertainty and not knowing what the “right thing” to do is. The courses also humanise and demystify mental health. Emphasizing that someone experiencing mental health needs is simply unwell puts it in a similar context to someone who has a physical health need, which makes it easier to understand and allows people to feel more confident in offering support. Helping professionals to develop this confidence to offer support, even in a non-professional setting, is positive. It means that your colleague feels more able to listen to you and be there for you if you’re experiencing an episode of depression, it means that you won’t have to worry about being seen as weird if your anxiety is too much and you have to leave the office to calm down for a while, it means that we can help each other to access support when we need it.