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Some progress, so much more to do

January 20, 2018


Abandoned Illness

It was good this week to return to the issues affecting people with schizophrenia and psychosis when I joined colleagues at Rethink Mental Illness to mark the 5th anniversary of the publication “The Abandoned Illness” the report of the Schizophrenia Commission. The Commission remains one of the most interesting, and fulfilling, pieces of work I have been involved in, in the course of my career. 5 years is a good perspective from which to judge the impact it has had and how the cause of those affected by severe mental illnesses such as schizophrenia has fared given 5 years of priority for mental health but also 5 years of austerity. Rethink Mental Illness published an assessment of the key developments.

The picture is inevitably mixed. There are some areas of clear progress. Not surprisingly top of the list is the impact of a reducing level of stigma towards mental illness and those affected by it. When we started on the journey with Time to Change and other action to tackle stigma and discrimination there was a fear that, while it might be possible to reduce stigma to more common conditions such as depression, the prejudice towards people with schizophrenia and other more severe mental health problems would be untouchable. This has not turned out to be the case and brings benefit in helping people affected by these conditions to engage, where possible, with work and with other social activities.

It was also good to celebrate the impact of the waiting time standard for early intervention. The model of early intervention remains, for me, one of the most positive developments in mental health care in recent times and it has a clear evidence base both for delivering better outcomes but also for reducing the costs of future care.  At the time of the Commission there seemed to be a threat that early intervention would be diluted under the financial pressure faced by Mental Health Trusts. Norman Lamb, the Minister for Mental Health at the time, deserves an enormous amount of credit for making early intervention one of the first standards for mental health.

There are areas of mixed achievement. The poor physical health of people with severe mental illness is now widely recognised and a lot of effort is being made to build more integrated models of service delivery. There is, however, a long way to go to provide the level of input and support which will make a real difference to such a deep-seated problem. The pressure on primary care services does not help but there is no doubt that further investment here would have a real pay back, not only in terms of years of life for people affected by severe mental illnesses but also in terms of savings for physical health services.

Inpatient care remains a point of concern with levels of occupancy across the system well above the level of 85% recommended by the Royal College of Psychiatrists and too many patients having to be placed out of area to secure a bed. I am pleased that there is a national focus on reducing out of area of placements and I welcome developments, which were called for in the Schizophrenia Commission, to facilitate a transfer of resources from secure care to strengthen community services. However, there is a need to face up to the fact that there in many places there are insufficient resources to create an effective acute care pathway with the right balance of beds and community resources. As this week’s report from the King’s Fund confirmed such a situation is inevitable in world where parity of esteem for mental health still comes second to the pressures in the acute physical care hospitals. A system under strain like this, inevitably, has its impact on the staff working in it and there is a danger we have created a vicious circle where the pressure of the environments we ask staff to work in has a negative impact on recruitment and retention, perhaps most worryingly for new trainees.

The most depressing part of the piece though must be the impact of austerity on areas such as housing, benefits and community services which provide the underpinnings for people with severe mental illness remaining well in the community. There is no doubt for me that this is having an impact in increasing the demand for mental health services and it was sad to hear from carers and others at Rethink Mental Illness the traumatic effect of the work capability assessment amongst other things. This remains the most blatant area of discrimination in society against people affected by mental health problems. While I, of course, welcome the current review of the Mental Health Act, a far more urgent requirement is to make a serious commitment to tackling the injustices which people with mental health problems face in the social security system.

So, 5 years on there are definite areas of progress but still so much to do. However, I was also struck by what Sir Robin Murray who chaired the Schizophrenia Commission had to say at the event this week about hope. For him, one of the biggest learnings from the work of the Commission was the importance of a message of hope in supporting people with a diagnosis of schizophrenia or other severe mental illness. This has a lot of resonance. Hope is not necessarily the same as optimism but hope inspires the will to try and to fight and that for individuals and for society battling with the issue of mental health is what we need more than anything else.



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