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This week is the Mental Health Foundation’si 16th Mental Health Awareness (MHA) week, which given its proximity to the resolution of the election, is a timely reminder of the need to honour the various pledges that suggest funding and provision of mental health should be given parity with physical health. The focus of this year’s MHA promotion is mindfulness - the meditative technique designed to “clear the minds, root oneself in the present and give respite from the stresses and anxieties of modern day living”.ii This week’s blog therefore explores this concept of mindfulness and considers why the new government should prioritise mental health more widely.
Mindfulness, has much in common with cognitive behavioural therapies (CBT) in as much as it supports strategies to give pause to - and even avoid - negative thought cycles and feelings. As such it is a technique to help tackle, not cure, depression and other emotional disturbances by moderating feelings which might otherwise be harder to cope with, and fostering a greater sense of wellbeing. Mindfulness is paying attention to the present moment, without getting stuck in the past or worrying about the future. Mindfulness can be practiced anywhere, for 5 minutes or 5 hours. At the heart of it, mindfulness helps people observe the way they think and feel about their experiences, whether good or bad, helping to change the way reactions to stressful situations are managed, while providing a tool to help people stay mentally healthy. An expanding body of evidence shows that it really works.iii
Mindfulness is known to be successful in helping a range of problems, from stress, depression and anxiety to chronic pain, eating disorders and concentration. It can boost productivity at work, and lead to a greater enjoyment of life. However, while the MHF run a four week online course, designed to guide participants through the elements of Mindfulness-Based Cognitive Therapy (CBMT) and Mindfulness-Based Stress Reduction (MBSR). However, there is currently only limited access to this and other training and support in mindfulness. Indeed access to psychological therapies remains limited, providing little choice of treatment and leaving many waiting with inadequate support. iv
Mental health services have been under intense pressure for some time with evidence of cuts in community teams and in services for children and young people, meaning increased pressure on acute beds – with reports of clinicians sectioning patients in order to get a bed.v Meanwhile the Health Foundation and Nuffield Trust’s QualityWatch report in October 2014 highlighted clear signs of recent decline in quality across several areas, with particular concerns about severe pressure on access to mental health services.vi
Mental health problems are a main cause of sickness absence in the UK although recent years have seen some improvements in society’s attitudes towards people with mental health problems. Contributing to this shift, was the coalition governments publication in January 2014, of Priorities for Change, detailing 25 priorities for change in how children and adults with mental health problems are supported and cared for, albeit led largely by the Liberal Democrat coalition partners.vii
Other policy actions include a crisis care concordat, pilots to better integrate employment and mental health services, pilots to identify and divert people with mental health problems from the criminal justice system, waiting times standards, a new national intelligence network for mental health, on-going work on a mental health tariff and a children and young people’s mental health taskforce.
In March 2015, the coalition government announced its intention to provide £1.25 billion of new funding for children's mental health services, and to support provision for pregnant women, young mothers and armed forces veterans. The funding was to be accompanied by new waiting time standards for child mental health and a commitment to provide specialists in children’s talking therapy in every area of the country by 2018. The Conservatives manifesto’s main mention of mental health is on page 39, and although it acknowledged the need for additional funding, unlike other parties manifestos failed to specify how much. Instead, the commitment to 'continue to take mental health as seriously as physical health' appears somewhat vague.viii
The concern, now, is how much of the above activity will be sustained. Especially when the biggest ask from mental health charities and policy groups is more money for mental health as well as more focus on preventing mental health problems. Indeed the focus on the need to improve mental health is building. At the same time as Mental Health awareness week, the ‘Time To Change’ pledge, led by MIND and Rethink Mental Illness, is campaigning to challenge mental health stigma and discrimination and bust a few myths:
- Myth: Mental health problems are very rare. Fact: 1 in 4 people will experience a mental health problem in any given year.
- Myth: People with mental illness aren't able to work. Fact: We probably all work with someone experiencing a mental health problem.
- Myth: Young people just go through ups and downs as part of puberty, it’s nothing. Fact: 1 in 10 young people will experience a mental health problem.
- Myth: People with mental health illnesses are usually violent and unpredictable. Fact: People with a mental illness are more likely to be a victim of violence.
- Myth: People with mental health problems don't experience discrimination. Fact: 9 out of 10 people with mental health problems experience stigma and discrimination.
- Myth: It’s easy for young people to talk to friends about their feelings. Fact: Nearly three in four young people fear the reactions of friends when they talk about their mental health problems.ix
Given the above, and whichever way you look at it, raising the profile and priority given to improving mental health is not just the right thing to do, it also makes economic sense. Most commentators agree that what is needed is a fundamental rethink of the strategy and approach to preventing and treating mental health alongside a refresh of the funding allocation. While the new government decides its funding priorities, a focus on resources and support for mindfulness could well be a good place to start. In particular, the Mental Health Foundation’s focus on preventing future mental health problems and building resilience to life’s challenges, is a clear “starter for 10”x.
iThe Mental Health Foundation is the leading mental health research, policy and service improvement charity; and has pioneered new ways of looking at mental health and improving the lives of people experiencing mental illness for more than 60 years. See also: http://www.mentalhealth.org.uk/about-us/our-history/
xIinformation about good steps to take on sleep, exercise, nutrition and relationships can be found on www.mentalhealth.org.uk and a new website, bemindful.co.uk, gives information about mindfulness and access to the national database of teachers.
This week is the National Council for Palliative Care (NCPC), Dying Matters Coalition, Dying Matters Awareness Week (DMAW), with the theme, ‘Talk Plan Live’. The aim being to highlight the importance of talking about dying and, importantly, of planning ahead. In October 2014, we published the Centre’s report on Transforming care at the end-of-life, so this seems like an appropriate time to consider developments since then and why raising the profile of dying really does matter.
Whatever your political persuasion, the NHS continues to be a high priority for all parties, and if the promises of increased investment are to be believed its future, at least for next five years, is safe whatever the outcome of the election. The only difference is what constitutes safe, and how much additional money and staff might be available to deliver the various commitments. As people wake up to the results of the election, this week’s blog looks back at the various commitments made.
The digital revolution, which began several decades ago, has completely transformed how we access, collect and transmit information. In the last decade the ‘internet of things’ and the increasing capacity and capability of smartphones, tablets and more recently wearables, have had a profound impact on society as a whole. Changing consumer expectations, behaviours and demand. In response, businesses are constantly adapting and innovating from contactless and online banking services to smart energy meters and now the ‘connected homes’.
This week we launched our latest report Connected health: How digital technology is transforming health and social care, which analyses opportunities and barriers to the adoption of technology enabled care (TEC). While the emphasis is on the UK, many of the challenges and potential solutions are relevant to most health economies facing rising demand for services in the face of constrained supply of health and social care resources. The report considers how digital technology is shifting the dynamics between patients and clinicians, and helping providers to work differently.
Given the increased focus on NHS targets, especially those process targets that appear to be increasingly difficult to achieve, this blog focusses on two high profile healthcare associated infections (HCAIs) reduction targets . These targets, like many other targets, have consistently polarised views. With many believing that they were the best way to ensure that hospitals gave this significant patient safety issue the highest priority and others questioning the evidence for, and clinical validity, of the targets.
One of the hot topics for the election is yet again the call to reduce public sector bureaucracy. When it comes to NHS bureaucracy the link is immediately made to the NHS having “too many managers” and promises to “reduce the number of NHS managers”. But in reality there is limited evidence that the NHS has too many managers and a growing body of research which suggests that rather than having too many managers, there may be too few, and that under-management could actually add to increases in the costs of running the NHS.
With Parliament dissolved and the 2015 General Election now five weeks away political parties are beginning to outline where they stand on healthcare as an election issue. While political parties may have preferred to try and de-politicise healthcare, the relentless media focus on NHS performance, especially in relation to waiting times and the increase in accident and emergency attendances, emergency admissions and delayed discharges suggest this is unlikely to be an option.
This week the Kings Fund published its report 'The NHS under the coalition government'. This report examines the NHS’s performance between 2010 and 2015, based on routinely available data (inputs such as funding and staffing and outputs such as hospital admissions and A&E attendances). It also draws on surveys of patient and staff experience; data on access and waiting times targets; and measures of safety and quality of care. The report concludes with an analysis of NHS productivity and an assessment of its prospects in the next parliament and beyond.i
This week we’re delighted to share some thoughts from a US colleague on a topical healthcare issue. In this ‘My Take’ Harry Greenspun, Director, US Center for Health Solutions, discusses how advancements in data driven medicine hinges on earning the public’s trust.
Yesterday, March 11, 2015, marked this year’s NHS Change Day.i The third such event since its inception in 2013. Few people working in the NHS can have missed this impressive social movement which appears to have caught the imagination and commitment of staff at all levels. A movement which uses social media to give frontline staff, carers, patients and families a voice and permission to make change happen. At its simplest, it’s about individuals making a public pledge to improve care in their field or area of expertise but its potential lies in its ability to galvanise staff to take control and become part of a social movement that transforms ways of working across the NHS and social care.