Tackling mental health stigma is a key piece of the puzzle – but it’s not the only piece” – Dr Andrew McCulloch on the need for action in mental health care
A new national campaign calling for an increase in funding for mental health services in England, is the latest in a series of events putting the spotlight on care inconsistencies and petitioning for equal treatment for mental health services. But is an awareness campaign necessarily the answer to care improvement? Or enough to turn talk into action? Tackling mental health stigma is a key piece of the care improvement puzzle – but it is not the only piece.
Awareness is key to any campaign, but an elevated profile is not enough in itself to enable progression. For real change to be achieved you first need awareness and understanding to support a call to action, (the word action being key). Then you need a realistic implementation plan.
Thanks to the combined impact of Labour’s appointment of a Shadow Minister for Mental Health, Luciana Berger, and the knock on effect of an overall government acknowledgement of the issue, mental health has moved to a higher level of public consciousness in recent months.
The 2015 Community Mental Health Survey results supported understanding of people’s experiences, shining a stark light on the reality of care provision. While the bulk of the results could be described as troubling at best, the fact only 41% of people felt health professionals either “always understood what is important to you in your life” or “always help you with what is important to you,” was particularly alarming.
The remaining 59% not agreeing with these statements is testament to the continued stigma and lack of understanding around mental health. There is a prevailing myth “it is something that happens to other people”. Service users are an anomaly and their needs hard to understand. In reality, a mental health service user’s needs are fundamentally no different to those of any other service user, and they are not so difficult to understand. They want to be well and live well-rounded, satisfying lives, and to be supported to do so, despite their condition.
The truth is mental health is not a stand-alone issue and eventually an end to stigma may have to coincide with an end to the dualistic model of health as mental and physical. It does not need to be treated in isolation and it actually affects most people one way or another during their lives, with over a third of general practice consultations having mental health elements to them.
This then leaves action, which between funding cuts, rising urgent care admissions and deteriorating survey results, it’s evident that there has not been much of.
Mental health funding and staffing adjustment are long overdue and would make a substantive difference; however for tangible, long term improvement to be achieved, we must start to address the way mental health services are structured and delivered within the community – understanding and focusing service goals in terms of supporting people to live their lives as they choose.
It’s often said no one knows or understands their care needs more than patients themselves, and the growing number of service user led and co-designed services are clear evidence of this. This was particularly apparent during my recent experience on the judging panel of the 2015 Positive Practice in Mental Health Awards, which was both inspiring and eye opening. The quality of the entries highlighted the desire to improve and unify services by sharing best practice, and were a real reflection of an effective person-centred approach in action. Our category alone, excellence in patient experience, was inundated with entrants – with 26 shortlisted for consideration, many of which were service user led or included a focus on service user engagement. Personal understanding means that the services and people running them are able to be highly really responsive to people’s needs.
As countering the lack of understanding becomes less of an issue, the challenge will be to move beyond understanding, towards continuous measurement and quality improvement, both in terms of experience and clinical treatment. This challenge sits at the heart of Picker’s charitable mission. We are in the process of developing a tool to measure people’s experiences of children’s and adolescent mental health services, which when complete will provide services with a chance to facilitate early intervention in people’s lives. And also help to lay the foundation for positive long term service engagement and experience, where service users are consistently involved in the quality improvement cycle, from childhood through to adulthood.
While patient experience is important in any care interaction, communication, trust and general relationship building are core to the mental health treatment process, and profoundly so to the quality of the care experience. In mental health patient experience is not an add-on or extra consideration, but the foundation for long term compliance, service engagement and clinical effectiveness. Without someone having the right kind of patient experience, it’s impossible to achieve the right outcomes, demonstrate respect for service users, or challenge the ever present, but slowly diminishing stigma.