I was invited to present on key priorities regarding mental health care at a specially convened meeting at the House of Commons on 20 April to a group of mental health colleagues and MPs including Luciana Berger, the shadow minister for mental health. Among the areas I included was the category I describes as ‘specific areas of the forgotten mental health issues’.
In fairness, many would argue they are not forgotten at all – they simply don’t feature prominently on the well described mental health radar. I'm talking about the homeless, those in prison, the vast array of rare somewhat disparagingly referred to as ‘minority groups’ and those isolated, lonely, disenfranchised people whose needs are not recognised and therefore not addressed.
The Five Year Forward View for Mental Health (2016)1 and the various iterations before it sets out and updates on areas of mental health focus and priority dating back to the National Service Framework for Mental Health (1999),2 New Horizons(2009),3 No Health without Mental Health (2012),4 and most recently Closing the Gap (2014).5 In each of these strategy documents headlines were drawn but some areas were given low profile or ignored altogether.
My talk in the Commons set the scene for some attention to be given to those that get less attention. What I said included the following:
· We have not done enough about children and young people to date – some themes have been addressed but we know much early life stage development is hampered by poor image, self esteem, low confidence and normalised behaviour such as deliberate self harm and overly sexualised role modelling via peer group pressure, causing a lot of insecurity stacking up for later life. Cyber bullying through social media is also meaning young people’s lives are heavily caught up in round the clock interactions with others and not always in a positive and innocent way. A recent study reported 12-17 year olds were spending around one whole day each week immersed in social media and/or internet gaming. Revenge porn too has become a recognised high-risk element of life for people leading to massive upset and trauma for those affected.
· I mentioned domestic abuse and the hidden reality currently being given a much-needed elevated profile thanks to the Helen and Rob storyline in the TV show The Archers.
· Homelessnessis a theme that is often ignored or brushed under the morality carpet with various justifications as to why this is an acceptable part of modern life
· I spokeabout the prison population where a huge proportion of inmates have diagnosable mental health conditions. I also referred to the issue ofsex offenders where studies and reports tell us up to 1/8 of prison occupants are either serving a sentence for offences of this type or have a history associated with sexual offending.
· I said a few words about the growing number of people feeling isolated and detached from society and local communities,these include people with poor communication capability and cultural or ethnicity differences such as an increasingly high proportion of migrants, but also the reputed one million older people that arelonely and vulnerable. Additionally,It is easy to ignore those with undiagnosed autism in adult life and people withlearning disabilities too.
· The so called minority group reach stretches beyond those I have mentioned already – I have liaised with our localLGBT services where much prejudice still exists, I speak with those who have experienced bereavement sometimes long ago and also people dealing with loss and trauma including postarmed forces personnel and their families who often struggle with readjustment and acclimatising after active service
· I wrote an article for the Mental Health Nursing Journal in 20146following a spate of high profile suicides of what for many seemed successful people dealing with financial, competitive, intolerant and tormented pressured lives. There is little doubt that many ostensibly mentally well people are finding a combination of austerity, expectation disconnect and fast paced over valuing of material success has its risks. The regular media glorying in the latest ‘celebrity catastrophic mental health crash and crisis’ can be seen as another of the forgotten categories of both the hard to reach and those disinclined to be reached for.
In a context of mental health service pressure where stretched resource must be focused on the highest priority some members of our communities will be missed. Eligibility for help in less obvious places must be regarded as everyone’s business – workplace support, care regarding negative lifestyle choices such as excessive substance use and misuse. I would include tobacco reliance in that list to be frank – smoking cessation, access to psychological help to those with high body mass index status liable for bariatric referral and alcohol dependence.
A final word on the forgotten mental health problems and one worthy of greater attention and coverage I believe is the two part common strand that we must address for all themes – resilience and robustness in our coping with all of the above. Robustness is the core of how we endure distress and despair and resilience is how we resist the spiralling negative patterns that can lead to disintegrating self-care and management.
1. Department of Health. Five Year Forward View, 2014. england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 20 May 2016).
2. Department of Health. National Service framework for Mental Health, 1999. gov.uk/government/publications/quality-standards-for-mental-health-services (accessed 20 May 2016).
3. Department of Health. New Horizons – Strategic Guide for mental health care, 2009. webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109705 (accessed 20 May 2016).
4. Department of Health. No Health without Mental Health, 2012. gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf (accessed 20 May 2016).
5. Department of Health. Closing the Gap, 2014. gov.uk/government/uploads/system/uploads/attachment_data/file/281250/Closing_the_gap_V2_-_17_Feb_2014.pdf (accessed 20 May 2016).
6. Coxon G. Becoming a radical mental health nurse – what does good look like and what can bring benefits will it bring.Mental Health Nursing Journal 2015;35(2).
George Coxon, RMN, is the specialist mental health advisory board member for Nursing in Practice, MHNA chair and regional lead for Wales, Director of CCH (care provider), the Independent Commissioning Advisor for Devon, and chair of the Devon Residential Care Quality Kit Mark.
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