One in four people will experience stress, anxiety and depression at some point in their lives.1Yet, health services have faced funding cuts and a lack of resources over the past few years, as mental illness has not been considered on a par with physical illness. However, mental health issues haves risen up the agenda and their impact is finally receiving recognition.
Deputy prime minister Nick Clegg recently launched 'Closing the gap: priorities for essential change in mental health,' a document outlining 25 recommendations detailing how changes to local planning will improve services for people with mental health illnesses over the next two to three years.
Speaking at the launch on 20 January Mr Clegg said: 'All too often, attitudes to mental health are stuck in the dark ages; full of stigma and stereotypes. It's time for us to bring mental health out of the shadows and to give people with mental health conditions the support they need and deserve.
'We're calling for action - across the NHS, the mental health sector and wider society - to champion change, to transform outdated attitudes and practices, and to improve the lives of people with mental health problems.'
Care and support minister Norman Lamb echoed Mr Clegg's words by saying, 'we are determined to eliminate the stigma around mental health and drive up standards of care and treatment in the NHS further.
'Mental health must have equal importance as physical health - giving patients who are using mental health services the same rights as other patients is a crucial part of this.'
The recommendations in the document detailed how local services will be changed, so nurses in primary care and community mental health teams will be crucial in tackling early diagnosis, ensuring smoother referrals between mental health services and ensuring that those with mental health problems also take care of their physical health.
The report highlighted the importance of following up instances of self-harm evident in primary care patients and ensuring that they received adequate support from mental health teams.
Policy manager at the Mental Health Foundation, Emily Wooster, agreed that primary care services are key in diagnosing and treating mental health problems. 'Early intervention is vital if we are to support the population to secure mentally healthy futures, particularly as we know half of all lifetime cases of mental health problems begin before the age of 14. Primary care staff must be equipped with the appropriate tools and training to be able to spot mental health problems early and refer individuals to appropriate and accessible services.'
The report also recognised the need for primary care services to work more closely with housing associations and money advice schemes to be able to refer patients between the different services.
Ms Wooster welcomed the government's action plan for improving mental health services. 'The government's action plan demonstrates a renewed commitment to mental health care and it is encouraging to see the importance placed on the need to act faster to support those experiencing mental distress.'
| Brief overview of recommendations |
- Give patients a choice about where they get their mental health care.
- Introduce waiting time standards for mental health.
- Roll out the friends and family test to mental health services so patients can give feedback and mental health trusts can take swift action if improvements are needed.
- Expand talking therapies, already helping 600,000 people, so that 300,000 more people will get help.
- Provide more support to children with mental health problems, with more talking therapies and better support for children moving from adolescent services into adult services.
- Invest £43 million in pilots on better housing for people with mental health problems or learning disabilities.
Source: Department of Health
The link with physical health
One of the key ways that community and practice nurses can help people with mental health problems is by ensuring that they look after their physical health. This can be done by encouraging those with mental illnesses to regularly attend screenings for other illnesses, monitoring long-term conditions and regulating alcohol and drug misuse. Nurses can also advise those with mental health problems on the part that good diet and exercise can play in managing their conditions.
Ian Hulatt, the Royal College of Nursing's (RCN's) mental health advisor, believes nurses will drive improvements in physical health. 'Nurses need to be able to set the physical health agenda and ensure that people with mental health problems also take care of their physical health by attending screenings and taking up smoking cessation if required.
'There is clear evidence in the document that premature mortality is a problem for [those with] mental health [problems].
'Practice nurses often run clinics to manage long-term conditions such as hypertension and diabetes and should be aware that these long-term conditions can have comorbidities with mental health conditions such as depression,' he said. 'Practice nurses need to be aware of these and adjust their practice to help those with mental health problems and take a holistic view of all mental health,' he added.
'In primary care, practices should work with a patient-centred approach perhaps by offering longer appointments or earlier starts to cater to their patients.'
| Diagnosing mental health conditions |
An overview of common mental health disorders in primary care. The NICE pathway for each condition outlines identification and assessment, management, and how to develop local care pathways.
- Antenatal and postnatal mental health
- Generalised anxiety disorder
- Obsessive-compulsive disorder
- Panic disorder
- Post-traumatic stress disorder
- Social anxiety disorder
Commissioning specialist services
Another priority outlined in the report emphasises the need to commission specialist mental health services. The DH aims to ensure that commissioners have as much knowledge of mental health services as they do physical health services. NICE has already published a wide range of quality standards around mental health and is currently in the process of developing and reviewing more.2, 3
NHS England also recently launched its mental health leadership programme for clinical commissioning group (CCG) GP leads. It is working with relevant bodies to develop best practice specifications for commissioning specialist mental health services, for example for schizophrenia and bipolar disorder, and is developing a range of clinical commissioning tools to support commissioners that will support the integration of physical and mental healthcare.
The document also outlines how integrated approaches to local commissioning have an important role to play in promoting mental wellbeing and preventing mental illness as part of the local Health and Wellbeing strategy. Public Health England (PHE) says it is working to build up the evidence base around what kind of services and programmes are most effective. On a national scale, PHE, NHS England and the Local Government Association will work together to develop the resources that will support local authorities and CCGs in commissioning services to meet the needs of those with mental health problems.
For example, PHE alcohol and drug teams will work with NHS England area teams, local authorities and CCGs to promote the commissioning of mental health and substance misuse services.
Data will be collected through a new national Mental Health Intelligence (MHIN), in order to improve mental health services on a local and national level. It will work in a similar way to the National Cancer Intelligence Network and the Child and Maternal Health Intelligence Network, drawing together information about mental health and wellbeing to provide a greater insight into mental health problems and how they vary with age and across different parts of the country. It will also gather information about how effective local services are.
Its main purpose will be to help local health and wellbeing boards and CCGs to decide the types of services to provide in each local area.
While the stigma surrounding mental health is decreasing, many people still find it difficult to talk about mental health problems and are often unaware of the symptoms.
Yasmin Miller was diagnosed with depression in 2003 and initially thought she was suffering from stress and did not seek help for it herself. 'My workplace eventually put me in touch with an in-house occupational therapist, after I had been feeling down at work. I had thought it was just stress, and was signed off from work, but things got bad very quickly. I hadn't thought it could be depression, until my GP diagnosed it. I didn't even know what depression was at the time,' Ms Miller explained.
The Time to Change campaign, run by mental health charities Mind and Rethink Mental Illness, is helping to reduce the stigma that surrounds mental health. It released the findings of its biggest ever survey on 20 January 2014, to launch its latest advertising campaign, Time to Talk. The survey of almost 5000 people with mental health problems showed that 34 per cent said they came up against stigma and discrimination on a monthly or weekly basis. One in 10 people said they faced it every single day. The Time to Change survey also found that over half of people said that the stigma and discrimination was as bad as or worse than the illness itself.
However, the findings also indicated that public attitudes are improving. Sixty-one per cent of respondents said they now found it easier to talk about their mental illness than they had done in previous years, and over a third (34 per cent) reported that when they finally told someone, the response was better than they had expected.
Healthcare professionals are leading the way in reducing the level of stigma surrounding mental illness, by encouraging patients to openly discuss their conditions, and by looking beyond a person's illness.
'Diagnostic overshadowing is unhelpful. People with mental health conditions should not be referred to by their labels, such as 'schizophrenics', but be seen as a person away from their condition,' says Mr Hulatt.
Figures from the first annual report by the NHS's Health and Social Care Information Centre into the Improving Access to Psychological Therapies scheme found that less than half of the people who went to the NHS for help for anxiety and depression received any treatment. GPs made 883,968 referrals for psychological support in England in 2012-13. Only 434,247 (49 per cent) led to someone starting treatment. The other 51 per cent of those referred did not receive a first treatment during 2012-13, of whom 166,458 (37 per cent) were still waiting at the end of the year.
The DH report has outlined how NHS England will commit to setting new standards that focus on improving access to adult mental health services. These will be introduced in 2015 and will cover access to or waiting times for services.
The data will be published so that the waiting times for different services in various areas can be easily accessed.
While many people do have to wait a long time for referrals between services, Ms Miller says that she was one of the lucky ones who was referred between services quickly and efficiently. 'From first seeing my GP to being prescribed medicines and seeing a counsellor and a community mental health nurse was about three months in total.
'I'm aware that a lot of people are not as lucky but I found that my overall dealing with the professionals was positive.
'I initially saw an NHS psychiatrist who I didn't find very helpful. However, through work I had private healthcare insurance and saw a private psychiatrist for several years, who was excellent.
'The work of my community mental health care team was also very good, especially the first mental health nurse I saw, who came to my house and was very good at talking to me and understanding my depression. She set me small targets to achieve, such as getting dressed and taking a shower and also provided my husband with coping strategies too. After a few weeks I was assigned a new nurse who was still good, but a little detached. But she still provided me with the space to talk, which was what I needed,' she explained.
Ms Miller's experiences of both private and NHS-based mental health services highlights inconsistencies in the mental health provision. The recommendations in the government's mental health report emphasise and addresses the need for frontline services and community teams to receive more training in recognising and treating mental health illnesses. This will ensure that those suffering with mental health problems receive the correct support and encouragement to deal with their physical health problems as well as their mental health.
1. Department of Health. Closing the Gap. January 2014. https://www.gov.uk/government/publications/mental-health-priorities-for-change. Accessed January 2014.
2. NICE. Common mental health disorders: Identification and pathways to care. May 2011, http://publications.nice.org.uk/common-mental-health-disorders-cg123. accessed January 2014.