Today, the Care and Support Alliance published an open letter to the Prime Minister calling for urgent social care reform. But I fear this call will fall on deaf ears.

The Care and Support Alliance – a group of 78 charities, campaign groups and campaigners, including Rethink Mental Illness and the Alzheimer’s Society – made the call (see here) ahead of tomorrow’s Queen’s Speech, which, it is rumoured, will not contain details of a social care bill.
If this rumour is true, it will put any legislation to reform social care back until the following parliamentary session. This means any legislation will not become law before late 2013 at the earliest. It would also delay any funding decisions until after the next comprehensive spending review, which is set for autumn 2013.
Without reform, the Alliance warns, “too many older and disabled people will be left in desperate circumstances: struggling on alone, living in misery and fear”.
The letter comes after rumours emerged last week that a social care bill was not going to be included in the Queen’s Speech on May 9.
Fears had been growing that something like this might happen once it became clear that the social care white paper, long promised for this spring, would now not be published until June, at the earliest.
Additionally, it is thought that the white paper will now focus more on the quality of care provision, with funding issues addressed in a separate ‘progress’ document. It is also rumoured that little headway has been made on this aspect of care reform.
It is with this in mind that the Alliance makes its impassioned plea to the Prime Minister – who has repeatedly spoken of his support for social care reform – to try and ensure that the bill goes in to tomorrow’s speech.
It is hard to argue against anything in the Alliance’s letter. From what I’ve read and heard anecdotally, cutbacks to services have left many older people, and those with learning disabilities and mental health problems, with fewer services – if they’ve not had them cut completely in the past year. As a result, their lives are becoming much more difficult.
The Alliance is also right to say that all sides – politicians, charities, providers, community groups etc – need to come together to find a solution. The system is creaking and is in urgent need of reform.
I really hope that the Prime Minister and the Government will heed this letter and ensure a social care bill is included in this parliamentary session. But my fear is that the decision has already been made, that it won’t be.
The rumours about a lack of progress on finding a solution to the social care have failed to go away and this, I suspect, is the major stumbling block to reform.
If this is the case, then many social care service users will remain living with, as the Alliance puts it; “the fear of what tomorrow might bring.”

Mental health problems are estimated to cost the British economy more than £30 billion per year in lost hours and reduced productivity. But there are initiatives to try to bring this figure down.

While I treat statistics like this with some scepticism – you wonder how, exactly, these figures are arrived at – there is no doubt that mental health problems cost the economy a great deal in terms of lost hours and productivity. Nobody works at their best when they are ill – whether physically or mentally – and many people need time off to recover, which can have cost implications for both employers and employees.

You might therefore think that employers would be proactive in ensuring the health of their employees. And while there are some out there who are understanding, and do look after the mental health of their employees, apparently there are many that do not – or at least, they don’t do enough. Employment body Acas recently referred to mental health at work as being “the last taboo in business” and has launched ‘Mental health: we need to talk’, a guide aimed at encouraging employers to deal with the issue.

Acas' guide gives step-by-step advice on how employers and managers can raise awareness of mental health issues, create a culture where issues can be talked about and help the employee to recover from their difficulties. This is welcome, but you wouldn’t expect Acas to produce literature like this if someone had, for example, heart problems. It shows that mental ill-health is, in general, still not viewed as seriously as physical ill-health.

So Acas is right that mental health is still often a taboo issue in workplaces. I’ve heard many examples in recent years where people have admitted to an employer that they have a mental health problem and it has caused them all sorts of difficulties in their workplace – even leading to their dismissal, in some cases. That’s just plain wrong, of course, but it demonstrates, albeit anecdotally – some of the stigma – and over-reaction to mental health problems – that still exists in some workplaces. Breaking down this underlying stigma will take years, which is why initiatives such as this, as well as wider campaigns such as Time to Change, are important, because they can make a difference. Acas’ guide may only change things in a relatively few workplaces, but it is nevertheless worthwhile – because it will ensure more people with mental health problems get the help and support they may need.

While improving the bottom line is important for employers, so too is the health of their employees, as I’m sure everyone would agree…. 

Sometimes I read mental health-related reports and think that the findings and recommendations are fairly obvious. But then I think, ‘if they’re so obvious, why haven’t the recommendations been implemented before?’ That is usually a much harder question to answer.

One such report is ‘Making It Matter: Improving the Health of Young Homeless People’ by homelessness charity Depaul UK and pharmaceutical firm AstraZeneca. It found that 40% of young homeless people are likely to experience depression compared to 21% of their non-homeless peers. In addition, 27% of homeless young people have been diagnosed with a mental health condition, compared with only 7% of their non-homeless counterparts.

That mental health issues are more prevalent among young homeless people than their peers who have permanent housing is not surprising. Leaving aside any other problems they may have, life on the streets is generally more stressful and chaotic than when you have a roof over your head.

Depaul UK’s report made several recommendations, including making services for young homeless people more easily accessible in places such as drop-in centres and ensuring that mental health services should not exclude people who take drugs or alcohol and vice versa. These seem fairly obvious. Homeless people, by their nature, can be hard-to-reach for mental health services, so having them in places where they are likely to go, makes sense. Ditto for mental health services helping people with drink or drug problems.

Hearteningly, care services minister Paul Burstow’s comments after publication of the report – "The difference in health outcomes between the young homeless and the rest of the population is unacceptable and we must do something about it" – seem to indicate that the Government agrees. He also said the report will influence the policy agenda, so there’s more hope of action.

The key to all of this sits with the Ministerial Working Group on homelessness – of which Burstow is a part. It published its first report last July and is developing a second, which will focus on what steps can be taken to prevent homelessness and integrate services for homeless people. While that sounds promising, any optimism is tempered by the knowledge that there is a world of difference between well-intentioned comment and reports like this, and action on the ground, especially in these financially austere times.

However, with the number of homeless people of all ages jumping by 14% in just a year, according to figures from the Department for Communities and Local Government, published in March, it is a problem that is only going to get worse. Can the Government afford not to do anything? The answer, surely, is obvious.

Research from the US has found that older people who are mentally active have better memory skills, suggesting mental stimulation may protect against memory decline. It shows again that, in terms of mental capacity, you really do have to use it or lose it.

While several previous studies have found this, this research by Rush University Medical Center in Chicago, found that when people’s participation in activities such as reading newspapers or playing board games declined, it was followed by a subsequent decline in cognitive function over time. Previously it has been unclear whether a lack of mental activity is a cause or a consequence of cognitive decline – this suggests that it is a cause.

While this was not a study into dementia, a decline in cognitive function can be a precursor to it and understanding the factors that are linked to this decline could be key to helping prevent it, as Marie Janson, director of development at Alzheimer’s Research UK, said.

With the numbers of people with dementia in the UK rising – about 820,000 people have the condition – research such as this could help people to, if not prevent it, at least mitigate the effects for some time. It shows that reading a newspaper, or doing a crossword or Sudoku is not just a diversion to kill a spare half hour, it really could have lasting benefits.

Results from a survey of staff at the University of Cambridge, which found that even a short burst of counselling can make a positive difference to the lives and productivity of people suffering from problems like anxiety, stress or depression, demonstrate that mental health services have a role in the workplace – if only more employers would recognise this.

The study found that 70% of the staff concerned experienced a "clinically significant" upswing in mental health after receiving workplace counselling, which enabled them to cope more effectively with their working lives.

But it seems that fewer and fewer employees now have access to such services, as Rick Hughes, lead advisor at BACP Workplace, a division of the British Association for Counselling and Psychotherapy, said: "Throughout the UK, workplace counselling services are facing significant cuts and in many cases closure as organisations seek to reduce costs.”

If the results of this survey are to be believed, it could be a false economy for employers to cut counselling services. It is well known that in times of recession, stress levels increase, in the workplace as well as the home, especially if there are worries about jobs, for instance. And, when employees are suffering from stress, anxiety or depression, it stands to reason that they will not be as productive as they could be.

So, while employers may look to cut costs in the face of continuing economic uncertainty, they should think twice about axing services such as workplace counselling. Justifying services that don’t obviously contribute to the bottom line can often be tricky, but counselling can have real benefits. Such relatively low-level – and inexpensive – interventions can even save money by helping to stop mental health problems escalating, which could end up costing the employer more, not only in lost productivity but in sick pay and in finding temporary cover, if the person involved has to take time off.

To me, it is a no-brainer to keep the service on, and Hughes summed things up perfectly: "If employees really are the most important resource within an organisation, then it is crucial that organisations fulfil their duty of care and make available to staff a range of accessible counselling support interventions."
 

Prime Minister David Cameron’s announcement of a national "dementia challenge" and a bid to improve awareness, care and support for people with the condition and research into it is welcome news – and long overdue.

With the numbers of people in the UK with dementia continually rising – an estimated 800,000 people currently have the condition, and this is set to break the 1 million mark within the next decade, according to the Alzheimer’s Society – it has to be a national health and social care priority, especially as it is estimated to cost society £23 billion.

Now, it appears it will be, with public awareness campaigns planned, as well as consultations on how to improve quality of life for people with dementia – which are due to report back later this year – and a doubling of the amount put towards research into dementia.

The public awareness campaign is needed because there is still stigma attached to the condition – as the Alzheimer’s Society report ‘Dementia 2012: A national challenge’ revealed, nearly half of those diagnosed have lost friends as a result.

Care and support also needs to change. The Alzheimer’s Society report found that 75% of the general public don't think society is geared up to deal with people with dementia. There needs to be more done to help people with dementia live well – whether that’s remaining independent for longer or being treated with dignity and respect in a care home – and again that is a welcome commitment from the Government.

That the funding given to dementia research is to be doubled to £66 million by 2015 is also much needed. For many years dementia has been the poor relation when compared to other conditions such as cancer and heart disease, despite it affecting more people in the UK.

However, it should be noted that even with this extra money, funding for dementia research will still lag behind cancer and heart disease.  Nevertheless, it should increase the amount of research into dementia and, as chief medical officer, Professor Dame Sally Davies, said: "This will accelerate the identification of causes, cures and better ways of caring for a disease that is such a burden on patients, carers and society."

It’s not often there are good news stories like this, and it should be celebrated. But whether it turns out to be "turning point" in the battle against dementia, as Shirley Cramer, chief executive of Alzheimer’s Research UK said, remains to be seen. 

These are all fine words from the Prime Minister and others, but it needs to be backed up with actions. The targets set out by the Government for what needs to happen in the next 3 years are ambitious – but focus and pressure needs to be kept up to ensure they are delivered. The national dementia "crisis" – as Cameron referred to it as – cannot be allowed to get any worse.

The Department for Work and Pensions (DWP) trumpeted its latest statistics on people found fit for work in their incapacity benefit reassessments last week, but, as mental health charity Mind pointed out, they don’t tell the full story.

According to the DWP, of the first 141,100 incapacity benefit claimants to start the reassessment process as they are migrated (or not, as the case may be) to employment and support allowance (ESA), 37% of those whose claims have been concluded have been found fit for work. But this conveniently ignores the number of people found fit for work who are appealing their decisions.

And, as Mind’s chief executive, Paul Farmer, said, 40% of fit for work decisions are appealed and, more significantly, 40% of those appeals are successful, which brings that 37% figure down somewhat.

It seems evident that the work capability assessment (WCA), which is used to determine incapacity benefit claimants’ fitness for work, still has flaws – and these need to be addressed. For people with mental health problems – who make up some 40% of incapacity benefit claimants – the stress of the WCA process, and subsequent appeal if their claim is initially turned down, can have a major detrimental effect on their wellbeing. If assessments were got right in the first place, the effect could be significantly lessened. It would also save the cost of the appeal, which, of course, has to be noted in these austere times. Obvious maybe, but the DWP apparently hasn’t spotted this.

Mental health service users, charities and organisations have flagged the flaws in the WCA ever since it was introduced. The main gripe is that the test remains too focused on people's ability to function, disregarding whether they can cope with the more subjective stresses and strains associated with the workplace. There are also concerns that the WCA does not adequately take into account the effect of fluctuating conditions.

In November 2011, after he had concluded his second review of the WCA, Professor Malcolm Harrington said more work was needed to improve it, especially for people with mental health and fluctuating conditions and made recommendations to that effect. But some – including Mind, responding to Harrington’s review at the time – have said that the DWP has been slow to take up the previous recommendations. The charity also called for a delay in the reassessment process to ensure the recommended changes had become embedded, but this request was not acted on.

So the cycle of reassessments and appeals looks set to continue unabated, which will not only cost the taxpayer millions but, more importantly, put thousands of people with mental health problems through unnecessary stress and anxiety as they wait to find out whether they will retain their benefit. Something you won’t see highlighted in any Government statistics.

While Lord Richard Layard’s recent call for a dedicated mental health minister in the Cabinet may not be a new one, it is certainly well worth the Government considering, especially if it is serious in its aim to put mental health on an equal footing with physical health.

Labour peer Lord Layard made this call at a lecture at the London School of Economics, where he claimed mental illness lies at the root of Britain's social problems, and requires much more attention from the Government.

Of course, those involved in mental health services – as professionals or users – have long called for Government to give greater priority to mental health. Given that mental health problems are said to affect one in four of us over our lifetimes – and cost the economy about £100 billion per year, according to the Mental Health Foundation – you would think it already would be.

While I haven’t seen a Government reaction to this call, it would be a welcome move if such a post was to be created. There has been a sense among many in the sector that mental health does not have an effective voice in Government, especially since the demise of the National Mental Health Development Unit a year ago, and that it is therefore somewhat neglected as a policy concern. The relative lack of progress on the mental health strategy, No Health Without Mental Health, in the year since it was launched, is often cited as proof of this lack of interest.

But the issue merits more than a ministerial appointment. An amendment to the Health & Social Care Bill – still edging towards royal assent at the time of writing – will give the health secretary an explicit duty to put mental and physical health on an equal footing, but this is still far from being a reality.

With reform of health and social care now seemingly inevitable, and greater integration of the two a key aim, there is a unique opportunity for the Government to ensure that people with mental health problems do benefit from an integrated service that is every bit as comprehensive as they would receive if they had a physical illness. Talk of integration needs to be backed up with action and – crucially – money to ensure that this happens.

But, whether the opportunity is seized is another matter. There are still many concerns about the Bill – such as whether GP commissioners can adequately commission mental health services – and it remains to be seen whether these fears are justified. If they are, then equality for mental health services could end up being even further away than it is now – minister or no minister.

News that the government is to invest £22 million in improving access to psychological therapies (IAPT) for children and young people is very welcome.

Coming at a time when many other mental health services are experiencing budget cuts, this is, perhaps, an unexpected move – it is additional to previous money put towards the scheme – but shows the Government’s continuing interest in, and support for, IAPT.

The Department of Health says the money will be spent over the next three years to expand state-of-the-art psychological therapies and extend training for people working with youngsters outside of health settings, such as in schools or youth groups.

This should help to reach out to children and young people who may not ordinarily register on health or mental health services’ radar. It also increases the chances of a young person getting treatment earlier, before they hit crisis – which can make an immeasurable difference to the outcome.

Indeed, since one in 10 children aged 5-16 experiences a mental health problem and half of adults with mental health problems develop symptoms by the age of 14, early intervention can be crucial in helping people to tackle their difficulties and, in time – hopefully – recover.

Of course, earlier intervention could also reduce the burden on adult mental health services by tackling depression, anxiety and self-harming, sooner rather than later.

However, as Barbara McIntosh, head of children and young people’s programmes at the Mental Health Foundation said, it is important to note that this investment will not signal ‘job done’ for children and young people’s mental health.

For instance, the right services need to be commissioned – in collaboration with young people themselves – to ensure that they reach the right individuals, at the right time.

And, while the money will certainly make a difference, further investment is still needed – at a national and local level – to ensure that all children and young people with a mental health problem receive the help they need when they need it.

Rethink Mental Illness has developed the resources as part of its ‘20 Years Too Soon’ campaign, which aims to raise awareness of the fact that people affected by severe mental illness die, on average, 20 years sooner than those in the general population, mostly as a result of preventable physical conditions.

The charity hopes that the resources will help mental health professionals think more about the physical health of their patients.

This is a welcome development and one that should be applauded, but it again highlights the need for greater integration in health services. Too often, different aspects of the system work in isolation, whereas a strategy that took into account all of an individual’s needs – physical and mental – would probably result in better outcomes for the person, and cost savings for services.

Indeed, as recent research by The King’s Fund and the Centre for Mental Health found, people with long-term physical conditions are 2-3 times more likely to experience mental health problems than the general population; but these problems are often not identified, which results in poorer outcomes for patients, and costs the NHS billions.

This shows that mental health needs to be an integral part of all health services. The arguments are too strong to ignore. Of course, it’s what many professionals have been saying for years…

While it may initially cost more to achieve greater integration, the money must surely be found. Most importantly, it will improve outcomes and life expectancy for people with mental health problems and physical health conditions. This is the crucial benefit and should be foremost in everyone’s thinking.

However, given the current economic situation with budget cuts for the foreseeable future, this is not enough for those in power. So, here is the trump card in the argument: improving mental health services, will end up saving money. Not only in the wider NHS, as the King’s Fund and Centre for Mental Health outline, but also in mental health services themselves. It could also increase tax revenues, if people recover sufficiently to return to the workplace; and it would cut the benefits bill at the same time.

All in all, a win-win-win-win situation.  So – David Cameron, Andrew Lansley et al – what’s stopping you ? These could be healthcare reforms we could all agree on.
 

Two recently-published studies have brought us another step closer to understanding dementia and its effects on the brain, giving renewed hope that a cure can be found. The studies also reinforce the value of research into the condition.

Firstly, scientists in the US have shown that dementia moves along synapses in a similar way to infections, meaning that the process might be able to be stopped, early on.

This finding is significant as it shows that dementia does not just ‘pop up’ in different parts of the brain, over time, as formerly thought.

Meanwhile, scientists at the University of Cambridge have developed a new way to study Alzheimer’s disease using stem cells, which allows researchers to track the disease over a matter of weeks.

Skin cells donated from healthy volunteers and those with Down’s syndrome were turned into stem cells. These were then used to generate networks of functioning nerve cells in the lab, which resemble the complex wiring of cells in the human cerebral cortex, which makes up over three quarters of the brain and suffers particular damage during Alzheimer’s.

People with Down’s syndrome have an extra copy of chromosome 21, a segment of DNA that carries a gene responsible for producing the Alzheimer’s protein amyloid. Due to this extra version of the gene, people with Down’s syndrome have a much higher incidence of Alzheimer’s than the rest of the population. By generating nerve cells from the skin cells of people with Down’s syndrome, the scientists could observe the disease process over a period of weeks and compare this to those cells derived from healthy volunteers.

These studies again offer hope that a cure – or more effective treatment – for dementia might be on the horizon. One of the medical ‘holy grails’, it has taxed scientists for generations, but these studies show that they may be getting closer to the breakthrough.

While this is good news, it should always be remembered that this is research, so if any new treatments result from it, they will not be available to the public for many years.

These studies also emphasise the importance of continuing research into dementia. In financially constrained times, research is often one of the first things to suffer in a round of budget cuts. But, with the promised breakthroughs dependent on further research, that could be a false economy.

People are living longer, so the number of people with the condition is growing rapidly – and set to break through the 1 million mark in the UK alone, within the next 10-15 years. Finding a cure, or more effective treatments, is therefore an imperative. The cost of dementia to the UK runs into billions per year, and finding a cure could save a large proportion of that. When put in those terms, can the Government afford not to invest in research? 

Last week, the House of Lords made an amendment to the Health and Social Care Bill which will place a duty on the Health Secretary to give mental health the same priority as physical health. But you have to ask; why wasn’t the commitment there in the first place?

The amendment, tabled by cross-bench peer Lord Patel, was passed by a margin of 4 votes. Three Liberal Democrat peers rebelled against the Government.

This is good news, although the margin of the vote still seems awfully close for something that is vitally important for all mental health service users.

But that the amendment was even needed was a surprise. When the Government’s mental health strategy ‘no health without mental health’ was launched last year amid much fanfare, one of its key tenets was putting mental health on a par with physical health. Doesn’t the title say it all?

At the time, the consensus was that this was long overdue, and it was hoped that it would be the end of mental health being treated as a ‘Cinderella’ service that often lagged behind those concerned with physical health. But all that seems to have been forgotten somewhere along the way – until the Lords intervened.

The need for mental health to have a higher priority in health services is undeniable, and, handily, the Centre for Mental Health and think-tank, The King’s Fund, published statistics last week, that back up this assertion.

They report that the failure to treat mental illnesses appropriately adds some £8 billion to the costs of treating long-term conditions like diabetes and heart disease, as well as dramatically increasing a patient’s risk of dying prematurely from those conditions.

This report also adds weight to calls for greater integration of physical and mental health services. Again, this is something that those across the sectors have been calling for, for years, but never quite seems to have happened.

Hopefully the Government will accept the amendment, although this is not guaranteed, as the recent Welfare Reform Bill debates showed, with MPs overturning some of the Lords’ amendments to employment and support allowance clauses.

Of course, all of this is assuming that Government doesn’t abandon the Bill entirely, as some of its many critics – including mental health bodies, such as the Royal College of Psychiatrists – have called for. But from what Prime Minister David Cameron and Health Secretary Andrew Lansley have said, the Government is determined to see the Bill through Parliament, despite the increasing opposition to it.

If that is to be the case, then the amendment could at least help to give mental health the prominence it deserves and break down some of the boundaries that still exist between services and perhaps even start to make a difference to the mental health of the nation.

Last month Hollywood star Brad Pitt admitted publicly that he has battled depression in the past. It was a timely reminder that mental illness can happen to anyone at any time, and came just after the launch of a new initiative from anti-stigma campaign group Time to Change that encourages people to talk about their problems.

Time to Change’s new campaign is called ‘Its time to change. Its time to talk’, with the aim to get more people talking about mental health issues, thereby challenging the stigma that can grow when it is not spoken about.

It seems that talking about our mental health is something people in the UK are still not good at. While mental health stigma is not what it once was, it is still a problem and many people do not feel comfortable or able to talk about their feelings.

Statistics released to coincide with the campaign revealed:

o Only 15% of the British public admit to being truthful all of the time about how they’re really feeling
o Younger people between 18 and 24 years are twice as likely (27%) to hide how they’re feeling compared to those aged 65 and over (12%)
o A third of people confess the reason they’re not always honest is because they don’t want to depress other people (37%) or don’t like talking about how they’re feeling (35%).

These statistics don’t surprise me. Talking about feelings is difficult – and other people don’t always want to listen. At least some of that will be down to the stigma of having a mental health problem.

This is why Time to Change’s campaign is needed. The adverts on television that form part of the campaign have made an impact and got people thinking and, hopefully, talking, which is a step in the right direction.

Let’s hope people take the lead from this campaign and follow several well-known figures who have spoken openly about their mental health problems in recent years, including actor/presenter Stephen Fry to Somerset and England cricketer Marcus Trescothick.

Such public admissions are very welcome; it all helps to ‘normalise’ mental health problems in the public eye and make it part of everyday life – which, of course, it is. With celebrity magazine favourites such as Brad Pitt also talking about mental health, it can only encourage others to do the same.

Time to Change has done some great work in addressing mental health stigma in the past four years, and this latest campaign should carry on that work. As the organisation admits, challenging mental health stigma is a long-term aim, but with funding secured until 2015, plans can be laid for more sustained campaigning and advertising that will keep mental health in the public eye and help people to open up and talk and break down the stigma that still exists.

For the first blog of 2012, I’m going to look forward to what the year may hold for those interested in mental health. Unfortunately, I’m finding it difficult to be optimistic.

Mental health seems to have fallen down the government’s agenda in the past 12 months. Yet, when the national mental health strategy, ‘No health without mental health’ was launched in February of last year, there was a lot of optimism that it would be a priority.

The strategy’s focus on outcomes, early intervention and wellbeing were all welcomed as being long overdue, as was the intention to put mental health on the same footing as physical health.

However, optimism was quickly tempered by disappointment when, at the end of March, the government axed the National Mental Health Development Unit (NMHDU). At the time, many wondered who would pick up the mental health baton within government, and the fears this prompted appear to have been confirmed. Since then, the government has gone very quiet on the strategy.

Yet the ministerial advisory group, which is tasked with leading the delivery of the strategy, has met a few times and has asked for service users and carers to join the group. Hopefully more will be heard from it this year.

But there is cynicism about whether the strategy can be delivered in the face of swingeing public sector cuts. In 2011 there were regular stories from around the country of mental health services being cut back, and anecdotal evidence from service users that social care was also being reduced. This is not going to get any better in 2012 – if anything, things will get worse, as cuts continue to bite and the NHS and councils struggle to balance their books. Sadly, this will be the situation for years to come.

For service users, worries about benefits remain. The work capability assessment for employment and support allowance (ESA) is still being criticised for not adequately taking into account mental health issues – despite further revisions in 2011 – and many people on incapacity benefit are set to be reassessed for ESA this year, and could lose their benefit, under the revised eligibility criteria.

Upcoming disability living allowance reforms are also causing concern, with many worrying that the assessment process will not adequately recognise the impact of fluctuating conditions.

Mental health charity, Rethink Mental Illness, has called for the government to pause on its welfare reforms – in the light of widespread protests from people with disabilities and mental health problems – but, at the time of writing, the government has given no indication that it plans to do any such thing. On the contrary, it has said that it plans to push ahead with its reform programme.

Though times are undeniably tough, nobody should become entirely disheartened. There are many individuals and organisations doing great work with people with mental health problems – and making a real difference to their lives – regardless of funding cuts or government policy. And, constrained finances could drive innovation, as organisations and professionals seek to provide personalised services at lower cost.

While 2012 is set to be a difficult year for many people in the sector, it is important that good and innovative practice is given the prominence it deserves. Hopefully, that will ensure that such practice develops more widely and that the negative effects of cuts will, at least in part, be mitigated. 

The news that the National Audit for Dementia has called for a shake-up of hospital care for people with dementia will come as no surprise to those working in the sector - we’ve been here before with this one.

The Audit found that many staff lacked basic training in dementia and only 6% of hospitals have a dementia care pathway. Meanwhile, at a lower level – but often what can make a big difference to a person with dementia – 59% of wards reported that personal items, such as family photographs or cards, were not placed where the patient could see them for reassurance.

If all this seems familiar, it’s because it is. This report has striking similarities to the Alzheimer’s Society’s 2009 report ‘Counting the Cost’. It seems little has changed in the intervening two and a half years.

But, given that up to a quarter of acute hospital beds taken up by people with dementia, and 97% of nursing staff and nursing managers admit that they are usually caring for someone with dementia, according to the Alzheimer’s Society, it seems odd that provision for dementia care is seemingly so poor – and has remained so.

The recommendations the Audit makes are also quite similar to those made by the Alzheimer’s Society. They include all staff given basic training in dementia awareness, putting in place a senior clinical lead for dementia and personalising bed areas. Not that hard to do, you would think.

So, will those with power in government and the NHS listen to this report? You have to hope they will.

The fundamental point is that it is about improving care for people; everyone should have access to the best possible treatment that takes account of and is sensitive to their condition. After all, they are still people, not just someone with dementia. Surely this is at the heart of the NHS?

But I’m not naïve enough to believe that this will be the key driving force for change. If it was, it would have happened by now. No, for change to happen will require evidence of cost savings that would be made if the Audit’s recommendations were implemented; in these austere times, bottom-line savings are often the way to make people take notice.

But implementing these changes could save money. For instance, if hospital care is improved through better training and more person-centred care, then people with dementia could be released earlier – currently they stay in hospital up to twice as long as other people who go in for the same procedures – it could save millions each year.

Again, this point was made in ‘Counting the Cost’, and it is perhaps more pertinent now as budgets are being squeezed, and will be for some years to come. The evidence of the need for change is mounting; it is now up to those in power to act. 

Today sees the launch of what is reported to be the world’s first stalking treatment centre in London – and it’s long overdue. 

Stalking is one of those crimes that seem to be viewed with a degree of levity. People make jokes about it; not malicious per se, just off-the-cuff comments, such as bumping into the same person in the office kitchen several times and saying “are you my stalker?”, that sort of thing. 

But to victims, it is all too serious. Stalking is recognised as a component in more than three quarters of cases involving people murdered by ex-partners, according to a 1999 study by McFarlane et al. Overall, 1 in 5 women and 1 in 10 men will be the victims of stalking at some point in their lifetime, according to the British Crime Survey. 

Stalking doesn’t always seem to have been treated with the seriousness it deserves in mental health services either. While there is provision for the victims, who can suffer terribly, it can be patchy.  

But treatment for stalkers themselves is scarcer; like other kinds of offenders, can repeat their offences and without treatment many return to stalking either the same, or a different, victim.  

Treatment and rehabilitation can be effective, according to various expert reports, so the launch of the National Stalking Clinic (NSC), to be run by Barnet Enfield and Haringey Mental Health NHS Trust, which has extensive experience of working with stalkers, is a great step forward on several counts. 

Firstly, it means that recognised stalkers can get access to specialist assessment and treatment. 

This could help cut down on future incidents of stalking, which is good news for everyone. 

And, if crimes are averted, it cuts down on the psychological harm done to victims, who can suffer depression, anxiety or post-traumatic stress disorder. This would also cut down on costs for mental health teams – something that always has to be considered in these austere times. 

If this clinic is a success, then hopefully the model will be replicated in other trusts around the country, and some of the thousands of stalking incidents that occur each year can be prevented. 

While both reports released last week looked at a different aspect of mental health, crisis care and psychological therapies respectively, each found that significant numbers of service users have to wait to access treatments.

The two reports concurred that while there are examples of great practice out there, some people struggle to access services quickly enough to stop their mental health deteriorating further.

Mind’s independent inquiry, ‘Listening to experience’, into accessing emergency treatment, found that while excellent crisis care does exist, there are problems with in-patient hospitals and community crisis teams. These include: people struggling to get help, staffing problems, poor quality care environments and not enough treatment provided to help people recover.

The findings prompted Paul Farmer, chief executive of Mind, to say: “Mental health crises need urgent treatment, yet our investigation found that far from receiving the instant, 24-7 response we expect for physical health emergencies, people experiencing mental health emergencies can be faced with long waits, poor quality care and in some cases are unable to access help at all.”

Meanwhile, the National Audit of Psychological Therapies (NAPT) – commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Psychiatrists’ Centre for Quality Improvement – reported that 1 in 7 people wait more than 3 months for their first appointment.

Both reports are surprising. Timely interventions for people with mental health problems – whether acute or secondary – are crucial in preventing further deterioration and getting people on the road to recovery, more quickly.

It is widely accepted that early intervention can reduce the need for longer and more expensive services – whether in- or out-patients – which is surely crucial in this era of austerity and counting every penny?

If you’re reading this and thinking that the above sentences are statements of the obvious, then you’re not alone. I do too. But judging by the findings in these reports, the message isn’t getting through to every service. And it needs to. People are suffering unnecessarily and everyone loses out as a result.

While these reports are useful pointers to show where improvements can be made, it is now up to the providers – and those involved in commissioning services – to make the necessary changes.

Pressure needs to applied, from government downwards, and service users upwards, to ensure that they do. Austere times are not an excuse for allowing poor practice to continue.

Dementia may be the second most feared disease after cancer, but people need to face their fears if they suspect that they, or someone they love, have the condition as soon as possible.

Unfortunately, all too often people don’t, and as a result don’t get the treatment that can slow the progress of the condition.

Indeed, 6 out of 10 people with dementia never receive a formal diagnosis, according to government figures. So the launch of a £2 million government campaign to raise awareness of the signs of dementia, with a focus on seeking an early diagnosis, is to be welcomed.

There are still many myths around dementia. For example, still too often dementia is mistaken for just being a symptom of getting older. As a result, many people still ignore the symptoms – putting them down to things like ‘senior moments’ – until its too late and they end up in a crisis situation and the dementia has become advanced. What is lost can never be got back.

Yes, dementia is scary, as the recent international study by Harvard School of Public Health and Alzheimer Europe showed, but that is all the more reason to take action quickly.

As Dr Simon Ridley, head of research at Alzheimer’s Research UK, said: “Although people may be fearful of the worst, a diagnosis can empower them to access the right treatments and support to preserve independence.”

He’s right; getting a diagnosis can give people a whole new lease of life. Knowing what is wrong – and getting the right treatments – can have a hugely positive effect on the person with the condition and their loved ones.

Indeed, in the past I’ve met people with dementia in support groups, such as the Scottish Dementia Working Group, who still lead full lives. Members of the group have developed new hobbies and interests post-diagnosis while getting to speak at international conferences and generally enjoy their lives.

For the group, dementia is part of them, but doesn’t define them – or stop them doing whatever they want to. Getting an early diagnosis means that the person can access the drugs and treatments they need to slow the progress of the condition and give them vital extra years to spend with their family and friends.

Writing that sentence, it seems the obvious thing to do, but many people obviously don’t, whether it is through ignorance of the symptoms, fear or a myriad of other potential reasons.

Whatever the reason, a campaign to increase awareness of dementia and the importance of early diagnosis is needed but should be the start of a sustained initiative.

Raising awareness is a long-term process, and campaigns need to be sustained over several years to be truly effective.

Let’s hope it is just the start.
 

Dan Parton writes (11/11/11): Stigma should not be a barrier to success 

Stigma is still one of the biggest issues that people with mental health problems face on a day-to-day basis – and it can stop them achieving their potential in employment and in life. So its welcome news that anti-stigma campaigning group Time to Change has received the funding it needs to carry on.

The government’s recent pledge of £16 million, over the next four years, to Time to Change – along with £4 million from Comic Relief – will enable it to continue its work until March 2015.

In the short-term, the next phase of the campaign will include testing new approaches to tackling mental health stigma and discrimination among children and young people, and some specific work with the African Caribbean community.

I’ve said before in editorials for the print version of Mental Health Today that the only way to effectively tackle mental health stigma is through a sustained campaign, and this money will enable Time to Change to build on the work it has done in the past few years, and plan for longer-term initiatives.

It is certainly needed: while mental health stigma is gradually diminishing – down 4% according to Time to Change – it can still be a significant problem.

However, changing public attitudes to mental health is a long-term, multi-generational goal and campaigning needs to be targeted towards groups such as employers and children – among many others – to ensure that progress continues.

After all, we need to remember that some of the greatest Britons, including Sir Winston Churchill and Florence Nightingale, had mental health problems and it didn’t stop them achieving all that they did. Indeed, some say that grappling with their mental health issues helped them to attain greatness.

But would they have achieved what they did if they had been open about their mental health problems at the time? Arguably not, because of the prejudice they would have encountered.

While the stigmatisation of mental health problems is by no means as bad today as it was in Nightingale’s or Churchill’s times, we still need more work to address it, to ensure that people with mental health problems are not subject to prejudice because, just like anyone else, they are capable of so much, including, from time to time, true greatness.

Care in the community has failed to protect the most vulnerable people with mental health needs, a report by the Centre for Social Justice (CSJ) has claimed. While that might be highly debatable, it does point the way to much needed reform of mental health services.

The statistic used to back this claim up – that in two thirds of cases treatment fails to reduce mental illness – is the attention-grabbing bit designed to be the hook for newspaper reports. But behind the headline figures is something much more constructive to the ongoing debate about reforming mental health services. 

For instance, the report ‘Completing the revolution – Transforming mental health and tackling poverty’ calls for greater integrated working, saying that people with mental health problems need more than medication and therapy to recover. This has been said for many years by service users and practitioners alike. It is common knowledge – if not common sense – that often people with mental health problems will need such things as support into/back into employment and help with housing.

It goes on to say that some patients are being denied treatment because there isn’t the capacity in primary mental health services provided by GPs, nurses and psychiatrists. Again, this has been said for many years, but mostly anecdotally. 

Another thing many campaigners have been calling for - early intervention and prevention of mental health problems – are also mentioned as priorities. This will also reduce the bill for mental health – currently around £6 billion per year, or £105 billion, including higher general health and social care costs, lost working days and family breakdown. Yes, there is a financial aspect to this, but then, when isn’t there in “the current economic climate”? 

The report also notes that the link between mental illness and violence is “vastly exaggerated” and partly persists because of media scares. Again, this is a salient point and one that needs to be addressed more widely. Now that respected thinktanks such as the CSJ are saying such things, maybe the media will listen. Maybe. 

The CSJ says that addressing these needs has to be a priority, and they’re right. Mental health should not be treated in isolation as solely a health and/or social care issue In summary, most of the headline points in the CSJ’s report are not revelations for anyone with mental health problems, or to those who work with people with mental health problems. But if this report can provide the basis for proper debate among government and the mental health sector about the way forward, then it is a good thing. 

Reform is needed in mental health and, as with so many other issues within health and social care right now, it is no longer an option but a must. Let’s hope this is one of the first of many steps towards it.