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Is the stigma becoming less so?

Isn’t it wonderful that nowadays everyone is much more willing to talk about mental health? It is so important that the stigma associated with having a mental rather than physical illness is confronted.  It really is amazing to have members of the royal family speaking publicly about their own mental health issues. One just couldn’t imagine that happening even 10 years ago – and that has to encourage those who are still embarrassed or scared to open up and discuss the fact that they are suffering inside to try to get some help. Fear of being labelled has always affected people’s willingness to seek treatment so it is of huge significance that the general ignorance about mental illness is now being so much more openly discussed.

Unfortunately, the problem with all this increasing awareness and openness is that is actually adding even greater pressure to our existing mental health services as more sufferers come forward to seek help – and the fact is that all this increased awareness does not seem to be leading to increased action to manage the issues.

Once opened, it needs addressing.

It is all very well to tell people that it is okay to be open about having a mental health problem and that you should seek treatment – but if there is no treatment available then you risk actually making things worse. If, when you finally try to discuss your very personal problem, you’re just put on an 18 month waiting list to see someone and sent away with a packet of pills you are unlikely to feel as if someone really cares. One can’t help but point at those senior government politicians who have publicly declared their commitment to raising awareness while failing to actually ensure that there is an increased investment in mental health services – but is that fair?

When questioned, they always claim that all this extra money has been allocated to mental health, but a recent Freedom of Information request showed that more than half of all NHS Clinical Commissioning Groups won’t be spending more on mental health services this financial year. Even where there is more money, there are still desperate shortages of staff in every mental health trust in the country, with over 10% of clinical posts unfilled. It looks like the political will, even if it is there at a national level, just isn’t working at the regional level at which the NHS works. Not only are there huge numbers of unfilled posts, staff turnover in NHS mental health services is extremely high – for instance, a third of consultant psychiatrists leave within 5 years of completing their training, suggesting that there are fundamental issues with the design of current services which money alone won’t address.

No tea, Vicar.

So the evidence is that recently improved mental health awareness and better understanding of the importance of seeking mental health treatment has actually led to further effective cuts to services due to the increased demand.  However, the existing services were already creaking at the seams, as they have always done as mental health has never been well funded. Historically, mental health services have only ever been able to provide help to those who suffer from severe and enduring conditions; but even there they are only just keeping up with demand now. You have to be very ill indeed to get rapid attention. For the vast majority, there is nothing available but some very broad brush medication from a GP and perhaps some CBT. A modern version of the vicar’s tea and sympathy, provided by the NHS rather than the church, and probably not much more effectively.

That public education on mental health problems, and on how to find help, needs to go hand-in-hand with making improvements to mental health services is something we can all agree is necessary – but who has any realistic ways to really change things for the better? It is not enough to just blame it on the politicians and demand more money, there has got to be a complete examination of what is not working and how it can be changed. Mental health services need a major rethink – and that has got to include thinking about why staff morale is so poor and how to change that.

Home is where the heart is.

We believe that we have an answer. We believe that the answer to the problem of how to manage both the increased demand and the poor staff morale in existing mental health has got to be through recognising that a large part of mental health provision is ideal for development as a nationwide online service and that to do so will also save money and improve services as well.

To receive treatment for one’s health care from the comfort of one’s own home is an ideal for any illness – but for mental health it is now easy to do. There is seldom a need for physical examination and the discreet nature of an online interaction is a huge boon in combating nervousness around stigma. On the other side, to work from home, interacting with patients over the internet, gives clinicians a freedom which, once they’ve tried it, few would choose to give up.  The economic argument is equally strong – the reduction in time wasted, the savings on buildings, staffing, travel, and thus environmental harm means that working online reduces costs dramatically.. For instance, not only are missed appointments massively reduced, their impact is negligible – the clinician is at home so they can always do the washing up or walk the dog!

However, the most important improvement is in the waiting times and the impact on clinical outcomes that this has. The best predictor of improved outcomes in any area of health is rapid access to specialist help. Working online allows that – it allows one to access a multitude of specialists at the press of a mouse, including specialist language skills for instance. It won’t solve all the problems and, of course, local services are necessary too: but they only need to deal with those severe and enduring problems – everything else can be done online.

The future is here.

We are working to make this happen; we are collaborating with lots of innovative and exciting people, enthusiastically grasping the opportunities that the digital age offers us for development of services for depression, for anxiety, for ADHD, for addictions, for schools and universities, for international refugee agencies and international businesses, for local businesses and local government – and for the NHS.

We have a tested model for GPs that we know that every surgery in the country would take if they were offered it – and it would cut referrals to local mental health services by 50%. We would love to talk to someone in the NHS about what can be done. We’ve tried, of course, at all levels. However, except for from individual GPs and on behalf of individual patients, we have completely failed until now to get any serious engagement.

If you are interested in what we are doing, please do contact us. We are always interested in ideas as to how we might improve our services. We are particularly keen to collaborate on developing the uses of a very adaptable online medical mental health risk management system which provides medical diagnosis, prescribes medication and makes onward referrals to therapists working under indemnified medical management – especially if you happen to be a commissioner of mental health services in the NHS.

 

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