‘Mental health – are we doing enough?’ was the subject of Connect Health‘s latest Change webinar on Wednesday 9th February, highlighting a need for greater accessibility and a more considered approach to patient care – as demand for services hits an all-time high.
Speakers at the event outlined the opportunities of digital innovation in improving NHS mental health provision, while acknowledging that achieving the required transformation would be no mean feat – “like trying to turn an oil tanker from pointing north to south” in terms of the size of the challenge ahead.
Opening the session, Chair Shazna Khanom, Director of Mental Health Services at Connect Health, asserted that “there has never been a more crucial time than now” to address mental health support, following an estimate by the Centre for Mental Health that 10 million people in England will require support in the next three to five years, as a direct result of the COVID pandemic.
That is concerning enough, but what is even more concerning is that predicted levels of demand are two to three times higher than current NHS capacity, despite additional investment, Shazna said.
Speaker Zohra Khaku, Senior Project Manager, IAPT (Improving Access to Psychological Therapies), NHS England & NHS Improvement, focused on how digital innovations are helping to optimise delivery of IAPT services.
Outlining the target of the IAPT’s long term plan to reach 1.9 million patients by 2023/24, Zohra acknowledged that activity is currently on course to achieve around 70% of this.
Emma Branch, CEO of The Counselling Foundation, gave an overview of the Foundation’s work – and the work of other VCSEs (Voluntary Community and Social Enterprises) – in helping to bridge the services gap for patients who may not meet criteria for NHS mental health support.
As a result of The Counselling Foundation’s ‘agility’ as a voluntary service, some patients start treatment just five weeks after referral, with sessions often costing less than £5 each. Emma highlighted how they can liaise with other services, such as patients’ GPs, to ensure integrated care.
Emphasising the “amazing work done by so many people within the NHS mental health sector,”, she said
[however], I don’t think many of us would disagree that mental health as a sector is historically underfunded and remains fragmented. And although change is trying to happen, making change within the NHS, particularly when trying to integrate that change with other statutory support bodies, is like deciding to turn an oil tanker pointing north to point south – and that’s to do with size, complexity and the competing needs across our health system.
In contrast, she said that VCSEs – which can also deliver IAPT programmes – at times are better positioned to offer more client-centred, tailored care, make decisions quickly and respond to present challenges. When asked about specific skills the sector can bring to mental health support services, she said:
In the voluntary sector, you often get specialists within their field…and it can also attract people who maybe don’t want to work for a large, and at times bureaucratic, organisation – it can provide a greater access to talent and trained skills.
Sometimes people are suspicious of the NHS. Sometimes people don’t want to access care through their GP. There can be a whole host of reasons why statutory bodies feel like a scary barrier to people, whereas approaching a voluntary organisation can feel less intimidating. Smaller organisations are often closer to clients and their experiences, and they can respond rapidly to feedback.
Emma also pointed to a need for sustainably-funded partnerships, without current short-term tender cycles. “NHS procurement processes are often complex and time-consuming, making it impossible for small but excellent organisations to respond to 200-page tender documents,” she said.
Diversity & Inclusion Consultant Sanisha Wynter outlined her own experiences, having been diagnosed with severe mental health illnesses, including borderline personality disorder, mixed anxiety and depressive disorder and PTSD.
Speaking impactfully of her experience of seeking support, and initially “not feeling heard” she said:
[It’s been difficult to access] services as a patient [due to] the way that I’m perceived… I can articulate how I feel and I’m emotionally intelligent… when I first interacted with services, I was told ‘but you’re such a strong black woman’. I felt frustrated. The GP was well-meaning but the impact it had was that it silenced me.
She went back to her GP and was referred to the IAPT programme. Describing the process of diagnosis, she said
When I was diagnosed, I was shocked…because I felt ‘how could somebody who has achieved so much, from my perception – being the first in my family to go to university, the first to do lots of different things that my family hadn’t done, why was I feeling unwell and did that mean I had failed?’
She emphasised the “many different stigmas and stereotypes around mental health disorders” that continue to exist within the system itself, highlighting the racism and sexism she has encountered. She asserted that women “can be seen as hysterical when asking for help”, with other patients labelled as “difficult”, and pointed to a need for all staff to speak out to help reduce harmful stereotyping.
Silence is being complicit in oppression. There is so much stigma and harmful language thrown out about people, specifically with borderline personality disorder. Know that if you are hearing those conversations, being part of those conversations and not challenging it…you are continuing the cycle.
Sanisha also highlighted ‘the racialised issue’ of labelling some communities as ‘hard to reach’ in justifying a lack of support.
[No communities are] hard to reach, [rather] our approach or our research needs to adapt to [each] community,” she said. “Mental health support must be tailored to individuals, not just about ‘what do we have funding for?’
Wrapping up the event, chair Shazna asked speakers for the one thing they would change to improve outcomes for those impacted by mental health.
Emma: “For service users and VCSEs to be at the core of design, build and implementation of the new structures in addition to embedded in the on-going governance and monitoring of service delivery.”
Sanisha: “For patients and people with lived experiences, for their voices to be valued and to be included in the co-creation of new research and projects, so we’re there from the beginning.”
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