Karen Newbigging, Senior Lecturer in Healthcare Policy and Management (HSMC)
World Mental Health Day 2015
In this blog, I reflect on this year’s World Mental Health Day’s focus on dignity. The last week has seen events take place in various parts of the world to celebrate World Mental Health Day (WMHD). In this country, there have been art exhibitions, football matches, conferences and workshops, promoting emotional resilience and wellbeing and celebrating positive initiatives to reduce stigma.
An affront to personal dignity
Some organisations have used the opportunity to focus attention on how personal dignity can be affronted by poor access to acceptable high quality care and support, and the pernicious consequences of inequalities, stigma, and coercive treatments in mental health. Through the current promotion of parity of mental health with physical health, it is clear that this is a widespread concern and that comprehensive action is required to ensure people experiencing mental health problems can access the right kind of support at the right time. Indeed, this was the theme of a recent Care Quality Commission report that found unacceptable variations in timely access to effective support for people experiencing mental health crisis. Our attention has also been drawn to:
- the lack of provision for children and young people experiencing mental health problems with one in 5 being turned away by mental health services , despite the evidence that half of all adult mental health problems have their genesis before the age of 24;
- perinatal mental health, despite the evidence that the early months and years are crucial for children to form secure attachments to see them through life
- inequalities in the availability of good mental health care and support to people from communities hard hit by the current austerity measures, with psychologists walking 100 miles in the summer to highlight the effects of sanctions, the Work Programme and austerity on their patients
- homelessness and mental health
- continuing alarm at disproportionate rates of detention and treatment of people from African and Caribbean communities
- Increasing numbers of people, including children and adolescents, being placed in hospitals, including expensive secure facilities, long distances away from home and their families and friends.
All of these represent an affront to personal dignity.
Parenting and mental health
I celebrated World Mental Health Day at a parenting and mental health conference in Halifax, organised by Calderdale Healthy Minds. The assault on dignity by the lack of understanding and availability of good care and support for parents experiencing poor mental health was a recurrent theme of the day. Katie Siobhan, who has used mental health services for many years, gave a moving account of encounters with maternity services in which her mental health history was frequently referred to and in a way that emphasised the potential risks, overshadowing her pregnancy, colouring the experience for her and her partner. Katie had a simple message; see me as a mother first and a mental health service user second. We heard from women at the Women’s Centre Calderdale and Kirklees of their experiences of living apart from their children, in response to mental health or substance abuse problems, raising the question as to how this could be prevented. Neelam Singh and I reflected on how problematic access to good support for parents was further complicated for people from different communities experiencing additional discrimination and disadvantage.
These different accounts highlighted the familiar problems of mental health-related stigma, inequalities, targets that miss the point, funding, a lack of good multiagency working and leadership that is constrained by competing political agendas. Despite these challenges that shape the response from statutory services, we heard of resilience, creativity and above all the value of peer support. Katrina Jenkins, from the Mental Health Foundation described the Young Mums Together project, which provides emotional and mental health support to young mothers in Hackney. Sam Walker set out the case for demedicalising the response to self-harm, and how this has been progressed through peer support, solidarity and training for health and social care professionals.
Ensuring dignity as a focus for mental health care
There are many people across the country committed to ensuring that dignity is a central focus for mental health care and support so that people experiencing mental distress can access the support they want and need to enable them to live their life to the full. Such examples include strengthening community assets; positive parenting programmes; service-user led peer support; improving the response of primary care to mental health; early intervention; the development of crisis houses as an alternative to inpatient care; advocacy; and reframing mental health difficulties in a psychosocial rather than a biomedical discourse. Such initiatives often co-exist with business as usual and may be funded on a short-term basis or seen as valuable but supplementary to the core of mental health care and support. If we are serious about dignity in mental health, support and care needs to be organised around prevention and early intervention and approaches and initiatives that foreground personal dignity and self-determination for people experiencing mental health difficulties. If we are serious about dignity in mental health, this not only requires that approaches that enhance our personal capabilities and resources are at the heart of mental health support but that we also tackle the wicked issues of rising rates of coercion; the contravention of people’s rights; relatively low levels of investment in mental health compared to physical health; the socio-economic and environmental factors that influence our mental health and inconsistent political attention to mental health.
Are we serious?