World Mental Health Awareness Week gives us an opportunity to reflect on how mental health service provision has improved and how far we have yet to go. As one of the leading sites in the UK, Birmingham has been in the vanguard of the delivery and evaluation of innovative mental health services for Early Intervention (EI) in Psychosis.
Psychosis refers to a broad range of mental health problems, including specific diagnoses such as schizophrenia, characterised by hallucinations and delusions. Prior to the development of EI, people with psychosis often received poor quality treatment, coercive inpatient admission, and long delays in accessing care. EI has led to transformation in mental health care across the UK with economic analysis suggesting this model of service provision saves the NHS approximately £5000/person/year and having clear clinical benefits for patients1. These evidence-based benefits have led to psychosis being the first mental health problem to have a NHS target and models developed in Birmingham have had a significant impact both within the UK and globally on the development of new pathways. However, psychosis is not atypical of mental health problems more generally, despite having had this focus. Like most mental disorders, it begins in adolescence or young adulthood2, a crucial time for a young person who may be in the midst of exams, starting university or entering the work place, leaving home, and developing relationships. This is also the time where the NHS divides services between paediatrics and adult medicine, between child and adolescent mental health services (CAMHS) and adult services. Birmingham has been innovative in addressing this false break in care with the Birmingham Women’s and Children’s NHS Foundation Trust leading the novel Forward Thinking Birmingham 0-25 youth mental health service – a model which addresses some of the issues raised in the Government’s Green Paper.
It is apparent that young people, including university students, are suffering increased rates of mental health problems and are often not able to get the care and support they need. The Institute for Mental Health (IMH) is leading inter-disciplinary youth mental research with our partners regionally, nationally, and internationally to co-produce research, teaching, and training with young people themselves who have had lived experience of mental health problems and service use.
Research into mental health has never been more important and our research into support and detection of self-harm by GPs and teachers, of autism and psychiatric illness, and the onset of mood disorders in young people, such as depression and bipolar disorder, are just some of the ways we are looking to grow our knowledge in this area, as well as influence policy discussions.
Early Intervention is an example of secondary prevention – an intervention designed to reduce the harms once an illness develops. An ambition of the same, if not greater, importance is primary prevention – to prevent mental health problems developing altogether. A prominent strand of my research has been to detect and support young people who may be at risk of developing psychosis, and providing care to try to prevent the illness develop.
Together with colleagues in the NHS and education sector, implementing anti-bullying strategies, and evaluating their effectiveness, is going to be a key element of our research going forward. In fact, research from the LSE and MQ suggests that spending £1 on bullying interventions brings the economy back over £7.50 as a result of the long term impact of bullying.
One of the great strengths of the University and the IMH, alongside its track record of innovative clinical service delivery, is in its health policy and cognitive neuroscience. Professor The Rt Hon Paul Burstow is shortly due to deliver the outcome of the Birmingham Mental Health Policy Commission, exploring treatment gaps for young people with mental health problems. We also benefit from strong local, regional, national and global partnerships that allow us to use this wealth of resource together with our existing and recognised expertise in cognitive neuroscience, psychology, social policy, philosophy, ethics, education, health economics and medicine to inform policy and practice which will make a step change in the mental health of our young people and society.
- Marwaha S, Thompson A, Upthegrove R, Broome MR. Fifteen years on - early intervention for a new generation. The British Journal of Psychiatry. 2016;209(3):186–8.
- Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustun T. Age of onset of mental disorders: a review of recent literature. Current Opinion in Psychiatry. Current Opinion in Psychiatry; 2007 Jul;20(4):359–64.