Systemic Change Needed in Mental Health Provision and Attitudes

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Personal perspective By Dr Mereille Nemh

Mental health is not a new fashion to be nodded to like a new spring fashion but a major long term need

As a doctor and mental health professional practising privately in the UK, I have seen the strain that the system has come under in the past 12 months. Referrals to mainstream CAMHS (Children and Adolescent Mental Health Services) have actually fallen, while underlying demand has increased, and some of that has been taken on by the private sector, by professionals like myself. We have been working on our own front line. The somatic implications of COVID-19 including the impact on Intensive Care Units, hospitals and the Ambulance services have been well noted, but the secondary mental health implications have been mostly hidden. Rates of mental health in children have risen, according to the recent NHS mental health survey, so that now 1 in 6 of children may have a mental health concern. 

But it is not just for children that Covid-19 has created major mental health concerns: I remain concerned for an uptick in anxiety, depression and perhaps suicide rates among the very many who have seen their careers upended. In my own practice, I am concerned about increasing suicidal ideation and severe anxiety concerns from many men faced with bleak economic futures. Men tend to be silent sufferers and at a greater number than suicides by women.

My general stance here is: while much of the governmental rhetoric is well placed (for example the role of mental health within the NHS Long term plan), more capacity and more distributed localised capacity is needed within our mental health services and schools, based on people with the right training. Just as it takes many years to develop a nurse or doctor in the NHS, we should be taking a systemwide approach to development of the right sort of capacity for mental health provision, with professionals with the right training. For me, the NHS, private-practice and the 3rd sector can all help support our mental health, and more joined-up thinking here would be of importance. Experts have looked at the mental health impact of quarantines and isolation and saw that the damage is more related to the length of the total quarantine and feelings of loneliness rather than the intensity of such measures.

More than this, there is an ongoing need for attitudinal changes in the British populace to Mental Health. The Royal family with “Heads Together” have started us down the right path, to where mental health issues can be just as easily discussed between friends and colleagues as a sore knee. But there is still a stigma for children in schools, where they may feel labelled for seeking help. While attitudes have shifted, we still need to see Talk Therapy as sometimes a better response than medication in the treatment of our mental ills. While the NICE guidelines do support mental health provision, such as intensive CBT and psychoanalysis in many situations, GPs can still too easily use medications, seen as a panacea, but they are not.

 And to return to my major point, we need a system-wide response to tackling the long-COVID mental health issues. Private clinicians (just as private hospitals did for the NHS during COVID) provide a wealth of resource that can be tapped. And the third sector, in organisations both big and small, can also make an enormous difference. While the government did give £750m additionally to mental health provision during this last year, and £10m to mental health charities (more than 144 of them according to Nadine Dorries), much grass roots support in the community is given by small charities, such as Skylarks (www.skylarks.charity) a charity for children and families of those with Special Needs, of which I am a long-term Trustee for example. This is a wonderful resource for Londoners, especially those in West London, in supporting the most vulnerable (and with growing users across the country through its online provision) but these are small charities not supported by central government’s largesse. We need to do more to build up sustainable capability in the public provision (including in schools and GP surgeries), in the private provision and in the third sector so that there is much local and distributed capability. We need to move fast so that these services are available now as we unlock.

 For those of us who work in the system, we are pleased by the occasional attention that our efforts bring. However, mental health is not just this spring’s new health fad – it is a long term commitment and calling and I call upon the system to build new capabilities and the public to see mental health as each person’s “new wealth”. 

Dr Mereille Nemh is a Private Doctor and Mental Health Professional practising in London

and a Trustee of Skylarks Charity.