Sunday, 3 July 2016

I’ve heard the question, but there’re no easy answers from this Professor

I belong to a group called the Mental Health Nurse Academics UK (MHNAUK). Its a group that meets periodically to discuss the state of mental health nursing practice, research and education. Every University with a mental health nurse education programme is entitled to have a representative. All Professors of mental health are automatically ex-officio members. Recently the group have been looking at the threatened erosion of the professional identity of mental health nursing. Those responsible for the regulation and commissioning of nurse education are considering the adoption of a more generic approach to the preparation and practice of all nurses including those in mental health practice.

Given the changing nature of health and social care provision, and in particular the move towards integrated services, I have mixed views about whether this is the battle we should be engaged in. Up until 2 weeks ago I would have probably written that time will tell how successful MHNAUK are in the efforts to protect the mental health nurse professional identity. The uncertainty of the UK’s political landscape and what is likely to be a governmental  'brain drain' of effort in working through the consequences of the UK withdrawal from the EU, will mean that many issues are likely to remain un-addressed for the foreseeable future.

Mental health care in the UK is one of these areas. The recently published tough, open and evidence based publication, The Five Year Forward View for Mental Health, presented a critical analysis of the current state of mental health care in the UK. It was a report that was welcomed by many concerned with improving mental health care. The report recognised the scale of mental health problems being experienced by people and the cost of mental ill health to the economy, some £105bn a year. Mental health ill health represents 23% of the disease burden in the UK.

The report made some big promises as to how these services would be improved. It recommended that an additional £1bn a year in funding was required. This was a sum in addition to the £1.4bn over the next 5 years to improve access to children and young people's mental health services announced last year by the Prime Minister (see here). And these services need improving. It’s thought that 1 in 10 children experience a mental health problem, yet children can wait over 5 months to get a routine appointment with a mental health practitioner, 7-8 months if you want to see someone from a community team. Some 258,000 children were referred to child and adolescent mental health service in 2015. This lack of care provision has an impact on other parts of the health and social care system.

The number of children attending A+E departments with mental health problems rose to 20,000 in 2014-15, doubling where it was 4 years ago. ChildLine (the free 24/7 counselling service for children and 30 years old this year) has helped 4 million children since it started. A child contacts ChildLine every 25 seconds, every day.

Last week, the Guardian newspaper reported on research undertaken by YouGov which revealed the concerns many parents have about their children and mental health problems. 67% believed their child would never recover from a diagnosis of a mental illness; 49% felt their child would never get married or have children of their own; and 44% of parents thought their child might be removed from them. When I first read the article I was disappointed by what I thought was the degree of ignorance and stigma these statistics revealed. However, there is no doubt that whether it's you or your loved one who is experiencing a mental health problem, it can be a difficult place to be. For parents of children who might be experiencing mental health problems this is often more so. Sometimes a combination of the emotional burden of care, the corrosiveness of guilt, and the lack of timely and appropriate help result in a crushing sense of despair and impotence for many people, feelings that can be almost overwhelming. 

From someone who has been there, to that sometimes dark place, and as mental health professional of many, many years I can say there are no easy answers. Being there, and being there for others, whatever the difficulties is the approach I have found the most helpful. And actually, I don’t think I ever needed to be a mental health nurse to understand that or to try and ensure I was that person.