Paying lip service to the need for change in mental health care?

I’m officially old. Well, that is according to our youngest child. On Thursday we were discussing her lips. She had her lip filler dissolved recently and wasn’t sure if her lips now looked like she wanted them to look. Jane and I had a look and both said they looked lovely and she had a great smile. ‘Yes’ she said ‘but you are an old man and woman’, I think implying we wouldn’t know what ‘good looked like’ when it came to lips or smiles.

There were lots of things last week that might have made me feel a little depressed, but being reminded I was an ‘old man’ wasn’t one of them. In fact, the reverse was true and we had a chuckle about her comment, which proved a source of amusement throughout the evening. That said, anxiety and depression for all kinds of reasons seem to be rising at an alarming rate. The Department of Health and Social Care (DHSC) recently published an interim report of their independent review into mental health conditions. It’s an interesting, if a somewhat long read, have a look here. I found it a fascinating account.

It is clear that there has been a rise in the numbers of people experiencing anxiety and depression and psychological distress over the last two decades. This rise is particularly prevalent in young people and young adults. There has been an epidemiological shift too. Historically, the evidence showed that people experienced these common mental health problems in midlife, more so than when folk were younger. Today the situation is reversed. It is younger people rather than those in their 40s who report higher levels of distress. It’s a trend that predates the Covid 19 pandemic uptick in mental health diagnoses, and can be traced back to starting in the 2010 years.

Interestingly, it is the common mental illness and distress that seems to be on the rise. Rates of people experiencing severe mental illness, such as schizophrenia, bipolar disorder and other serious conditions seemed to have remained stable. The exception appears to be eating disorders where prevalence rates have risen (again with younger people). However, whatever the severity of the mental health problem, the impact upon the individual and the wider society can be challenging and disruptive.

What is important in all cases, is that for the individual, their experience of distress or poor mental health, will be real. All providers of care need to understand that individual experience, even where the person’s presentation doesn’t fit into a clearly defined diagnostic category. This is not a new concept. Professor Sue McAndrew and I have published a number of papers that explore the impact on individuals where a person’s lived experience is ignored.

Last Monday I visited one of our Early Intervention Services. As always, it was an informative and interesting afternoon. Talking to my colleagues, it was absolutely clear that intervening early, and particularly with people under the age of 35, helped ensure that many individuals don’t go on to have a lifetime’s engagement with secondary mental health care. It is an approach that the DHSC report makes clear requires further investment.  Again interestingly, the report also tackles what at times, are perceived to be increases in the prevalence of ADHD. Often both politicians and the public share this perception. The evidence, however, is clear. Epidemiologically, over the last 10 years, ADHD prevalence rates have remained stable. What is different is a substantial change in the recognition of the diagnosis. Probably more importantly, is the link of a diagnosis and access to clinical services and disability benefits such as personal independence payments (PIP). Last week it was reported that every day 1000 new individuals are claiming PIP. That is each and every day. Think about that for a moment.

Such a situation is not sustainable or desirable. There is no date agreed for when the final DHSC report is to be published. I hope I’m not too much older before it is finally published. I also hope that it will contain strong, evidence-based and affordable recommendations as to how we change the current situation.

Later this morning Jane and I will be attending our church Harvest Festival. It is one of my favourite services of the year. I may indeed be an ‘old man’, but I will enjoy singing the familiar hymns first heard when I was a school boy! It is a service that always brings a smile to my lips, although I might just check them before I go.     

While men argue, nature acts

Last week was a busy one for sure. For all kinds of reasons, strangely, there was just as much waiting around for meetings to start, as there was time spent in the actual meetings. On one of these occasions, I was standing waiting and chatting with Chris Oliver, our new CEO and he was admiring our in-house library. It is wonderful to have this facility available to colleagues and those using our recovery academy. However, as I pointed out to Chris, at one time we had a much larger library, which was housed in a magnificent building called Century House. Sadly, the building is no longer there.

The building had Virginia Creeper growing up three of its walls and in the autumn the reds and orange leaf colours made for an eye-catching display. A lifetime ago, I spent many happy Saturday mornings there reading, discussing life, the universe and all things mental health with a consultant psychiatrist named Som Soni. He was a man who possessed enormous patience and kindness. Som lived in a large house in Hale, a very upmarket area of Manchester. Each summer, he would invite those that worked with him to a garden/pool party. Such was his generosity, he always insisted that on these occasions you brought nothing at all, except yourself.

Som was generous in other ways too. My very first ever published paper was written with him and two other colleagues. I was immensely proud, when it came out. That was in 1989. The world and attitudes have changed greatly since that time, but I think much of the discussion in our paper can still be seen as being relevant today.

The world has changed in many other ways since that time, something I was reminded about last week when the NHS England Chief Executive, Sir Jim Mackey, visited our Trust. He met with the Board and senior leaders from across the organisation. He has an accent I could listen to all day long. He also has a very calm measured way of speaking that inspires confidence. One of the things he noted was how the world was changing, as a consequence of climate change. He talked about the impact of climate change in the context of productivity, which across the NHS had dipped during the summer of 2026.

Last year the UK experienced four heatwaves. This year, since May, we have experienced five distinct heatwaves; another one is promised for parts of England in the coming week. Trying to deliver comprehensive health during the heatwaves has been a real challenge and in many parts of the NHS, services almost ground to a halt. Operating theatres were closed, ambulances services were almost overwhelmed in some parts of the country, and staff found themselves working in intolerably hot conditions.

Whilst it has been a challenge in 2026, I’m not sure that the NHS has woken up to the future challenges resulting from such climate change. If I look at our Board Risk Register, climate change doesn’t feature on it at all. It’s becoming increasingly clear that the world, as we know it, is heating up more rapidly than the science had predicted it would. The consequences have been easy to see. There have been floods and wild fires, the like of which most of us have never seen. It’s not just here in the UK, the devastating floods in Nepal are said to have been caused by the effects of climate change.

There are some effects that are harder to see, which will begin to have just as great an impact, as the floods. Food production and food security for example. We are already seeing scarcity in some food products, a situation likely to only get worse, as farmers struggle to plant next year’s crops. It’s estimated that the UK needs 120% of its normal rainfall over the next seven years, in order to deal with the effects of this year’s drought.

Possibly we are too late to completely reverse the impact of these changes to our climate. Leading experts and concerned citizens have produced a call-to-action film The National Emergency Briefing; you can watch the trailer here (thank you to Chrissie Cooke for the link). If you go on their website, you can find out where there might be a screening near you. The hope is to get the film screened on national television. Whilst setting out the stark reality of where we are now, the film does however, offer hope. And if we act now, that hoped-for future, could still be realised.

Silence and life’s ticking clock

I was in my colleague Leena’s apartment in Finland when I saw the news of a plane flying into one of the twin towers in New York. I watched the TV with a mixture of horror, fascination and impotence as the second plane crashed into the other tower. It’s hard to believe that last Friday marked a 25-year anniversary of that dreadful day. I have been to New York a few times, and went up the twin towers a few times on those visits. I have visited New York three times since the 9/11 attack.

The last time was in 2018 when Jane and I were able to visit the 9/11 memorial and museum. It is a humbling place. The memorial has a strong, powerful emotional impact on one’s sense of self, and where we all stand in the historical passage of time. I felt something similar on our recent visit to the Auschwitz camp in Krakow.

In both places, one of the things you become aware of, is the silence. In Auschwitz that wasn’t surprising. The camp is away from any major town or city. The 9/11 memorial, however, is just a few hundred yards from the bustling streets of New York. In a world that can often be filled with noise, distractions and challenges, embracing moments of silence can be a powerful part of mindfulness.

Silence can also form an important part of therapeutic conversations. The late psychoanalyst, Andrea Sabbadini, argued that silence is a form of communication in its own right. Writing in 1991, he used the lovely description that silence was a ‘container of words’. Much earlier it was William Penn, the American statesman and philosopher who said, ‘Let silence be there - let’s not disturb the sound of silence as within the sound of silence there are more words than spoken speech’.

However, it was Sabbadini who described there being ‘different silences’ which can have ‘different meanings’. This can clearly be problematical in therapeutic encounters. Different types of silences can also be problematic in non-therapeutic encounters. Last week I enjoyed an absolutely uplifting experience when I visited a group of my colleagues providing psychotherapeutic care. It is always  great to go and spend time with colleagues, and I’m always grateful for the time they give me.

Last week's visit was no different. I had a warm welcome, and following a tour of their facilities (once again car parking for colleagues was an issue), we retired to their seminar room for a group discussion. I was left on my own while colleagues were rounded up and tea and coffee brewed. Sitting there, in the silence, I gradually became aware of the clock ticking away on the wall. To start with, the sound was slightly hypnotic and reassuring. It was the passing of time, one tick at a time. After a while, however, that same tick began to sound quite menacing.

Now I’m very comfortable with silence. I don’t undertake any clinical therapeutic work these days, but even in my everyday encounters, I’m very happy to embrace silence. So, I cannot account for my uncomfortableness at sitting there listening to the clock ticking. There will be a reason for sure, and on reflection, I was probably in the right place, with folk with the right skills to help me understand my lived experience. However, I think we had a much better conversation.

One of the things that they wanted to talk about was the use of the term ‘service user’ when talking about the people we work with. It was a great challenge, and one that I have heard several times recently. I prefer person and people, but I think we are a while away from this becoming the norm. Labelling people can often have unintended consequences and raise challenges for people. I shared with them an experience of writing a paper about people who were given the label of having a borderline personality disorder. The publishers refused to allow us to use the Miss Nomer in the paper's title, insisting we use misnomer instead. It didn’t make much sense to us, judge for yourselves here.

Finally, I welcomed seeing the introduction of a minute’s silence at the 9/11 remembrance services this year. It recognised not only the 2,977 people who died on the day, but also the more than 9,000 people who have died of 9/11 related illnesses since. It feels important to remember that those 2,977 people went to bed on the 10th September never imagining they would be dead the following day. Let’s all try and live, love, and make the most of each and every day; nobody knows what is around the next corner of life.

The older I get, the better I used to be

I start this week’s blog with a reference back to my blog posting of 23rd August (see here). In that post I warned that the UK may, as a consequence of climate change, see a rise in diseases up to now only found in places like Africa and Southern Europe and Asia. Well last week the UK Health Security Agency reported that Aedes aegypti mosquitoes had been found with larvae in East London. These mosquitoes can spread the Zika virus, dengue fever, and yellow fever; none of which you want to get! You have been warned.

There was a different kind of warning posted by the Department of Health and Social Care last week. The warning was about the shortage of a common antidepressant, Venlafaxine. The shortage is likely to last until the end of the year, and guidance has been issued regarding restricting new prescribing of the drug. We know from the Office of National Statistics that mixed anxiety and depression are the most common form of mental health disorders. Young people aged 16-29 have the highest rates of depressive symptoms, with just over a quarter of this group reporting moderate to severe symptoms.

This data is a cause for concern. Doctors from the Royal College of Paediatrics and Child Health reported that there had been a 36% rise in the numbers of children and young people presenting at A&E departments between 2019 and 2025. A&E environments are not great places for anyone in distress, but 8% of young people are still having to wait over 12 hours to be seen. That said, many families are ‘forced’ to use A&E services, as gaining access to appropriate children and young people’s mental health care in the community can be almost impossible.

Whilst the current mental health service offer for children and young people is not broken, often they appear to operate on the basis of only offering services when a child is ‘unwell enough’ to qualify for an intervention. That is unacceptable, and unacceptable to those in need and to those providing care.

There are signs that the current government has a growing awareness of the need to both improve and transform mental health services for children. Improvements to children and young people’s services feature in the Government’s 10-Year Health Plan – see here. A new mental health strategy is due to be published later this year. I just hope the improvements and the availability of new resources can be achieved at pace. In England so far this year, 894,212 children and young people have accessed mental health services. Just in June there were 538,766 children and young people with an open referral.

I drew this data from the fabulous NHS Digital website. I mention this as apparently, in a report published last week by Age Concern, only one in six folk, over the age of 65, are confident about being able to use online services. The rest of this group struggle in different ways to access services such a banking, council services and health care. Interestingly, the report notes that whilst 1.6 million older people are ‘digitally included’, 1.4 million never use the internet at all. So, the majority of people in this age group (7.9 million) are somewhere in the middle. Sadly, I find myself increasingly in that middle group. Fortunately, Jane is totally digitally literate and does everything on her phone. So when I run into problems and lose my patience, she simply says ‘would you like me to help?’ and these days I gladly accept her offer.

She is a whizz. Jane can find emails, reports, booking confirmations and so on that as far as I am concerned have disappeared for ever, and can’t ever be found.  Unfortunately, there are many people who don’t have access to a Jane. Like Age Concern, I firmly believe that we are never going to reach a time where everything we have to do we have to do online. I get so frustrated when I can’t simply pick up the phone and speak to someone, a real person that is, and not a chatbot. And don’t get me started about security codes…

I’m an active campaigner, as is Jane, for there always being a non-digital alternative to accessing public services like health and local council services. My GP practice understands this. One outcome from a recent visit was the decision to have a fasting blood test in 3 months’ time. My GP sent me a text reminding me of this, telling me I didn’t have to go online to book an appointment, the practice receptionist would do it for me if I called in. Perfect service.