Thursday, 23 July 2015

Mind over matter in Fuse?

Posted by Peter van der GraafAskFuse Research Manager

Mental health is a rising star on national and local agendas. At national level, mental health was for the first time ever included in all of the main political party election manifestos and features significantly in the NHS Five Year Forward View. At local level, Public Health teams across the North East are reviewing their mental health services and upskilling themselves in the best ways to reduce self-harm and suicide. You may ask what all the fuss is about?

Various reports have pointed out that poor mental health is costing the UK economy £105bn per year, including £8bn annually in sickness absence, and a further £15bn in lost productivity absenteeism (where people are at work, but under-perform due to mental health issues). The Care Quality Commission (CQC) recently sounded the alarm over the state of mental health services in England. In its first ever review of mental health crisis care, the regulator found that 42% of patients did not get the help they needed.

The picture is particularly bleak in the North East, which has the highest suicide rates in the UK and rates have been going up steadily since the economic recession and public sector cuts (after a long period of stabilisation) and are likely to increase further with additional cutbacks planned in recent spending reviews. Not surprisingly, mental health issues are higher in deprived areas, among men, those who are unemployed, and related to alcohol problems, all of which the North East is leading on in national league tables. Mental health services, described by one of our practice partners as “the Cinderella of Public Health”, are bearing the brunt of these cuts, in times when you could argue that their service users need them most.

To make the most of existing intelligence and services, the Public Health Intelligence Northern England (PHINE) network recently organised a dedicated event on self-harm and suicide, offering participants access to various interactive data sets (e.g. Community Mental Health Profiles) to help local authorities make sense of national data for their own patch. Where are the suicide hotspots in different localities? Who are most at risk and what services can they access? The data profiles were well received by the audience but were also met with some criticism around lack of integration with local data, such as counselling data collected by GPs in the North East. Moreover, although this data helps to identify what is happening where, it does not allow for answers to the question why? Public health commissioners need help to interpret this data and understand why suicide and risks are going up in one area or user group but not in another.

What can Fuse do to support this? Are we making our research on mental health issues available to decision makers and professionals? For instance, where can Public Health practitioners find information about the lessons learned in the award winning Change UR Mind about Young People project (evaluated by our Translational Research programme); or about the literature review on self-harm produced by the Knowledge to Action Group within our Complex Systems programme? Moreover, is our research responding to local concerns and needs? Do we help them in interpreting national data and matching this with their own data? And do we support them in developing interventions to address hot spots? How can Fuse work more effectively with partners in the region that are working on suicide prevention strategies, post-event services and mental health research?

Partners are closer than you might think. For instance, The Westgate Unit at HMP Frankland is a therapeutic, personality disorder treatment service based in a high security prison setting.  The Unit helps prisoners diagnosed with Borderline Personality Disorder who are most at risk of self-harm and suicide. The unit has developed its own research on why different prisoners self-harm but is struggling with budget cuts and would welcome support from academics in developing and conducting further research. You might counter that this is not public health, but given the significant impact of mental health on the UK economy, the NHS and, last but not least, the impact on families and communities, I would argue that this is a unique opportunity for Fuse to get involved.

Our region already has a wealth of clinical expertise available on mental health: the Mental Health Research Group (MHRG) is a joint initiative of the Tees Esk Wear Valleys (TEWV) NHS Foundation Trust and Durham University, in which clinicians, academics and service users, including young people, collaborate to improve local health services. The group recently showcased their research during their annual conference. Unfortunately, Fuse is not a partner in this network. However, clinical staff in the Trust are keen to develop their research skills and contribute to a better understanding of mental health issues and interventions in the North East and would welcome collaborative research with Fuse.

This might be a good time to ask: should Fuse put mind over matter when it comes to mental health?

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