Inquiry into Parity of Esteem

Transcription

1 Inquiry into Parity of Esteem What we re doing: The APPG on Mental Health is conducting an inquiry into parity of esteem, to assess how effectively the Government is meeting its objective to give mental health equal priority to physical health. The inquiry is led by James Morris MP, Chair of the APPG on Mental Health. The Government through its mandate to the NHS - has committed to achieving parity of esteem for mental health. NHS England and wider partners now have responsibility for delivering this work nationally. The APPG inquiry will assess the Government s efforts to deliver parity of esteem and agree recommendations that would help deliver tangible improvements in mental health outcomes. How we re gathering information: The inquiry will comprise three oral evidence sessions, focusing on the following areas: Session 1: Reducing premature mortality for people with mental health problems (29 January 2014) Session 2: The quality of mental health emergency care (March 2014) Session 3: Mental wellbeing as a public health priority (May 2014) In addition to oral evidence sessions, we are asking interested stakeholders to contribute to the inquiry through the submission of written evidence. The written evidence will be used to build on the findings of each oral session, and it will be taken into consideration for the final report. The group will publish the final report on the inquiry in July Session 1, Written Evidence: To inform the first session on Reducing premature mortality for people with mental health problems, we asked people with direct experience of mental illness, their carers, families, and health professionals, to submit written evidence. In total, 195 people submitted written evidence in response. The survey was publicised widely by the APPG on Mental Health, and by the group s secretariat organisations Rethink Mental Illness, Mind and the Royal College of Psychiatrists. This evidence was gathered through an online survey, direct submissions to secretariat organisations and to James Morris MP. All responses were anonymous, and individuals could contribute their experiences in as much detail as they wished through free text entries. The survey focused on the following four areas: People s experiences of physical health care What were the good things about physical health care received What physical healthcare would people like to have received What could the Government do to implement better physical healthcare nationally. This report contains a summary of written responses received.

2 Policy background: Reducing premature mortality for people with mental health problems The first meeting will assess how the Government and health bodies are making sure that people with mental health problems have access to good quality physical health care, to reduce current high rates of avoidable deaths. Currently, people with severe mental illness die, on average, 20 years earlier than the rest of the population because their physical health needs are not addressed. Many people develop serious physical health problems such as diabetes, heart disease and respiratory disease. Many of the premature deaths of people with serious mental illness are due to poor medical care that fails to monitor risk factors, such as smoking and obesity. This can be due to side effects of medication, lifestyle factors, poor monitoring of physical health, and because physical health problems aren t taken seriously when someone has a mental health problem. The Secretary of State for Health is soon to be publishing a premature mortality strategy, Living Well for Longer which will set out actions for reducing early deaths among the population. Given that one in three of the 100,000 avoidable deaths every year have a mental illness, this must be recognised and acted upon in the strategy.

3 Results Question 1: Person with mental health problems (135) Carer (21) Other (39) 69% (135) of respondents were people with mental health problems, 11% (21) were carers, and 20% (39) were other. Respondents in the other category included health professionals (including Mental Health Nurses, Mental Health Recovery Workers, and Occupational Therapists) family members, friends, health students and people who had previously had mental health problems.

4 Question 2: Please tell us about your experiences of physical health care for people with mental health problems Experiences of physical health care Respondents gave anecdotal evidence of poor physical health care that they or a close family member had experienced. Responses can be divided into six themes: 1. People feel that are not treated as a whole-person where physical and mental health are not treated holistically: If someone with mental health problems requires physical health input, they would not necessarily be treated with understanding for the mental health needs as well as their physical health needs. The hospital staff and CAMHS staff are trying to work together, but the complexity of her health needs and the complexity of her mental health needs makes this very difficult for them to understand each other s sphere of expertise. 2. There is a lack of physical healthcare monitoring in primary and secondary care: I wasn t given advice on physical health care from either my Doctors, Nurses or Psychiatrists. In psychiatric wards they do not offer anything no basic needs for health such as place to walk, healthy fresh food, exercise. 3. Many people face diagnostic overshadowing where physical health problems are attributed to a mental health problem:

5 It s very hard to get doctors and consultants to take physical health symptoms seriously they dismiss all symptoms as in your head. It took 5 years to get a brain tumour diagnosed. They always assume if you have some type of mental health problem that every physical illness/symptom you have is due to it and do not do any type of investigation. 4. Side effects of medication are not monitored or managed: I asked to see a nutritionist as I have gained a significant amount of weight as I am on a high dose of antipsychotics but my request was never actioned. Service users are expected to accept a physical ailment from side effects of medication as a necessary evil of resolving their mental health issue such as chronic constipation or type 2 diabetes. 5. There is poor choice and access to physical health services: We are told that we should try to exercise by healthcare workers but there is very little or very poor quality services in this area. In almost 10 years I have been offered 1 course through mental health services called healthy living which was poor to say the least. 6. Lifestyle factors due to mental illness are not being addressed, including smoking, poor nutrition and lack of exercise: Medication and lethargy has increased my son s weight. Due to boredom and poor ward facilities, he started smoking during his first hospital admission and smokes quite heavily now. There was not physical health care during that time Chaotic lifestyles such as poor and erratic sleeping and eating patterns are not addressed by our medical carers. People with mental health problems and health professionals also gave examples of good practice where physical healthcare is prioritised in primary and secondary care: We have just introduced annual health-checks for service users taking anti-psychotic medication. One of the pitfalls is that as mental health nurses we routinely assess and ask about physical activity and smoking. We records these details however the services we refer to for physical health needs are stretched and have long waiting lists. Physical and occupational therapy whilst in mental health hospital was exceptional. They organised two PE sessions outdoors per week, had health living classes and took patients for short supervised walks.

6 Question 3: What were the good things about physical healthcare you received? e.g. what health professionals did or what services you found useful? 35 What were the good things about the physical healthcare you received Physical health checks (6) Medication information (3) Primary care support (30) Secondary care support (9) Information & advice (9) Physical health activities (7) The figures above show that far fewer respondents gave examples of good physical healthcare, compared to those who submitted evidence of poor physical healthcare in the previous questions. 1. Some respondents stated that they have had access to good physical health care in primary care services, including through GPs, Community Psychiatric Nurses (CPN), Community Mental Health Teams (CMHT) and Psychiatrists: My son has an annual physical health check with a GP. This is obligatory. I have ongoing health conditions such as back pain, migraine etc. I did not feel that I was treated different from anyone else (i.e. I was taken seriously) and I continued to receive good advice from my GP about managing those conditions. What I found helpful was my psychiatrist pointing out that my mental health could be linked to physical problem I have. If it was not for their constant persistence, I would not have been aware that my physical health was in danger. Respondents also gave evidence of good physical health care in the following areas: 2. Experiences of good physical healthcare in specialist secondary mental health care services, including inpatient settings: At the unit I work at, there is an increasing push for staff members to encourage residents to engage in exercise for the physical and mental wellbeing.

7 There is now a physical health nurse who work full time on the mental health ward. It s an integrated approach, rather than saying we can t deal with that here. 3. Access to regular physical health checks: The Mental Health Trust has started to do checks, but only weight and blood pressure. My current GP ensures I have an annual physical health check up at minimum 3. Information on medication being proactively given: Pharmacist adviser at the Maudsley is very helpful for specific questions. 4. Information and advice on physical health available to patients in high-risk groups: I found advice booklets and relaxation CDs useful to calm the physical signs of things like anxiety. We had a full day session with expert professionals explaining diabetes. My son was unable to understand but it helped me as a carer. 5. Physical health activities offered to patients in high-risk groups: I attend a weekly conservation group which is a good help for physical and mental health.

8 Question 4: What physical healthcare or support would you have liked to have received? e.g. a specialist service or health professionals doing something different? Practical physical health support (21) Being treated holistically (10) Better staff training (26) Physical healthcare in secondary services (6) Medication side effects reviews (13) Monitoring and checks (15) Integrated physical & mental, primary & secondary care (9) 1. The majority of respondents would like to see improved staff training on physical and mental health for healthcare professionals: For all doctors to have an understanding of mental health effects on physical health. To have a better understanding by health professionals of all physical health matters that surround mental health issues. 2. Many respondents would also like improved practical support for their physical health. This includes provision of physical health activities in inpatient and community services, access to specialist physical health advice such as a nutritionist, and support with healthy living: An exercise programme to encourage mentally ill people to get out and about would help. Stress relief, relaxation, yoga, swimming anything to improve my wellbeing.

9 I would have liked to have been able to see a nutritionist given my weight gain and high cholesterol. Respondents would also like to see: 3. A holistic approach to healthcare, taking into account how physical and mental health impact on each other: I need the people around me to help me see I am making things worse mentally by making things worse physically no-one ever seems to do this because they either look at my mental health or physical health symptoms in isolation. 4. Improved physical healthcare in secondary inpatient services: Patients in clinics should have more opportunity to participate in physical activities. There are far too many people who sit around and vegetate if not prompted, included or offered these opportunities. 5. Improved guidance on managing medication side-effects: I would have like a health professional to have discussed the physical side effects of my medication and discussed things that might help. My GP should have been aware that potentially my medication would cause my appetite to increase and my weight too. By the time this was discovered I was already diabetic and on my way to having a stroke. 6.Improved physical health monitoring and checks A full health check with GP for mentally ill people to check they are not neglecting themselves. A yearly check of regular blood tests, and a check on the amount of medication with a view to the possibility of reducing the high amounts he is on. 7.More integrated physical and mental, primary and secondary health care services, so staff are clear on who is responsible for physical healthcare: You get batted between services with no-one taking responsibility I spent years being told by neurologists that my symptoms were psychological and by psychiatrists that my symptoms were neurological with no-one taking responsibility. Better co-ordination between the dietician, doctor and counsellor would have been tremendously helpful.

10 Question 5: What could the Government do to implement better physical healthcare nationally? What could the Government do? Increase funding for services (24) Work to tackle stigma (7) Make physical health checks mandatory (15) Integrate physical & mental health services (14) Improve staff training on mental health (43) Respondents cited a range of areas that the Government could deliver to improve physical healthcare for people with mental health problems. The most common responses were: 1.The Government should introduce improved and/or compulsory mental health training for all health professionals: Train front-line healthcare professionals more in mental health needs so that they feel equally able to deal with a mental health issue as a physical health problem so people can be treated for both, not separately. 2.The Government must provide increased funding to meet demand for services: Fund mental health as for physical health. More money and more options for GPs to refer to. More money. The resources are there but they re stretched beyond capacity. 3. The Government must carry out national work to tackle stigma: The Government should heavily push campaigns against stigma. The media need to be adequately controlled and education in their sensational reporting of mental health problems.

11 4. The Government must make physical health checks and monitoring mandatory for high-risk group: Targets for GPs on physical health of mental health patients. Implement a clear criteria of physical healthcare for those on high dose antipsychotics that GPs have to follow and penalise them financially if they fail to comply. 5. The Government must ensure that physical and mental health services are integrated: Improve physical healthcare services within mental health services and vice versa. There need to be a more collaborative approach between mental healthcare teams and physical healthcare teams. Have closer links between physical and mental health care professionals to develop a better understanding that a person has a mind and body and they are intrinsically linked and have direct cause and effect on each other, so the professionals of both fields should be working together. For further information about this report, please contact: contact@appg-mh.org.uk