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Mental health and the NHS estate: putting it right

With toilets falling apart, poor soundproofing, and uncomfortably hard flooring, mental health facilities can often feel more like prisons than actual hospitals.

In December 2018, the Independent Review of the Mental Health Act made a clear and unequivocal statement about the need for far-reaching improvements to the inpatient environments the NHS offers to people who are in hospital for mental health assessment and treatment.

It concluded that “people are often placed in some of the worst estate that the NHS has, just when they need the best,” and it called for major capital investment in renewing the mental health NHS estate to put this right.

The review noted that “the physical environment of wards… can create the kind of institutional atmosphere that psychiatry has been trying to move away from for the last half century because of its negative impact on patient experience. For example, rimless toilets, heavy wipe-clean armchairs, hard flooring, and bare walls that are easier to clean, but absorb little sound, make buildings oppressively noisy.

The review noted: “Poorly designed and maintained buildings obstruct recovery by making it difficult to engage in basic therapeutic activities (getting outdoors or social interaction with others) and contributing to a sense of containment and control.

Wards are experienced as cold and impersonal places that some say are more similar to a prison than a hospital – making a return to the community, with all its everyday stimuli and risks, more challenging.”

The review acknowledged that creating a safe, therapeutic, and effective environment is about much more than the physical fabric of an inpatient ward, or indeed any other place in which mental health care is provided. It exaplained: “Wards become people’s home, often for many months, and so should offer a positive community for the patient where they can build new relationships.”

“They should also support patients to keep connected to their communities and relationships outside of the hospital where that is appropriate. Ward culture should promote therapeutic benefit and minimise institutionalisation. Recruitment and retention of permanent staff at the right grades needs to be improved, and with ratios identified to ensure safety, a positive ward culture, and the development of meaningful therapeutic relationships.”

Full story: National Health Executive

Author: Philip Challinor
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Young people more likely to have depression at 18 if exposed to dirtier air at age 12

Children who lived in areas with higher air pollution when younger are significantly more likely to have developed major depression by the age of 18, according to research.

In the first analysis of how common air pollutants affect teenage mental health, researchers found young people were three to four times more likely to have depression at 18 if they had been exposed to dirtier air at age 12. Comparison with earlier work indicates that air pollution is a greater risk factor than physical abuse in raising the risk of teenage depression.

The scientists said their findings are particularly significant because 75% of mental health problems begin in childhood or adolescence, when the brain is developing rapidly. The work also suggests a link between toxic air and antisocial behaviour, but more work is needed to confirm this. A larger study is expected later this year.

The study, published in the journal Psychiatry Research, combined information from a group of children in London with high-resolution data on air pollution levels.

Of the 284 children studied, those who lived in the top 25% most polluted areas at age 12 were found to be three to four times more likely to have depression at 18, compared with those living in the 25% least polluted areas. In comparison, previous work has shown that children who suffer physical abuse are one and a half times more likely to develop depressive disorders.

The researchers took into account other factors that could affect mental health, such as a family history of mental illness, level of income, bullying and smoking habits. They also looked at levels of anxiety and ADHD, but found no link to air pollution.

The increase in risk of antisocial behaviour was three to five times higher. But unlike the link to depression, the result was not statistically significant, potentially because the number of adolescents in the study that behaved badly was small.

Levels of nitrogen dioxide pollution are at illegal levels in most urban parts of the UK and small particle pollution exceeds World Health Organization guidelines in many places. The government accepts dirty air shortens livesand harms children, but its latest action plan on roadside pollution was described as “pitiful” by environmental lawyers.

Prof Chris Griffiths, a founding member of the Doctors Against Diesel campaign, said: “Further studies are needed, but the urgency to reduce dramatically the exposure of young people to toxic air pollution remains.”

Full story: Guardian

Author: Philip Challinor
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Early risers “less likely to develop mental health problems”

People who are naturally early risers are less likely to develop mental health problems than “night owls”, according to scientists.

A large-scale genetics study found being biologically programmed to wake up early is linked to greater happiness and a lower risk of schizophrenia and depression.

The scientists behind the work said evening types may be at greater risk from the mental toll of having to fight their natural body clock due to most schools and workplaces having early start times.

The genes identified appeared to influence the time people went to sleep and got up, but not the quality or duration of sleep.

The evidence for a link between body clock and schizophrenia was the most compelling, with evening types being roughly 10% more likely to develop the condition. The data suggested morning people were also at lower risk of depression and reported being happier on wellbeing questionnaires.

Samuel Jones, the paper’s lead author, said: “Our work indicates that part of the reason why some people are up with the lark while others are night owls is because of differences in both the way our brains react to external light signals and the normal functioning of our internal clocks.

“These small differences may have potentially significant effects on the ability of our body clocks to keep time effectively, potentially altering risk of both disease and mental health disorders.”

Jones said the working hypothesis is that evening types are more likely to have to work against their natural body clock in school and the world of work, which may have negative consequences. Another possibility is the genes involved in determining the body clock have a more direct genetic influence on vulnerability to certain conditions.

Full story: Guardian

Author: Philip Challinor
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Majority feel teaching “resilience” in the classroom is a flawed concept

The public is sceptical of government plans that would see teachers tasked with instilling resilience through new mental health lessons being added to the national curriculum in 2020, an extensive survey conducted by Mental Health Today has established.

Mindfulness sessions are already in place at many schools. But an emphasis on teachers “cultivating” resilience is set to become mandatory within reshaped Relationships and Sex Education syllabuses, for both primary and secondary school pupils, in September next year.

As part of the proposed mental health national curriculum plans, students will be taught how to build – and practice – mental resilience.

The government’s current designs for mental health lessons state: “Relationships education is most successful where teaching about positive relationships is underpinned by a wider, deliberate cultivation and practice of resilience and positive virtues in the individual. These [virtues] should include believing you can achieve goals and sticking at tasks that will help you do so, even when the reward is distant or uncertain or you come up against challenges, honesty, integrity, self-control, courage, humility, kindness, forgiveness, generosity, trustworthiness and a sense of justice.”

“There are many ways in which secondary schools should support the development of these virtues, for example by providing planned opportunities for young people to undertake social action, active citizenship and voluntary service to others locally or more widely.”

However, analysis of 1,200 responses to MHT’s Teach Me Well survey has found that a majority disagree with the government that resilience can be instilled by teachers. Strength of character, emotional control, and a positive outlook, seen as key factors in overcoming challenges in life, are thought by 42 percent to be inherent traits. 30 percent feel counsellors and cognitive behavioural therapists and counsellors can help develop resilience, not teachers. Just forty two percent felt teachers could be expected to do it alone.

Full story: Mental Health Today

Author: Philip Challinor
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Pathways from Poverty: Mind welcomes report calling for DWP overhaul

A former member of Mind staff has authored a report sharing what he learned during his time at the Department for Work and Pensions (DWP). After working tirelessly on benefits and mental health issues for many years at Mind, Tom Pollard spent 18 months working as Senior Mental Health Policy Advisor for the DWP.

The secondment lasted from November 2016 until April 2018 and culminated with a report – Pathways from Poverty – published by DEMOS. The aim of Tom’s secondment was to advise policy and practice in order to better support people with mental health problems and other disabled people accessing the Government’s controversial welfare system.

This report highlights that progress is being hindered by barriers and resistance to change that are embedded within the DWP’s culture. Rather than challenging specific ideas or policies and looking at issues in isolation, the report calls for radical and institutional reform to a government department that is currently ‘institutionally and culturally incapable’ of supporting disabled people.

Responding to the report, Paul Farmer, Mind’s Chief Executive, said: “We welcome this report, which echoes Mind’s longstanding concerns about the benefits system. We have consistently campaigned for a system which supports, not demonises, those of us with mental health problems. If you are out of work because of your mental health, you need empathy, understanding and financial support, not mandatory activities or the threat of sanctions. This report shines a bright light on fundamental cultural problems within the DWP that are preventing the change we need to see.

“Given the high proportion of people with mental health problems who need support from the benefits system, it’s only right that mental health should be at the heart of every project, reform and policy. In order to properly understand and support people who need support from benefits, there needs to be greater mental health expertise within the DWP, and a willingness to involve people in decisions that affect them. Successive benefits reforms have encountered major problems and have often left people with mental health problems getting the worst deal. This report suggests the need for a fresh approach to welfare policy and delivery.”

Source: National Mind

Author: Philip Challinor
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Mentally ill people more at risk of losing benefits, study shows

People with mental health conditions such as psychosis, anxiety and low mood are at far greater risk of having their benefits stopped than those with physical ailments, research shows.

Benefits claimants who have a psychiatric condition are 2.4 times more likely than those with diabetes, back pain or epilepsy to lose their entitlement to disability living allowance.

The findings are based on government data about 327,000 people with either type of health condition who switched from receiving DLA to personal independence payments (PIP) between April 2013 and October 2016.

The findings raise fresh questions over whether people who are struggling with mental ill health are at a disadvantage when they have to negotiate the benefits system.

Ayaz Manji, the senior policy and campaigns officer at the mental health charity Mind, said: “This data is hugely concerning, but sadly not surprising as it echoes what we hear every day from the people we support, many of whom are being told they are no longer eligible for certain benefits.”

The study, which was carried out by five researchers from York University, led by Katie Pybus, found: “Overall, claimants with a psychiatric condition were 2.4 times more likely than a claimant with a non-psychiatric condition to have their existing DLA entitlement removed following a PIP eligibility assessment.”

People with serious psychiatric conditions can lose as much as £141.10 a week as a result, the study says.

People with attention deficit hyperactivity disorder (ADHD) – a neurodevelopmental condition- were 3.4 times more likely than those with a physical ailment to have their benefits taken away. Those with alcohol or drug problems were twice as likely.

In addition, 32% of the 148,700 people with a psychiatric condition in the study had their DLA taken away. This was double the 16.4% of the 178,300 with diabetes or a neurological or musculoskeletal condition who experienced that outcome.

Overall, 40% of those with ADHD had their claim disallowed, as did 33% of those with anxiety and low mood, and 32% of people with behavioural disorders.

“The findings suggest that in general, the number of claims disallowed following a PIP eligibility assessment is elevated for psychiatric conditions compared to non-psychiatric conditions, with variations by type of mental illness,” said the study, which will be published next month in the journal BJPsych Open.

Full story: Guardian

Author: Philip Challinor
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Government “has chance to avert catastrophe”

In a speech, the Secretary of State for Work and pensions announced important changes to current proposals for Universal Credit (UC).

Amber Rudd announced that the Department for Work and Pensions (DWP) will immediately lay two pieces of legislation relating to Universal Credit:

  • The first will provide protections for people currently receiving the Severe Disability Premium – additional benefits paid to disabled people who live independently, recognising the extra costs faced by people not supported by a carer. It will come into force on January 16, 2019, according to the original timetable and means there will not be a vote on this.
  • The second contains the provisions for the pilot of ‘managed migration’, which mean that once the pilot of 10,000 people has ended, the Government will have to once again seek approval from Parliament before they can move anyone else over to Universal Credit.

Paul Farmer, Chief Executive of Mind, responded:

“Today’s announcement gives the Government a chance to avert catastrophe when it comes to moving millions of people over to Universal Credit (UC) but still does not yet address fundamental problems. The Secretary of State clearly acknowledged that responsibility for getting this right rests with the Government, and not with individuals who have already been found eligible for benefits after going through a rigorous and bewildering assessment. We now need to see the Government’s actions match that promise. Starting with a pilot of 10,000 people doesn’t change the fact that these plans require people to make an entirely new claim and risk seeing their benefits stopped if they are too unwell to do so in time.

“The only safe and appropriate way to move people across to UC is to ensure nobody risks losing their income if they are unable to make a new claim within three months. Unless the DWP guarantee this, we fear too many people with mental health problems will see their benefits stop entirely, because they were too unwell to attend an appointment, read a letter or didn’t receive the right support to do what was asked of them and complete a new application.”

Full story: National Mind

Author: Philip Challinor
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Little progress made reviewing PIP claims during 2018

The Department for Work and Pensions (DWP) has revealed that they have only reviewed 140,000 Personal Independence Payment (PIP) cases (less than 10 per cent) in the last year.

In December 2017 Mind intervened in a High Court case and the Court ruled that changes to the assessments discriminated against people with mental health problems.

The ruling meant that the Government must now go back and review all 1.6 million cases of people who need support from PIP to check who might be eligible for more money. Around 220,000 of the 1.6million people receiving PIP need this support primarily due to their mental health. Many of these people could be missing out on additional funds which help them live full, independent lives.

The statistics also revealed that, of those who had had their cases reviewed and were found to be entitled to more support, people received an average of £4,500 – a huge amount of money, particularly for those who need support from the benefits system because their health makes it difficult to work.

Full story: National Mind

Author: Philip Challinor
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Categories: Latest News

Government must assess impact of Universal Credit on disabled people, says Committee

An influential group of cross-party MPs has published a report urging the Government to properly look at the impact of Universal Credit on disabled people.

The Work and Pensions Select Committee, chaired by Frank Field MP, is particularly concerned about people currently on the older benefit Employment and Support Allowance (ESA) losing out on disability premiums – extra money which will no longer be available after they’ve moved over to Universal Credit (UC).

Disability premiums are additional benefits paid to disabled people who live independently. They are intended to recognise the extra costs people face if they are not being supported by a carer. The disability premiums exist within ‘legacy benefits’ including Employment and Support Allowance (ESA) and Jobseekers’ Allowance (JSA) but have been removed in Universal Credit.

In addition, the report expresses concern about the lack of clarity or adequate protections for people facing the process of ‘managed migration’, which will see thousands of people with mental health problems make a new claim for UC within three months, and lose their income if they fail to do so.

Vicki Nash, Head of Policy and Campaigns at Mind said: “We welcome this report which adds to the growing body of evidence highlighting the impact of Universal Credit on disabled people. We’ve been calling on the Government to scrap their plans for ‘managed migration’ – it’s unjustifiable to place all the responsibility of moving over to a new benefit on those who are really unwell. We know the application itself can be a complex and stressful process, and there is a real risk that many will be left without income and facing destitution.

“It’s not too late for Government to see sense and withdraw and amend these regulations. Otherwise we want MPs of all parties to vote against them. Only by fixing the regulations now can we make sure that no-one faces having their benefits cut off before they have moved to Universal Credit.

“There needs to be a welfare system which works for everyone and allows disabled people to live full and independent lives, not one that leaves people destitute. We want the Government to reconsider proposals that could see people fall through the cracks, losing vital income, through no fault of their own.”

Full story: National Mind

Author: Philip Challinor
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Categories: Latest News

Supreme Court rules on deprivation of liberty under Community Treatment Orders

On 17 December 2018 a judgment handed down from the Supreme Court ruled that an individual placed on a Community Treatment Order (CTO) after coming out of hospital cannot be deprived of their liberty. Mental health charity Mind intervened in the case to highlight the widespread problem of CTOs.

CTOs are meant to help prevent people being re-admitted to hospital, for example by requiring them to attend appointments to help manage a mental health problem. However in PJ’s case – and many others – CTO conditions go much further, for example requiring them to live in a particular place or preventing them going outside without an escort.

This particular judgement handed down from the Supreme Court is important because it highlights that the conditions imposed on people can be very restrictive- often far more so than while in hospital. PJ was required to live in a care home and abide by their rules. This included his whereabouts being checked every 15 minutes and not being able to leave the premises without permission and a staff escort. PJ appealed against an earlier Court of Appeal decision that ruled a ‘responsible clinician’ had the power to impose conditions on a CTO which would deprive an individual of their liberty. The Supreme Court has now ruled in favour of PJ, effectively overturning the previous ruling. This means that going forward, mental health and legal professionals need to carefully look at the conditions imposed on their clients under CTOs to ensure that they don’t amount to depriving them of liberty.

Michael Henson-Webb, Head of Legal at Mind said: “We are really pleased that the Supreme Court ruled in favour of PJ, recognising that he was being deprived of his liberty. Unfortunately, this isn’t a one-off case – we hear from many people who have extremely restrictive conditions imposed on them after coming out of hospital. We’ve long been campaigning for a scrapping of Community Treatment Orders, or at the very least – independent oversight into their use. This would allow to better monitor and police the rules placed on people and ensure that they are given a level of freedom conducive to getting and staying well.

“The recently published Mental Health Act review made references to the worryingly high use of CTOs and that people seem to be under them for a much longer timeframe than intended. At the same time, we know these orders are not effective in reducing hospital readmission. The review did acknowledge the need to tighten the rules for imposing them but didn’t go far enough in terms of calling for them to be scrapped altogether. We hope this latest legal challenge will once again bring into question the use of these orders.”

Source: National Mind

Author: Philip Challinor
Posted:
Categories: Latest News

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