Welcome back to my Weekly Wellbeing Round-Up. This week I will be focussing on mental health, partly because items about this have been hitting me between the eyes all week and partly because of an amazing experience that I was privileged to be part of this week…but more of that later. Let’s get into it!
Children and Young People’s Mental Health
This week saw the publication by NHS Digital of its report into the Mental Health of Children and Young People in England, 2017.
On the positive side, in the opinion of the Children’s Commissioner, mental health services are showing some slight, slow signs of improvement. Also , despite the daily reporting by all and sundry that we are in fact Going To Hell In A Handcart, there was only a very slight worsening in the prevalence of significant mental illness amongst children and young people, most of it due to emotional disorders and anxiety. I’m not sure this could strictly be reported as a positive but a lot of expert commentators have been surprised that it wasn’t significantly more.
On the negative side, it is concerning that more than one in ten young people (12.8%) suffer from a formally diagnosed psychiatric disorder and one in four young women will be struggling with a mental disorder of some kind. Children with mental health disorders are also more likely to be heavy users of social media. In addition, the burden of mental health problems is carried by those who are disadvantaged and vulnerable, particularly in northern England.
Specialist services for children and young people are known as CAMHS (Child and Adolescent Mental Health Services). These services are seeing a continuing rise in demand. The children’s commissioner found that one third of referrals into CAMHS were not accepted. Those of us who have tried to access these services either as a health professional or a parent or young person will be entirely unsurprised to hear this. The average wait nationally is currently two months. For many people it is a lot longer than that. There is some good news. There is to be a new target of 28 days for CAMHS access, which is being piloted at present.
Austerity and Mental Health in the UK
This week also saw a damning report by Professor Philip Alston, the United Nations Special Rapporteur on extreme poverty and human rights. The twelve page document makes uncomfortable reading. Professor Aston, in commenting on 20% of the country living in poverty, says “in the fifth richest country in the world, this is not just a disgrace, but a social calamity and an economic disaster, all rolled into one”. He goes on to highlight the potential further risks of Brexit. The government response has been to take issue with the definition of poverty, which is defined by a new measure in this report. Speaking of Brexit, the Journal of Epidemiology & Community Health reports an association between the Brexit vote and rising prescriptions of antidepressants. Whilst interesting, we should remember that association is not causation and whilst this is topical, it’s also probably both simplistic and even a little opportunistic.
Positive steps to improve mental health
You might be forgiven for feeling a little on the gloomy side after reading this post so far. You might be asking yourself what you can do either for yourself, your friends or (if you are a medical professional), your patients?
Here are some of my suggestions:
Don’t be afraid to ask the question
A lot of people who are struggling with mental health issues feel ashamed and unworthy. They need help but find it difficult to ask for it. Most of us can sense when someone we know is struggling. Don’t be afraid to ask them how they are. You might get an initial, superficial response but it’s worth taking a little bit of extra time to dig a little deeper. Ask yourself what you would like others to do for you, and what a meaningful relationship really looks like.
We might also worry about asking someone whether they have had thoughts of suicide, in the belief that it might encourage suicidal thoughts that weren’t already there. There is absolutely no evidence for this. I have been asking patients this question for almost twenty years. No one has ever been offended or upset by my asking it and many have been relieved to be able to answer it honestly and open up about how they are really feeling.
Don’t give negative messages about medication
I spend a lot of time writing and talking about things that are at least as good if not better than drugs for mental health such as physical activity, a good diet, practising mindfulness and having good real life social connections. However, that doesn’t mean that drugs are unhelpful. Some people really benefit from them, particularly those who are more severely affected by serious mental health problems. I know friends and colleagues who have found them very beneficial. It’s important that we avoid “pill shaming”, as highlighted in this short vlog for BBC news.
Consider social prescribing
We hear the term “social prescribing” bandied about a lot these days. The government certainly seems very keen on it, as described in this article in the BMJ (subscription required for full article). According to NHS England, social prescribing (also known as community referral) “involves helping patients to improve their health, wellbeing and social welfare by connecting them to community services which might be run by the council or a local charity.” The determinants of health and wellbeing include socioeconomic status, education, physical environment and social environment – so it’s really important that GP’s and other health professionals have as wide a range of tools available to them to help patients to help themselves. In Hertfordshire, we have an organisation called Herts Help which contains within a network of locality-based Community Navigators. Patients can self refer or be referred. In some of our practices now, we also now have social prescribing groups set up by patient participation groups. Examples of social prescribing activities include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice, debt advice and a range of sports.
Ultimately we are social animals and real, physical connections are vital to us, particularly at times when we are struggling with our wellbeing for whatever reason. This is one of the five ways to mental wellbeing: connect, be active, take notice, keep learning, give.
A good news story
I thought I would finish off this week with a fantastic example of how a local community service helps people with addictions connect, support each other and recover. The Living Room is a non-residential service that provides therapy to help people to abstain from their addictions, achieve abstinence and secure long-term recovery. It does tremendous work and is highly respected in our locality. This week, an event was held in our church called “Stories From The Living Room”. It was an evening of spoken word performances delivered by the clients, past and present, of the living room as well as the counsellors who provide the service. Many of these people have never even written a story or a poem, never mind performed them in public. It was a truly amazing evening: a massive eye-opener for those of us who have never experienced serious addiction and its consequences. For the audience it was a particularly humbling and emotional experience.
Highly relevant to this issue is this week’s episode of Dr Rangan Chatterjee’s Feel Better Live More podcast. Episode #37 is a conversation between Rangan and Gabor Maté, a world authority on addiction, on how our childhood shapes every aspect of our health. I heartily recommend this episode to everyone, whether you have issues with addiction, are trying to support someone who does, or would just like to know more about this issue. It goes deep and I guarantee it will be well worth your time.
That’s all from me for this week. I hope you have found this week’s post interesting and helpful. Your comments and feedback are much appreciated as ever as they help me to make it as useful and relevant as possible for my readers. The weekly wellbeing round-up will be return. Until then, take care of yourself!
Dr Richard Pile
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