Five priorities for improving children"s mental health | Paul Burstow

The mental health of the nation is built on foundations laid in the early years of our lives. Yet our mental health system is designed and funded to pay the price of our failure to act on the evidence and invest in the right family support in those childhood years.

We go through many life changes and transitions in our childhood and teenage years. It’s why the age of 18 is the wrong time for child and adolescent mental health services (Camhs) to “hand over” to adult services. A joint report by the health and education select committees has turned the spotlight on the role schools can play.

According to a study [pdf] by Martin Knapp at the London School of Economics, the costs of poor mental health land disproportionately in our schools. Over half of the mean cost of addressing emotional and behavioural problems is incurred in frontline education.

Little more than 6p in every pound the NHS spends on mental health is spent on children and young people. Yet as the health and education select committees acknowledge in their report [pdf] on the role of schools in mental health, “50% of adult mental illness starts before age 15 and 75% has started before age 18”.

The select committees have put down important markers for any incoming government. The critical importance of whole-school working to promote the wellbeing of young people and the value of a joined-up approach to delivering mental health support are key recommendations.

When members of the select committees visited Regent High School in Camden to learn about the schools-based work of the Tavistock and Portman NHS foundation trust (of which I am chair), they heard for themselves the value of a joined-up approach. Equipping teachers with knowledge of mental health and making this part of their professional development is a step in the right direction. But a good grounding in child development should be at the heart of teacher training.

The presence in every school in Camden of an experienced clinician who is part of the wider Camhs team makes for a seamless response when there is a need to escalate. This whole-school approach means the clinician is there to see pupils and support staff. This pays dividends in staff resilience and help-seeking among young people who might otherwise go unseen by mental health services.

With the snap general election, the select committees did not have time to look for lessons from overseas. However, earlier this year I took part in an international study visit on mental health leadership to learn about the approach being taken by the education system in Australia. What was striking was the close collaboration [pdf] in New South Wales between the education and health departments.

Hallmarks of the approach are: acting on the best available international and domestic evidence; testing proof of concept; evaluating to ensure robust implementation; and sustained investment at scale. The principle underpinning the schools-based work I learned about could best be summed up as proportionate universalism: using the results of the Australian early development census of children in their first year of full-time schooling to identify the schools where support should be targeted, then offering support to the whole school.

So what should this mean for a green paper and future policy?

First, it’s time to make Camhs services up to age 25 the norm.

Second, mental health and wellbeing should be integral to the life and work of schools, not a bolt on.

Third, a proactive approach to identifying and meeting need could do much to prevent mental distress entrenching into lifelong mental illness, offering timely support to parents to strengthen parenting and reduce parental conflict.

Fourth, embedding mental health expertise in every school as part of a richer Camhs offer ensures there is no wrong door for young people when it comes to getting the right help at the right time.

Fifth, we need to build on the progress already made with the Children and Young People’s Improving Access to Psychological Therapies programme; deliver Camhs services that focus on outcomes; make a reality of shared decision-making; and deliver evidence-based interventions and support.

The mental wealth of the nation is critical to our future, the mental health and wellbeing of children, young people and parents should be a priority. As the select committees rightly say: “Schools and colleges have a frontline role in promoting and protecting children and young people’s mental health and wellbeing.”

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Five priorities for improving children"s mental health | Paul Burstow

What can be done to tackle the youth mental health treatment gap? | Paul Burstow

By 2020 one in three teenagers will have access to cancer treatment in England. Think about that: only one in three. There would be an outcry. It would be scandalous, horrifying, unacceptable.

It is not true, however. Unless you delete the word “cancer” and insert “mental health”, and then it is.

In medical terms, there is a treatment gap. The number of children and young people living with a diagnosable mental illness far exceeds the number who get any help. One in 10 children suffer a diagnosable mental illness, yet just one in four of them receive treatment. By 2020 the gap may close, a little, if plans in NHS England’s Five Year Forward View for Mental Health [pdf] are realised, but only a little.

Over half of lifelong mental illness and distress shows its first signs in adolescence. We have an opportunity to do something to change people’s lives for the better and dramatically reduce the number of adults living with entrenched mental health problems. This is a great prize.

In her first major speech of 2017, Theresa May stressed the importance of prevention. Green papers on social justice, family and the role of schools in monitoring mental health and wellbeing are in the pipeline.

But can the treatment gap be closed by scaling up access to treatment and providing more digital options alone? Where will the workforce come from to provide the extra services and sessions required?

What if we could reduce the number of people getting ill in the first place? What are the underlying causes of rising levels of mental distress in children and can we put in place measures that increase resilience and reduce risk? If so, what are the most promising approaches?

Our ambition is to look beyond treatment and containment towards prevention and early intervention.

These are some of the questions Birmingham University is setting out to explore in its new policy commission. I will be chairing the commission, working with a range of experts, and together we are calling for evidence from non-governmental organisations, academics, public agencies, thinktanks, and people with lived experience of mental health issues across the UK and internationally.

I first outlined the ambitions of the university’s mental health commission in my inaugural lecture last autumn. Our ambition is to put together a new approach that looks beyond treatment and containment towards prevention and early intervention.

There is already some good evidence of what works in mental health promotion and illness prevention. As minister for mental health I commissioned the London School of Economics to review the evidence [pdf] and rates of return on investment. Among the findings was that school-based social and emotional learning programmes return £84 for every £1 invested. However, often the “saving” does not land in the budget of those who must make the investment. Siloed budgets and misaligned institutional objectives get in the way.

Last year I wrote about my visit to New York to learn about Mayor Blasio’s mental health programme: NYC Thrive. Thrive is a city-wide action plan devised from a population health perspective. It is trying to break down some of the silos. It involves schools and colleges, housing providers, the police and businesses. Prevention and early intervention are at its heart.

The West Midlands has set out its ambitions in its own Thrive strategy and the mayor of London is also working on plans.

Over the next 12 months the commission will be taking evidence, looking at the most promising ideas and setting out the actions that government and other agencies can take to make the shift to an ethos of prevention.

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What can be done to tackle the youth mental health treatment gap? | Paul Burstow

Thank you, Liz Jackson, for your candour and courage in facing a bastard of a disease | Paul Daley

“Parkinson’s disease” – my father never spoke these words before he died eight years ago from pneumonia associated with his decades-long endurance of this dreadful affliction.

My mother, who saw him through the worst of it until she could no longer do so, never said them. Neither did the doctors – not to his children at least.

Dad tried to keep the disease a secret from us even though the symptoms made the affliction obvious. After his death Mum said he’d never even admitted to her that Parkinson’s disease was killing him.

Maybe he was too proud to admit that something beyond his control, something so humiliating, had him in its python grip. He might’ve feared, irrationally of course, that we’d think less of him. Who knows? We never talked about that – and so much else besides.

I’ve long admired the journalism of Liz Jackson, the multi-award winning ABC broadcaster and film-maker. To me she has always been prominent in a milieu of journalists from the broadcaster who have shown us later generations the way.

And now my respect for her has grown further, having watched her heartbreaking documentary, A Sense of Self, about her diagnosis with – and life since – Parkinson’s.

Her candour and courage and humour in the face of the disease and for her decision to tell the story of her family’s experiences is beyond admiration. Ditto her dignity, in volunteering that she tried for a while to hide the disease from her children out of fear they might see her as weak, or colour their enduring impressions of her.

Then there’s her journalistic professionalism – to tell the story come what the hell may and probably will; the legacy grows exponentially. There is a lake of tears for Liz Jackson now, but not for the pity she despises. No, it’s to celebrate a world that can make a woman who Google-doctors her symptoms, understands the shitful truth of it all but continues to do brilliant work and goes from doctor to doctor to outrun it – and make this documentary.

Anyone familiar with Liz Jackson and who saw the program would be shocked at her decline. It illustrates starkly what a cruel, bastard of a disease Parkinson’s is, the way it robs one of bodily, intellectual and emotional control, and renders the previously strong so terribly, terribly prematurely frail.

The program is remarkable, however, for the humanity with which she emerges – a person defined by everything else that she is, except the disease, really.

Former ABC journalist Liz Jackson and documentary maker husband Martin Butler. Together they produced A Sense of Self, documenting her struggle with Parkinson’s Disease Photograph: Tom Hancock

It is one of the most moving and important pieces of television I’ve seen, for the way it effectively transcends its immediate subjects so that it might interrogate and provoke us into considering how we approach and judge and emotionally respond to the dreadfully ill in our midst.

Dad was completely exhausted, wrung-out – a physical husk of a man – when he finally succumbed. He fought and fought and never really lost he will to live because he loved life and his kids, and especially his grandkids, so much.

He was a modest though proud bloke. Which is perhaps why he never volunteered what he had. And we never pushed him. When I think back, he probably lived with it for 20 years. But somehow, he kept the drug regimen a secret from us.

Even in his final months at home, before we intervened to move him into supported living because caring for him was going to kill our elderly mother, he would pretend it wasn’t happening. He’d sit there in his chair, drinking tea or on family occasions (which he loved), wine, through a straw, his hands shaking so violently that we’d want to help him.

Mum would give us a look that meant, “No,” then rescue his dignity, mop up, without a word or missing a beat, whatever he’d spilt on the floor or himself.

Parkinson’s is a dreadful curse. But nobody knows why we get it. Those who’ve seen a family member succumb to it reassure themselves that it is not hereditary. But its very mystery is testimony to the importance of what Liz Jackson has done in highlighting the cruelty and tragedy that freights it.

I have several friends who’ve lost loved ones to Parkinson’s. There is no common experience. Not all sufferers will endure the same symptoms. Dad had terrible tremors, he lost the capacity to write legibly, to remember – and say – names, even of family members such as my wife – and eventually he had terrible dementia.

But he was never afflicted with the depression and the panic attacks that have crippled Liz Jackson.

Liz Jackson, A Sense of Self

Just as my dad was spared her panic attacks and depression, I hope she and other Parkinson’s sufferers are spared his dementia.

In a way that was the hardest thing for us.

The dying months of the Bulletin magazine, for which I wrote, coincided with Dad’s terminal decline. Dad, though he never said so, read everything I ever wrote.

In late 2007 I skived off the federal election campaign when John Howard’s caravan passed through Melbourne. He was sitting in front of a TV in the nursing home, the Bulletin open, on his lap, at my story.

He looked at me. His eyes were blank. He no longer seemed to know me.

Thank you again Liz Jackson.

Thank you, Liz Jackson, for your candour and courage in facing a bastard of a disease | Paul Daley

Paul Hodgkin evaluations this week"s healthcare news

Nice guidance aimed at tackling kind two diabetes is great news but will cost the well being service dearly in the short term. Photograph: Hugo Philpott/PA

Each week brings news that demands our focus – like the two bits of Nice advice launched this week: 1 about staffing amounts, the other proposed guidance for stomach stapling that will support tackle type two diabetics. Each good information in their way, despite the fact that every single will cost the well being services dearly in the short term.

But what really caught my eye this week was a surprisingly optimistic batch of stories about the effective deployment of new science in complex situations – like the tweet from the Gates Basis celebrating Rwanda’s accomplishment in fighting child mortality. We overlook in the press of company just what a great time this is to be alive. Wonderful in both senses of the word – fantastic and fantastical. This is specially so if you are a clinician. Bioscience is moving at this kind of a rate that reviews from the frontline can appear closer to fantasy than the workaday digests we get from Great.

My favourite spot to get a down-to-earth flavour of how science and technologies are transforming the globe of clinical practice is Richard Lehman’s weekly overview of the major medical journals in the BMJ. It truly is a delicious canter via the latest important papers plus a suitably jaundiced see of the undignified gavotte danced by Massive Pharma, with statistics. This week’s overview included news of three trials each and every displaying huge results for monoclonal antibodies that interfere with the underlying mechanisms for eczema and psoriasis. These problems plague hundreds of thousands and in time will offer actual help but, as so usually with Huge Pharma, currently expense the Earth. As Richard/Lehman says, “We must organize journeys to the Moon for men and women with eczema and psoriasis, due to the fact I hear these drugs are reasonably priced there.”

Tedmed sent me the newest listing of initiatives that they are supporting in their Hive programme, more fantasy football than the BMJ, but in its way, equally inspiring. Not only does this incorporate the UK’s really own Big White Wall it also takes in factors like mySugr that combines actionable large-tech bio-suggestions with social games. They aim to make engaging with your diabetes “beautiful, enjoyable and motivating”. Effectively, we will see but it beats stomach-stapling for certain.

Possibly the most extraordinary impact of science in the support of complex social troubles came from the Nurse Loved ones Partnership programme in the US. They have presently proven that their intensive intervention with very first-time teenage mums brings wellness and social advantages to disadvantaged youngsters. This review has proven that a 20-year adhere to up showed both mothers and youngsters had significant reductions in mortality compared with the unique management group. Wow! Not a lot of psycho-social programmes impact mortality, let alone twenty many years after the intervention.

Even some seemingly intractable social problems seemed to be receding this week as the Economist reported police warnings and convictions for youngsters fell by 75% in England and Wales between 2007 and 2012.

But it was not all good information of program. For me the most depressing occasion this week was the speed with which we collectively agreed to bind ourselves to the new safety state as the Drip (Information Retention Investigative Powers) Act was rushed via parliament. And for wellness pros this was not just anything happening “above there”: an FOI request from the doughty eHealthInsider showed the NHS Info Centre had launched non-clinical details (ie this kind of issues as tackle and postcode) to the police on 2,700 occasions in 13/14. Seems a whole lot to me.

And of course, beyond all this, the economic climate still has feet of clay and Ebola still stalks West Africa. Sobering to believe that a handful of much more banks catching flu in Portugal or a guy coughing blood on a flight from Sierra Leone, and all this progress could be blown away like thistledown.

Paul Hodgkin is founder and chair of Patient Viewpoint and a former GP

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Paul Hodgkin evaluations this week"s healthcare news

How to rebuild America"s mental well being program, in 5 huge actions | Paul S Appelbaum

No genuine technique of psychological well being care exists in the United States. This country’s diagnosis and treatment of psychological health difficulties are fragmented across a range of companies and payers – and they are all too often unaffordable. If you consider about it, the checklist of problems is practically countless:

• Families of loved ones with psychological sickness recount horror stories, as a number of have in the Guardian’s interactive series this week.


• Individuals transitioning from inpatient to outpatient treatment often fall amongst the cracks.


• Mental well being and standard healthcare therapy are rarely coordinated.


• Substance abuse remedy generally requires location in an entirely distinct method altogether, with tiny coordination.


• Auxiliary interventions that are so crucial to so several men and women with severe psychological illnesses – supported housing, employment coaching, social skills instruction – are supplied via a distinct set of companies altogether … if they are offered at all.

Our mental wellness method is a non-program – and a dysfunctional non-system at that.

The evidence is everywhere that items have been obtaining worse – far more and more Americans with mental illness are stranded in emergency rooms, for instance, and simply for want of hospital beds. And that is in no tiny component simply because no one has experimented with, in far more than 50 many years, to layout a comprehensive psychological wellness technique for all Americans.

It truly is time to consider again.

Mental wellness clinics in 1955 supplied a vision for attentive care that has not been replicated considering that. Photograph: 3 Lions / Getty Images

The final significant rethinking of the system’s flaws started, in 1955, with an act of Congress that resulted in the appointment of something called the Joint Commission on Psychological Illness and Well being. The commission’s report, Action for Psychological Health, provided a vision of local community-based mental well being remedy: a new clinic would be designed for each 50,000 persons – for prevention and early intervention providers. People who once had to wait for their symptoms to become undesirable adequate to go to the hospital just before anything at all could be completed? They would obtain prompt care in their own communities and return swiftly to daily life as normal – back at function, residing with their households, seeing their buddies.

Soon came the downsizing of big state hospitals and, in 1963, the passage of the Neighborhood Mental Well being Act. That legislation envisioned the creation of a network of mental well being centers spanning the country, so that each citizen would have a single stage of entry. A particular person experiencing early signs of mental disorder could receive emergency, inpatient, partial hospitalization and outpatient care – all in the exact same location – whilst her loved ones was educated about her disorder and how very best they could assist.

Regrettably, fewer than half of the centers have been ever developed, and adequate assistance for their operation was never ever presented. As federal funding ceased, many of the current centers shifted away from caring for the most critically ill … to serving having to pay buyers. The guarantee of an successful neighborhood-based mostly technique of care stays unfulfilled.

Nevertheless we are, half a century later on, in a various globe for which a diverse vision may be required – a vision of complete care aimed at helping people with psychological sickness carry on to be working members of society. But the vital notion of obtaining an integrated method of healthcare – a technique that recognizes the spectrum of needs linked with psychological problems, from household treatment to medication to supported housing – is also crucial to relinquish.

President Obama can kick-begin planning for a real technique of mental health care, by establishing a presidential commission to suggest realistic, re-inventive actions forward.

It could be a landmark minute, appropriate now, these days.

Here is what it may well get:

Illustration by Chloe Cushman for the Guardian

• No one struggling with depression or trying to locate assist for a troubled little one ought to have to spend weeks figuring out whom to contact. In each spot of the nation, a single stage of speak to should be designed to reply to concerns and triage people in require of help to acceptable services. Today, considerably of this details can be provided online – believe of the dwell chat boxes on many business and banking websites, or even the pop-up video for client assistance on Amazon’s Kindle Fire tablet.
  
  

Illustration by Chloe Cushman for the Guardian

• Today people are too frequently left to their own devices when it comes to assembling and monitoring the package deal of providers they require. Also usually men and women cannot find what they’re looking for. These solutions can assortment from medication to loved ones therapy to rehabilitation providers. Care coordinators must be available to shoulder those burdens – not patients and families.
  
  

Illustration by Chloe Cushman for the Guardian

• People with psychological ailments want much more than just a pill – but that’s often all that’s available to them. Psychotherapy can assist them understand and deal with the troubles they face. Substance abuse commonly accompanies mental disorders – and need to be addressed equally seriously. Several folks with serious psychological illnesses require assistance with occupation education and housing as essential elements of their recovery.
  
  

Illustration by Chloe Cushman for the Guardian

• Most psychological well being troubles can be dealt with inside a community, but when emergencies arise it becomes essential to have access to crisis providers, short-phrase respite beds and inpatient care. Reduced payments from insurers for psychological health treatment have led to the closure of many inpatient units, resulting in a backlog of folks in crisis getting held in emergency rooms – often for days or weeks.
  
  

Illustration by Chloe Cushman for the Guardian

• These days, paying out for mental well being care is nobody’s obligation. Insurers spend as small as attainable, frequently denying claims on flimsy grounds. States have reduce far more than $ 4bn from their psychological wellness budgets in the last 6 years. The federal government immediately contributes only a small volume to supporting mental wellness treatment method past the coverage it supplies via Medicare and Medicaid. A joint federal-state dedication is essential to funding the infrastructure of a care technique, even though insurers’ feet are held to fire to make specified they dwell up their obligations beneath the Mental Wellness Parity Act.
  
  

In the 21st century, with our instantaneous electronic communications, it could be significantly less essential to property these types of services in a single website – but it really is no less critical to insure that they are all accessible.

A half-century of patchwork efforts to improve a single or an additional element of the mental wellness technique has resulted in abject failure. Except if we get a thorough approach, and mend the security net that protects us all, we will fail again.

Let’s get to operate.

Paul S Appelbaum is the Dollard Professor of Psychiatry, Medicine and Law at Columbia University, and a former president of the American Psychiatric Association.

How to rebuild America"s mental well being program, in 5 huge actions | Paul S Appelbaum

Paul Ramsay, Australia"s Gentleman Billionaire, Dead At 78

Paul Ramsay, Australia’s gentleman billionaire, has died at the age of 78 following struggling a heart assault on his personal yacht whilst on vacation in Spain.

Well worth an estimated $ three billion Ramsay was Australia’s 9th richest particular person with the bulk of his fortune tied up in the firm he founded precisely 50 many years in the past, Ramsay Wellness Care.

Right after studying law and operating briefly with his father in a surveying business the then 28-12 months-outdated Ramsay acquired a big house on Sydney’s North Shore, converting it into a sixteen-bed psychiatric hospital.

Quick expansion followed, with an investment in a tv network extra to the chain of personal hospitals.

Survived A Fiscal Crisis

Growth was not without having the occasional hiccup. In 1988, shortly right after listing on the Australian stock exchange the aftershocks of a stock-market crash in the preceding year triggered a financial crisis for Ramsay, foremost him to de-record his organization for four years, returning in 1992 following repairing the company’s broken stability sheet.

The previous 22 many years saw his enterprise blossom into one particular of Australia’s leading 50 companies with Ramsay Health Care operating 150 hospitals in 5 nations, Australia, Britain, Indonesia, Malaysia and France. The hospitals provided employment for 30,000 individuals and medical services to one.four million sufferers a year.

Above the previous 5 many years, Ramsay Well being Care has been a single of the greatest doing companies on the Australian market thanks to a mixture of government incentives to motivate private hospitals, the ageing population and a corporate track record for supplying superb services under Ramsay’s powerful leadership.

The firm followed six ideas laid down by Ramsay, including integrity and honesty in dealing with every person involved with the hospital business.

No Clear Succession Program

After suffering his heart attack late final month Ramsay was admitted to a Spanish hospital ahead of currently being flown property to Australia with no regaining consciousness. He died at his residence close to Bowral in New South Wales.

At the time of Ramsay’s death his 36.2% stake in Ramsay Overall health Care was valued at $ A3.27 billion ($ three billion).

Usually approachable in the early years of his occupation Ramsay averted the media in later on years, while also trimming his organization and personalized interests. The television stake was offered, and he ended a 3-yr term as chairman of the Sydney Football Club in 2012.

Ramsay has not left a clear succession prepare. He was not married and has no young children. He leaves a twin sister, Anne, and a brother, Peter.

Paul Ramsay, Australia"s Gentleman Billionaire, Dead At 78

Paul Burstow: The Human Rights Act need to apply to all pensioners in care homes

So, for example, a individual living in a care house has no safety of tenure, and a resident can be evicted quite simply. It is properly acknowledged that the shock of getting forced to move out of a care home can contribute to someone’s death, and so the Human Rights Act is rightly a backstop in this kind of instances, but only if the Council organized the care.

Worse even now, if you are cared for in your own home by a personal or third sector company, even if the Council arranged it, human rights safety does not apply.

Final yr I was delighted when a cross celebration vote in the Property of Lords defeated the Government to amend the Care Bill to end this anomaly. But that Bill is not but law, and the Justice division is digging its heels in and now would like MPs to overturn that vote.

On ideological grounds the Justice Division would have MPs vote so that the Human Rights Act does not apply to older people who correct up their very own care. It believes that the Act ought to not apply to personal care arrangements.

But this is just not great adequate. How can it be acceptable that if men and women rob a bank and go to prison, then their dignity and care are covered by the Act – but not an elderly person with dementia living in a care home?

So as an alternative of making an attempt to unravel the alterations the Property of Lords manufactured, the Government should embrace it. Respect for a person’s human rights must be at the heart of very good care, it ought to be engrained in the culture of each organisation that supplies care, regardless of whether they are private, charity or publically run. Clarifying the law in this way would be a spur to every care supplier to develop a human rights method into the way they deliver care, assisting to drive up specifications across the entire social care sector.

The Care Bill will be a landmark reform of care in England, extensively welcomed by charities representing older and disabled folks. It is anything the Coalition can be proud of. I am as a result respectfully calling on the Justice Secretary to get rid of his ideological blinkers, and believe about the message he is sending out. I can only hope he reconsiders – for the sake of households and folks needing care everywhere.

Paul Burstow: The Human Rights Act need to apply to all pensioners in care homes