Tuesday, 21 January 2014

Closing The Gap

~ Nicola Byrom

I have been passionate about mental health for years. I think our society, today, has the opportunity to see a complete revolutionary shift in attitudes to mental health. The change is vital, but is the motivation there?

Most of our society is familiar with the statistic 1 in 4. 1 in 4 adults will experience a mental health problem this year [1] . 1 in 4 is also the number of people with a mental health problem that get treatment. Yes that is right. At the Deputy Prime Minister’s conference (20th January 2014) on Closing the Gap: Priorities for essential change in mental health, Nick Clegg set out a strong agenda for reaching parity between mental and physical health. Nick argued that we cannot have a stronger economy and fairer society without tackling attitudes to mental health. The problem still seems to be – how can we achieve this. As Graham Thornicroft [2] explained at the conference, 75% of people with mental health problems do not get treatment. This is despite the fact that we know that average life expectancy is dramatically reduced for men and women living with mental health problems; cut by 20 years for men and 15 years for women [3] . Can anyone even imagine this lack of treatment for a health problem with such an enormous impact on life expectancy?

Parity between mental and physical health needs funding. That funding has to come from somewhere. A medical ethicist at the conference noted that mental health “asylums” have been closed (a good thing, we might all agree) but the transfer of services to the community was less than perfect and the Department of Health is even now continuing to cut the number of beds on mental health wards. She asked Nick Clegg if he would be happy to specify which hospitals and which acute services would be cut to fund better mental health services. Her question was not entirely sincere, but it hits the nail on the head. We need a long hard look at how funding gets shared out within the NHS between services. This perhaps seems unlikely to happen as another individual noted at the conference that in December 2013, NHS England took £150 million out of the mental health budget to cover increased staffing levels in acute services.

There may however be a positive note to this question of funding. A representative from Clinical Commissioning Groups noted that CCGs were entirely on board with the mental health agenda and recognised that better (and more) mental health services needed to be commissioned. She asked for information – noting that her CCG needed to know what services worked. If she is to commission evidence based interventions, she needs the evidence. A short answer to this was provided by Lord Layard: why aren’t we using the NICE guidelines as standard? CCGs should commission services that meet the recommendations of the NICE guidelines. A longer answer should look at how the research is funded (after all, research is the generally accepted way of finding evidence based treatment interventions). In 2008/9 the Medical Research Council in the UK spent £24 million, 3.5% of its budget on mental health research [4] .

Nick Clegg recognised that there is a major problem with the transition between CAMHS (Child & Adolescence Mental Health Services) and AMHS (Adult Mental Health Services). CAMHS usually ends at 18. This is a time of major change for young people. Many will leave home and move to university or leave school and start jobs. With these upheavals in life, young people with mental health problems have enough going on without major changes in their service provision. Nick Clegg promised better support through this transition, but does this go far enough? Young people often can’t simply transition from CAMHS to AMHS because AMHS do not offer the same services for the same mental health problems as CAMHS. It is not surprising that so many young adults fall through the gap. And when the individuals are students and are moving to a new part of the country to study, it is even more likely that they will slip off the radar and be failed by the health service during what is likely to be one of the most stressful and challenging times of their life to date.

This gap needs to be taken seriously, but the agenda set out by Nick Clegg did not mention students once. The Royal College of Psychiatrists (2011) called for National Health Service providers to ‘recognise and respond to the particular mental health needs of the student population and the difficulties that many experience in gaining equal access to services’. I asked Nick Clegg why students did not feature in the new Department of Health priorities for essential change in mental health. Nick shifted responsibility from the Department of Health to universities, noting that universities have a duty of care for their students. Nick suggested that universities should be working closely with local health services to ensure that these services are meeting the needs of students. It seems that Nick Clegg would like me to hand this question over to the Rt Hon David Willetts, Minister for Universities and Science. I agree that pressure must be put on universities to step up to the challenge of mental health, but surely the NHS has some role to play in this transition?

The Rt Hon Norman Lamb however responded to my question later in the conference. He returned to his argument that “This cliff-edge must end – proper transition plans should be put in place, and our ambition is for this to be standard practice across the NHS. There must also be effective co-ordination between CAMHS and adult services, and a commitment to ensuring that the support given is always age-appropriate.” [5] Norman recognises the challenges that students face and suggested at the conference that serious consideration should be given to extending CAMHS to 25. Here here!


Monday, 20 January 2014

Nick Clegg unveils the government's new mental health strategy

Today the government will be launching its new mental health strategy at a conference hosted by the Deputy Prime Minister. The government has made a commitment to achieve parity of esteem between physical and mental health and today's conference is set to look at ways of improving access to treatment, raising awareness of mental health and reducing stigma. According to Mr Clegg:



It is just plain wrong to treat mental health as the poor cousin to physical health in the NHS. There are too many parts of the country that have suffered for too long with commissioners in the NHS not providing mental health services with the same support as other parts of the NHS.


So what needs to be done? Below are some of the key points that we would like to see addressed at the conference:

A clear action plan outlining steps towards achieving parity of esteem between physical and mental health, including a commitment towards early intervention and preventative measures for mental health, as well as plans to raise public awareness about mental health and reduce the associated stigma.

Students should be a special interest group in work to improve mental health: In a 2011 report, the Royal College of Psychiatrists called for NHS providers to 'recognise and respond to the particular mental health needs of the student population and the difficulties that many experience in gaining equal access to services'. The needs of students are all too often neglected when drawing up mental health strategies, yet the student population is particularly vulnerable:



  • The uniqueness of the student lifestyle involves adjusting to new academic demands, choices about alcohol and drugs, making new friends and living without parents for the first time.

  • The years when a young person is at university coincide with the age of onset for various acute difficulties such as schizophrenia and bipolar disorder.

  • Having a degree does not guarantee a student a job, so young people are experiencing even more pressure to gain good honours degrees and to develop their skills so that they can stand out from the crowd in today's competitive job market.

  • Student services are reporting an increase in the severity and prevalence of the troubles students are experiencing.

Support through university transitions: Despite the high prevalence of mental health problems among university students, there are significant gaps in support for student mental health:



  • There is a clear lack of specialist services for this age group.

  • Care systems are not adapted to the transient nature of student life, meaning treatment is often disrupted by frequent moves between home and university.

  • With the current crisis in NHS mental health services, university support services increasingly have to pick up the pieces.

Students are therefore falling through the gaps between children's and adult services, as well as between home and university services when they move away to university. We therefore need to see the government committing to a mental health strategy that includes provisions for students, from greater awareness of transient student populations among NHS commissioners to an increase in the provision of targeted, linked-up interventions for students.

University mental health provision needs protecting and expanding: The NHS is not the only piece in the puzzle of student mental health. Universities are a key player in providing support to students with mental health problems, yet squeezing funding to Higher Education could well lead to squeezing the very budgets for mental health and welfare support that need protecting. Some key steps to  providing effective support at university include:




    • A strategic commitment to a ‘whole institution’ approach towards student wellbeing to benefit all students

    • Investment in a range of interventions for a diverse university community

    • Action at times of transition

    • Inclusive teaching practices

    • Supporting staff development and training

    • Delivering effective, student–led health promotion activity

    • Working collaboratively with external agencies and the NHS

Greater support for carers: As part of the government's carers' strategy to empower carers and to ensure they are supported in their role, we would like to see the introduction of workshops for carers, friends and family members to help them spot the signs of mental health problems and to give them the tools to support their loved one. To help meet this need, we will be launching a series of two-part workshops for those supporting a friend or family member with an eating disorder during EDAW 2014. To find out more, go to www.studentminds.org.uk/supporting-supporters.

Student Minds Founding Director, Nicola Byrom, will be taking part in discussions about what parity means in practice and what steps can be taken to promote pioneering and innovative work in mental health. Follow us @StudentMindsOrg to find out more!

Tuesday, 7 January 2014

How to improve your body image

~ Abigail Legge

An Australian study conducted in August found that 80% of women are unhappy with how they look and it seems that the same number of men (80.7%) talk disparagingly about their own or others’ appearance. If you have struggled with body image problems in the past, you are most certainly not alone; and a healthy, positive body image can seem like an unattainable goal at times. But it’s not. Learning to appreciate yourself and your body is a life-long process, but it’s an exciting one, too: trying out new hobbies, forming relationships and learning what matters to you will all help you to grow as a person and develop a positive outlook towards almost everything -- including your own body. Here are a few ideas to point you in the right direction:

GET ACTIVE!

Exercise is an amazing way to get in touch with your body. When you exercise in moderation, you have the opportunity to release stress and focus on building yourself up -- and the post-workout endorphin rush can’t be bad for you, either!

Yoga in particular centres around the idea of balance and acceptance, making it an ideal form of exercise for anyone struggling with their body image. One study of women new to yoga found that, while 74% of the women reported some type of body image issue at some point in their lives, 75% reported improved body image after beginning yoga. Another great ‘mind-body exercise’ is pilates, which is also reported to have a positive effect on body image in many cases.

Yoga-Mats

A slightly different form of exercise, which I also recommend looking into, is strength training. Instead of concentrating on reaching a certain milestone in terms of physical measurements, or basing your progress on what you see in the mirror, you get to focus on building strength -- a totally different kettle of fish. And if you feel like you’re physically strong, you’re likely to have a more positive body image, as this study shows.

GET ENOUGH REST!

We all know that feeling of being over-tired, and how it tends to make daily life more of a struggle than when we’re well-rested and energised. University of Pennsylvania researchers found that subjects who were limited to only 4.5 hours of sleep a night for one week reported feeling more stressed, angry, sad and mentally exhausted than usual. When the subjects resumed normal sleep, they reported a dramatic improvement in mood.

Relax Image

Excessive worry about body image can lead to the temptation to over-exercise, or to neglect your body's need for rest and sleep. Always remind yourself that resting is not the same as being lazy; it’s a basic human right! Try to make sure that you:



  • Get as much sleep as you need (usually between six and ten hours a night)


  • Allow yourself to relax and unwind. If you find it difficult to sit still without fidgeting excessively, try some relaxation exercises or meditation


  • Limit your daily exercise: it is recommended you don’t exceed 90 minutes a day of high-intensity exercise


  • Give yourself at least one day’s rest from exercise a week -- you deserve it!

REMEMBER THAT BEAUTY SHINES FROM THE INSIDE OUT!

If you do good deeds, chances are you’ll feel pretty good about yourself as a result. A recent study conducted in the US found that 76% of volunteers have felt physically healthier as a result of volunteering. They identified four key benefits of volunteering that have a positive impact on the volunteers’ health:



  • Health: volunteers say that they feel better physically, mentally and emotionally


  • Stress: volunteering helps people manage and lower their stress levels


  • Purpose: volunteers feel a deeper connection to communities and to others


  • Engagement: volunteers are more informed health care consumers, and more engaged and involved in managing their health

So consider volunteering at your local charity shop, or getting involved with volunteer campaign projects.

If volunteering isn’t for you, don’t panic: look into picking up a new hobby! Ever been tempted by life drawing classes? Music lessons? A language course? That obscure society you signed up to at freshers’ fair, but keep forgetting to go to their meetings? Hobbies can be a great way to relieve stress, particularly when you’re studying at university -- luckily, uni is also one of the best places to try out all sorts of new things! Clubs and societies are also a great way to meet new people and widen your friendship circle :)

Piano Lessons

The important thing is to keep yourself busy and interested in what’s going on around you. That way, you’re less likely to get bogged down with negative thoughts about yourself. The more you ‘practise’ getting involved in things, the more natural it will become -- and I speak from personal experience!

STOP COMPARING YOURSELF TO OTHER PEOPLE! STOP IT!!

Comparing yourself to people around you is a really destructive habit: you shouldn’t have to prove your self-worth by looking better than other people. Instead, try to remind yourself that a positive body image can only come from your own mentality -- what other people look like is totally irrelevant! Catch yourself the next time you notice you’re comparing yourself to others -- it’s really, really not worth it. It’s also worth remembering that everyone has insecurities of their own, even if they seem perfectly content with themselves. Don’t let jealousy stand in the way of your own happiness and well-being!

Stay Positive

Lastly, never feel guilty about having a positive attitude towards yourself. You are your own life-long project, and you deserve to be proud of everything that you are and everything you hope to become!