Memorandum by Rethink (WP 57)
We are pleased to have the opportunity of contributing
to this inquiry. Rethink, formerly known as the National Schizophrenia
Fellowship, is the charity for people who experience severe mental
illness and for those who care for them. We are both a campaigning
membership charity, with a network of mutual support groups around
the country, and a large voluntary sector provider in mental health,
helping 7,000 people each day. Through all its work, Rethink aims
to help people who experience severe mental illness to achieve
a meaningful and fulfilling life and to press for their families
and friends to obtain the support they need.
It is essential that a key emphasis of any proposals
to improve the health of the nation should focus specifically
on initiatives to improve the lives of people with severe mental
illness. It is well documented that people with severe mental
illness are more likely to experience chronic physical health
problems than the rest of the population. Recent research by the
Disability Rights Commission suggests that they are also four
times more likely to die from a treatable illness than other patients
and 58 times more likely to die before the age of 50. This is
unacceptable, and it is only through integrating health services
for people with severe mental illness into the mainstream that
gaps in services can be closed.
We shall contribute on the sections of the White
Paper on:
— support for mental health and well-being
(pages 131 to 144); and
— making it happen (chapter 8);
and will comment on the general principles of the
paper, with specific reference to issues affecting people with
severe mental illness.
SUPPORT FOR
MENTAL HEALTH
AND WELL-BEING
We make the following points:
— we welcome recognition of promoting
mental health as an issue in the White Paper (paragraph 37) but
feel that more emphasis needs to be placed on meeting the needs
of people with severe mental illnesses like schizophrenia. Such
people need regular physical health checks given their poorer
than average physical heath, which is recognised in paragraph
42 for people with mental health problems generally;
— we also welcome the coherent approach
set out in paragraph 38. The latter para is in tune with the recent
Social Exclusion report on Mental Health and Social Exclusion
(referred to in paragraph 45);
— the training offered for mental health
staff should involve service users and carers (paragraph 41);
— the paragraphs on support for smokers
(paragraphs 46-57) seem to be aimed at smokers in general but
for people who experience a severe mental illness, the incidence
of smoking is significantly higher than the average. Statistics
show that 44% of adults surveyed who had a psychotic disorder
living in a private household and 74% of people in institutions
who have schizophrenia smoke. Therefore smoking for this group
needs specific attention, eg it may well be worthwhile having
smoking cessation pilots for people with a severe mental illness,
especially bearing in mind that it may be more difficult for people
who experience a severe mental illness to quit smoking This is
because:
— they are less likely to be in
employment than the general population; they may have a lot of
time on their hands, which is available for smoking;
— they may smoke to abate the physical
side-effects of medication such as poor concentration, anxiety
and hunger;
— people with a severe mental illness
are more vulnerable to stress; an adverse incident may cause them
to resume smoking;
— smoking is part of the culture
of mental health services;
— tobacco smoking has a stimulating
effect on people who have negative symptoms of mental illness,
including apathy, inertia and withdrawal; quitting smoking would
reduce their personal activity;
— they may lack self-esteem and
see the future as bleak; as a consequence, they may not bother
to look after their physical health.
— Likewise, obesity (paragraphs 58-72)
is a particular problem for people with a severe mental illness:
— they may gain weight as a side-effect
of the anti-psychotic medication they take;
— they are 2.2 times more likely
than the general population to die from respiratory diseases and
1.8 times more likely to die from digestive problems;
— there is often a lack for the
opportunity for physical exercise, especially in inpatient settings;
and
— people with severe mental illness
are often affected by poverty, which can limit access to healthy
food choices and leisure and exercise facilities.
— Dual diagnosis: people who have problems
with both mental health and misuse of drugs or alcohol can require
extra support:
— the availability of drugs such
as cannabis on psychiatric wards can impact on the service users
health; and
— vulnerable people on wards are
targeted by drug dealers.
MAKING IT
HAPPEN
— Resourcing delivery (paragraphs 9-10
on pages 176-176) is unspecific about the amount of new money
to be allocated to improve public health. To improve the mental
health of the nation it is crucial to know exactly how this will
be resourced.
We welcome the government's commitment to achieving
its public health goals of sustaining an ethos of fairness and
equity—good health for everyone in England. We feel that
some of the proposals will help towards achieving the goal of
enabling people to make healthy, informed choices about their
health. With specific reference to mental health, we welcome the
following positive features of the paper as follows:
— The Recognition that MH promotion
is about encouraging positive mental well-being as well as preventing
mental illness. It also acknowledges the relationship between
physical and mental health, with a welcome emphasis on the promotion
of a more joined-up approach to NHS support for people with poor
mental health.
— The recognition that the physical
health of people with mental illness is often neglected.
— Social exclusion is a key obstacle
for people with mental ill-health.
— The expansion of Child and Adolescent
Mental Health Services and more school-based work.
— Increased support to parents facing
difficulties, such as the Sure Start programme.
However, we are concerned that there need to
be more specific interventions and approaches to improve the lives
of people with severe mental illness if the goal to "improve
the mental health and well-being of the general population, reduce
mortality rates `from suicide and undetermined injury by at least
20%' 2004 Government PSA target" is to be achieved. Some
specific points to consider are:
— NHS Health Trainers: more clarification
is needed over how they will work effectively across all health/social
care agencies to ensure joined up working. Equally there needs
to be more clarification about how the community matrons will
work with people with severe mental illness.
— Access to real opportunities for
physical exercise for people with severe mental illness in psychiatric
units is not addressed.
— Whether the mental health elements
of the proposals will require a new stream of funding.
We feel that in order to ensure that the goals
to improve the health of the population are achieved, the government
needs to clarify the issues we have discussed above, and to use
the following principles and recommendations as a basis for moving
forward:
— people with severe mental illness
should be a top priority for programmes on obesity, exercise and
smoking cessation, because of the very high levels of these problems
among this group;
— the annual physical health check
for people with severe mental Illness should be a priority, and
solutions should be sought to reduce the high death rates among
this group offered in the new General Medical Services Contract;
— a massively increased programme around
stigma is essential, accompanied by adequate and long term funding,
backed by clear policy commitment including an end to damaging
political statements and a change in the Mental Health Bill;
— a public education programme around
the mental health risks of cannabis;
— social inclusion and employment measures,
with a focus not just on those who can relatively easily find
work, but which recognise the full range of experience of severe
mental illness; and
— a large scale expansion of talking
treatments on the NHS, so that people with common mental health
problems have the option of an effective non pharmaceutical treatment,
but also as secondary prevention for people with the early stages
of more severe mental illness.
We welcome this inquiry into the White Paper
and a commitment to improving public health, and recognise the
opportunity to ensure that improving the lives of those affected
by severe mental illness is a fundamental principle to achieving
these goals. We would be willing to give oral evidence at any
future inquiry meeting.
January 2005
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