Select Committee on Health Written Evidence


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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