Mental health.’ The disparaging attitudes often associated with these words are changing. What was once an issue barely acknowledged by government is now being given the platform it requires at a national level.
Image: Huffington Post
Monday 7th January 2019 saw the publication of the NHS Long Term Plan – a major milestone for mental health as the UK Government outlined an ambitious ten year plan to improve our public healthcare services and consequently the quality of peoples’ lives. Making peoples’ lives better is at the very core of what we do and I’m delighted that the Plan has given credence to the prevention, safety and recovery of those suffering from mental ill health. But the question is… does it fully address the “burning injustices”1 of our current mental health services?
Prevention, Safety & Recovery
The 136-page publication is a product of an extensive consolation process; including input from over 200 organisations and individuals who were asked to answer key questions specifically on the future of mental health.
One of the major outcomes is a focus on prevention. Preventing the development of mental health problems and, in more severe circumstances, preventing suicide. Whilst I absolutely welcome early stage interventions as a long term approach, my focus instinctively shifts to in-patient suicide prevention as this is when people are most vulnerable having already reached crisis point.
“Space is occupied by people… to live and heal in.”
When referencing in-patient care, the Long Term Plan states that ‘purposeful, patient-orientated and recovery-focused care is the goal from the outset’2; a goal that we passionately support. In the ‘Suicide prevention’ section, it also states that the NHS will ‘design a new Mental Health Safety Improvement Programme, which will have a focus on suicide prevention and reduction for mental health in-patients.’3 However, the strategy appears to classify recovery-focused care and suicide prevention as isolated issues which I think is a major oversight.
The Long Term Plan touches on the requirement of ‘upgrading the physical environment for in-patient psychiatric care’4 but lacks emphasis on how fundamental this is in providing ‘recovery-focused care’. Research from Design in Mental Health Network shows that there is a 20% reduction in average length of in-patient stay following a ward refurbishment, demonstrating how significantly the built environment can improve in-patient wellbeing.
Quite simply, the environment needs to be as therapeutic as possible at a time when people are more likely to commit suicide.5
Image: Design in Mental Health Network
We’ve always maintained that a combination of good design and effective clinical procedures are fundamental for in-patient safety and recovery. The ultimate goal should be to build well-designed environments that eliminate risks and facilitate staff to provide care.
The 2018 National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) 6 highlights the importance of allowing staff the capacity to carry out sufficient observations and therapeutic interventions to support patients’ recovery.
The problem is, mental health services are already seriously understaffed and underfunded. In July 2017 Jeremy Hunt, the Health Secretary at the time, promised to increase the NHS mental health workforce by 19,000. Eighteen months on and the opposite is happening as staff numbers continue to reduce.7
There doesn’t appear to be any reference to this promise in the Long Term Plan or to the mental health staffing crisis at all – how can we see an improvement in the care provided without the workforce to provide it?
Image: Design in Mental Health Network
A long journey ahead...
On the surface, there are a number of very encouraging plans for the future of mental health services put forward in the NHS Long Term Plan. But do I think that it addresses the “burning injustices”? Well, we’re taking steps in the right direction but we’ve got a long way to go.
The plan skims over the upgrading of the physical environment for in-patients – a major contributor to prevention, safety and recovery. Here at Safehinge Primera we believe this is a fundamental requirement as we continually push design standards higher with people in mind.
The plan also fails to address the current staffing crisis – an issue that the current UK Government promised to resolve eighteen month ago. This is not to say I’m not optimistic for the future – I do feel that things are definitely heading in the right direction for mental health. But, in order to pave the way for a brighter future, there needs to be greater attention given to some very immediate issues.