Should charities be propping up statutory services?

In the past few days, the closure of Kids Company has dominated the news. To an outsider, their rapid demise has come out of the blue. There were undoubtedly financial issues as Kids Company struggled to keep up with the volume of self-referrals from young people, operating an open door policy. I have a lot of sympathy for all those affected. Kids Company was a life line for an incredible amount of children and young people, many of whom had been failed by statutory services. The staff, who were paramount in delivering the services and support that these young people so desperately needed, are equally as dismayed.

The situation has made me reflect on the role of charities as opposed to statutory services. As someone who receives support from both CAMHS and a charity it raised some questions for me. Are charities picking up the slack? We know that there is a real issue when it comes to funding health and social care services. I was horrified to read an article in the Guardian which mentioned that only 1 in 9 children in need can be supported by social services. That isn’t right. It’s imperative to look out for the most vulnerable young people in order to give them the best chance of getting on in life. How much of that is the job of charities and how much of that is a job for statutory agencies? In an ideal world, I’d say that it’s a job for both. When agencies such as CAMHS and social services have the capacity to work with young people in need, the voluntary sector can compliment the work. However, when the burden of care falls almost entirely on a charity as local agencies cannot cope, it’s a risky position. Many of the young people who turned to Kids Company did so as they were not able to receive help from anywhere else. Now who will they turn to? If statutory services were unable to pick them up initially, will they be able to now?

The voluntary sector is amazing. I am a firm believer in the brilliant change that charities can bring about. If the government will not commit to spending what is needed for statutory services to do their job, then they would do well in not reducing their contracts and grants to charities. Is it any surprise then, that that’s exactly what they’re doing? Between 2010-2013 government funding for all charities fell by 11%, but funding for children and young people’s charities fell by 18%. When you couple that with the gaps in statutory agencies, it doesn’t paint a picture of a society run by those who particularly care whether or not the most vulnerable are protected.

Camila Batmanghelidjh has said that she feels silenced by the government as they felt she was too outspoken and raised issues around child protection which they’d rather keep quiet. I wouldn’t be surprised. The reality is though, that thousands of young people who desperately need support will be left without. Those who never reached Kids Company’s doors, who have never reached the case load of social services and most likely never will, are still in need. The issues that young people face are still just as prominent, the only difference being that we have now lost one thread of hope. I sincerely hope that the government finds a shred of humanity and starts to look out for those who need it.


£15m to go on new Places of Safety?

Earlier today the Guardian published an article (here)  claiming that Theresa May is to put £15m of new money into appropriate, health-based Places of Safety for those held under s135/136 of the Mental Health Act (MHA).

£15 million? Straight into new Places of Safety?! Great! As long as this investment doesn’t overshadow the genuine need for consistent, high quality mental health services. I don’t agree with the practice of seeing people detained under the MHA taken to police cells, but I also don’t agree with people being left without adequate support, leading up to a crisis (and potentially a detention under the MHA).

We cannot carry on this culture of sticking plasters over issues and expecting them to go away. An increase in Places of Safety is warmly welcomed by me, however we need to address the underlying issues that are causing people to come to contact with the police in crisis. Of course every case is different, but funnily enough, ensuring that we have a supportive mental health system in place wouldn’t strike me as a bad idea?! I know that effective help costs £££. I appreciate the stresses and strains that the NHS is under, and that we would all love a system that works for everyone. Nor am I saying that changes to the current structure would result in no-one ever having a crisis again, or needing help, but I personally have no doubt that it would make a large amount of difference.

What I am muddling along and saying is that £15m isn’t going to solve everything. We desperately need sustained investment across the board, from CAMHS to crisis services, CMHTs to LD services. The pledge to stop people from being held in police cells is ‘fashionable’ almost, thousands are outraged when we hear the news that teens are being held in cells for lack of 136 suites. We often draw the “but would someone with a broken leg be held in a cell?! I think not!!” parallel. But all areas of mental health services need to be seen as worth investing in, not just a small portion. Mental health services are vital for so many, life-savers even (myself included!) and it is our duty to ensure that they are not failing anyone when they need the support.

Wristbands for the mentally ill?!

My timeline on Twitter has been overrun with people who are outraged by a statement made by a Tory candidate standing in Cambridge, Chamali Fernando. In a local hustings she suggested that those with mental health problems should wear wristbands, colour coded by diagnosis. 

That sentence alone breeds all sorts of judgements and evokes all kinds of responses – how dare she? Does she understand how stigmatising it is? Etc. And I get it, I totally get it. I understand the reaction that was seen across Twitter and the media. But how good is the media at twisting things? I read the headlines and laughed, saying I’d wear mine with pride as I see no reason to be ashamed of my mental health. As I read the article however, and found out the context of her suggestions, it made a little more sense. 

The comments were made in the context of (from what I can gather) crisis care. More specifically, crises resulting in police attendance and potentially a s135/136. She said that perhaps it would help the emergency services and the professionals to know what a persons diagnosis is, if they had one and for some reason couldn’t let the staff know, in order to give appropriate help. When in context, the statement seems less outrageous. And from my dealings with the police, it seems that for quite a few staff the only mental health problems they know of are schizophrenia and depression. I have had countless conversations in crisis with the police which pretty much go along the lines of:

So are you hearing voices? No. Are you sure? Yes. Are you seeing things?? No. Are you depressed? No. So… What’s wrong with you?

That’s by no means a dig at the police, I think that for a lot of the general population the response would be the same. But in times when I’ve not been able to communicate, perhaps something written down would have helped. I’m not saying a wristband, and I’m not suggesting I carry my notes around just in case I get 136’d and want the police to have a bit of an understanding. It is perfectly normal for people with physical illnesses/allergies etc to wear a medical wristband in case of emergencies where they are not able to inform people themselves. We would never think of that as stigmatising.

But I can see where the logic was behind the comments. I think that we have done a great job of only seeing what the media say and of jumping on the sensationalist bandwagon that is rolled out every so often. While I think that the comments could have been thought out a little better and can completely see where the rallying calls of “this is so stigmatising!!!!! Stand down!!!! You don’t understand the plight!!!!” have come from, as it was my initial reaction too, take a step back. Sometimes we say tasteless things. This wasn’t a new election pledge, or a 50 page document on why we should have these wristbands, it was a comment that could have been put across differently. 

Last time I checked, depression didn’t make people crash their planes…

On Tuesday the Germanwings flight 4U 9525 tragically crashed into the French Alps, killing everyone on board. Naturally, there has been a lot of speculation as to why the plane went down – terrorism? Engine failure? Or the current theory – suicide?

Whatever the reason, the media have a responsibility to report appropriately. This morning, they made a fool of themselves. The majority of headlines linked the pilot’s mental health to his deliberate crashing of the plane, implying that he was a murderer and this was directly because of his depression. Making such sweeping statements is damaging – for both people who struggle with their mental health and for those who may not know a lot about mental health. It perpetuates the existing stigma that surrounds mental health, silencing those who need help. But imagine you didn’t know a lot about mental health problems, and the only things you were being told were things like this morning’s headlines, that people with depression were basically murderers. That’s not helpful for anyone! Of course, if that is the only information you are fed about mental health problems, you’ll adopt a stigmatized view. Newspapers are full of news (supposedly). They are trusted sources, and that’s why it’s so important that they take responsibility for appropriate reporting when stories come up that include a discussion about mental health.

The headlines this morning were pretty dire: The Daily Mail, charming as always, asked “Why on Earth was he allowed to fly?” claiming that the pilot had a long history of depression. Well, maybe because people who suffer with depression generally don’t fly their planes into the side of a mountain. The Daily Mirror announced “Killer pilot suffered from depression” in nice, bold letters, offering it as an explanation. At first glance this presumes that his depression was the cause of the tragedy. Thanks for that. The Daily Express offered up “Why jet crash pilot turned into killer” underneath writing “He was jilted and depressed”, again as a half-hearted excuse of an explanation. Personally, I think that the Sun trumped the headlines I have seen this morning, simply writing “Madman in cockpit”. Nice to see them flying the flag for reducing stigma. It seems that the UK press missed the memo this morning that says that tackling stigma is everyone’s business. It would also appear that they momentarily forgot the fact that they can have such a massive impact on people’s perceptions of different issues, mental health included.

I’d like to take this opportunity to point out that not once have I hurt anyone deliberately. (Oh and I have those dangerous mental health problems too, the ones that turn people into murders apparently) Nor has anyone else who I know. People with mental health problems are much more likely to be the victims of violence rather than the perpetrators, not that the media would let you believe it. Globally, 350 million people suffer from depression (WHO). Take a minute to think about that figure… It’s a lot right? Are all of those 350 million people going to take their lives along with 150 others? Probably not.

We’ll probably never know what the pilot’s state of mind was during that flight. His depression may not have played a part. Jumping on the bandwagon and sensationalism just seem to be the media’s favorite things to take part in. A quick, catchy headline is short-sighted, it doesn’t look at the potential damage that could be caused by publishing it. If we’re going to tackle the issue of stigma, we all need to play a part, including (and especially) the media.

The importance of a diagnosis?

Whilst you read this, please bear in mind that I am not a mental health professional. I am a service user who has been in the system for long enough to have been assigned an array of different diagnoses and labels in order to figure out what was wrong with me. Oh and these are literally just a collection of thoughts, with no real rhyme or reason to them…

I’m not “anti-diagnosis” by any stretch of the imagination. I really do believe that a diagnosis can be beneficial. By diagnosing someone accurately, you can then go onto providing appropriate treatment, whether that be therapy, medication, something else, or a mixture. There would be little use in incorrectly diagnosing someone, offering them an intervention which didn’t work, and then wondering why, 6 months later, little to no progress had been made. But how easy is it to accurately diagnose someone? In my experience, it seems to be quite hard. I have wandered for years through both inpatient and outpatient services, every so often being told that my diagnosis had changed, that the guys in charge had decided that I was no longer this or that. And I get it, diagnoses can change. You can ‘recover’ from something. But from what I can gather, the problem they faced was that my symptoms would overlap. Were my suicide attempts a result of depression? BPD? Of trauma? The intermittent nature of  the diagnoses I received led me to question the validity of them. How could someone outside of my head, not experiencing what I was, tell me what was wrong with me with any degree of certainty? It’s not a broken bone, you cannot just x-ray me to figure out what’s up. There was a point where I almost refused to acknowledge that diagnoses meant anything, however through my stubborn nature and my belief that a diagnosis didn’t exist, I ended up invalidating myself massively and getting increasingly frustrated as my distress was VERY real to me, but didn’t seem that way to others. I am however past that stage, and I do ‘believe in’ and see the use in a psychiatric diagnosis, although I do still have reservations about the potential transient nature of them!

There are a group of people who think that a diagnosis could do more harm than good. I suppose an obvious example would be the labeling theory: where the behaviour of an individual is said to be influenced by labels that are placed on them. Some would argue that mental health problems are a societal construct and people who are mentally ill are simply those who do not conform to the norms of society, resulting in the ‘mentally ill’ label. Once they have this label, they live up to the reputation and remain ill. I don’t agree with this, I think that it is a potentially damaging approach to take. A label can urge and encourage people to seek help. Most people who recognize that they are ill or hurt do get help – if I fell down the stairs and thought that I had hurt myself seriously I would probably go to A&E. If there I was told that I needed certain treatment, I would probably say yes! Unfortunately the opposite can be true of some who struggle with their mental health, a diagnosis can be incredibly stigmatizing and people may choose to suffer in silence rather than approach a professional or their family/friends. This is obviously damaging for the individual and a barrier to them seeking help.

On the whole, I do think that a diagnosis serves a purpose. Personally, I’m not sure how much importance I place on mine when I am given them, but I think that in the grand scheme of psychiatry they can be incredibly important.  They still seem to me quite telling of a professional’s preference (I’ve heard of some professionals who refuse to diagnose certain conditions, or those who diagnose most of their patients with the same diagnosis…) but they can be a useful tool in facilitating someone’s recovery.

“Future in mind” report and the promise of £££?!

Today marks the launch of the “Future in mind” report, setting out recommendations in the hope of improving children and young people’s mental health and wellbeing. 

Now, I do a lot of campaigning. I am also a CAMHS service user and so getting CYP mental health up the agenda makes me a very happy person! However my issue comes when I perceive what others see as concern and positive change as tokenism. Unfortunately, this is how I saw the launch of the taskforce report and Clegg’s recent ‘pledge’ to allocate £1.25bn of the Budget to mental health services.

I’m sure that many politicians do care about improving mental health services, Norman Lamb being one, but there is a “too little, too late” vibe around the entire thing. We could have put our energy into attempting to secure decent CAMHS services for our young people 5 years ago. Instead, our funding has been cut (in 2008/09 £758m spent was on CAMHS in real terms, compared to the £717m in 2012/13, the last year for which figures are available) resulting in a shortage of beds, resources and staff. 

“But, Stella!! We know this! It’s better late than never!” I hear you say. That’s very true, but – call me cynical – I fail to see how the money will make a substantial impact. It will make an impact, yes, and it is better than nothing, yes. But once it’s broken down over 5 years and into CCGs (of which there are 211) and further than that, into the CAMHS services that each individual CCG provides, it doesn’t leave a lot. I fear that a large chunk of the money will be used to replenish services and get them back to the levels that they were at before the majority of the cuts were made, before we can see any real improvement. 

As for the report, I have read it and I agree with the majority of recommendations made, but I’m sure that all the suggestions are ideas that staff and service users have been requesting since the beginning. Should all of the changes be implemented, CAMHS would be getting a pretty major facelift! Even in fairly ‘structural’ terms, with a recommendation for scrapping the tiered model and introducing another such as the Thrive model, on which I have reservations. 

As the pressure of the election rises – along with my cynicism(!) – so do the election promises. Politicians need to cover all bases and make as many people as they can willing to vote for them. Making CYP mental health an interest serves well, as not often has it been an issue of much concern. Without meaning to sound condescending, it almost seems like a niche issue to cover.

What roles do schools play in promoting and looking after young people’s mental health?

“Teachers are not mental health professionals” is a phrase I have heard often, both in and out of school. Most recently I heard Nicky Morgan, Secretary of State for Education say this on Wednesday in the Houses of Parliament during a discussion on mental health in schools. A group of young people, including myself, were invited to speak to Nicky Morgan and Sam Gyimah to see what schools are already doing what more we think should be happening.

The truth is that no, teachers are not mental health professionals. But that does not mean that they cannot have an awareness of mental health problems, either in a personal or professional capacity. Given that the statistics are that 1 in 4 people in the UK experience a mental health problem each year, the remaining 3 in 4 will come into contact with someone who is struggling. For those who work in schools, the person they come into contact with may well be a student. A majority of 5-16 year olds are in schools from 9-3:30, Monday-Friday. Spending so much time at school means that staff are in a prime position to notice changes in a young person and intervene. This does not have to fall on the shoulders of one lone teacher, it’s a team effort. Noticing subtle changes in behavior, attendance, concentration and willingness to engage can make huge differences and will most likely be picked up across the board. My mum is a HLTA and came home the other day having received a refresher safeguarding training. She’s never had any training on spotting mental health problems or promoting wellbeing/good mental health. In fact, it is not anywhere in teacher training.

How a child or young person presents with a mental health problem also varies from person to person. A young person ‘acting up’ is not always as simple as that. From the ages of 13-15 I would truant pretty much every day and get sent out of all of my lessons for being disruptive. I spent the majority of my time on report and with my head on the desk. I refused to do PE as I didn’t want people to see that I was self-harming. But I wasn’t a bad kid, I was just struggling with my mental health and not sure what to do about it, yet I knew people who were struggling with similar issues and they isolated themselves instead. There is no ‘one size fits all’ when it comes to trying to spot people who need help, and it requires a great deal of looking beyond the surface.

Everyone is talking about early intervention. Schools are a perfect place for us to help young people. With training staff can feel confident when talking about mental health to students and be able to spot warning signs. I’m in no means saying that we’re expecting teachers to become psychiatrists, the opposite in fact. School staff are school staff. They are not clinical. A teacher does not have the same negative connotations attached to the name as a mental health professional may. They are pretty consistent and there most days. This offers young people a different environment to talk about things that are concerning them, which may feel easier than seeking help from mental health services.

A basic requirement should be for all staff to at the very least know how to signpost to services and make referrals. That way if someone feels unable to help, the young person is able to receive help from an external source. Some young people may not want to talk to a teacher. For some school itself may be the problem! There needs to be a joined up approach between services, schools working alongside CAMHS/social services/YOTs etc in order to best support a young person. It’s by no means rocket science, nor is it impossible. But an attitude shift is required, from “mental health isn’t my problem” to ” mental health is everyone’s problem”. We preach about the importance of looking after your physical health, eating your 5 day, exercising and cutting out rubbish from our diets. But where is the emphasis on keeping mentally well? Where is the impact that lack of sleep can have on your mental health taught? I often go into schools and talk about wellbeing/mental health, and a recurring theme is that initially most young people do not even realize that we all have mental health. For as long as I can remember I have had an awareness of my physical health and have been able to tell if I was unwell or not. So why is it not the same for our emotional health?

We don’t need a massive overhaul in the education system, we just need small yet effective conversations to take place, and the training to make sure that all school staff feel confident in recognizing young people who need help. A lot of the emphasis in schools is towards passing exams, anxiety provoking for most in itself, but for those with underlying mental health problems it can be overwhelming. In order to succeed you need to be relatively healthy in all aspects of life and that’s why it’s so important for schools to play an active role in promoting good mental health and supporting students who are finding things difficult.