Mental health and child poverty: can we do better? – Alastair Noble

I think we need to take a step back and look at what we mean and diagnose as mental illness, and what mental health/wellness and mindfulness actually mean.

As a GP with a long-term interest in mental health issues, we place a high priority on appointing a large number of our vital professionally trained staff to enable our community to benefit from the right treatment for people with mental illness. This went in parallel with all the other important building blocks of a successful and sustainable community.

The Greeks several thousand years ago discovered the amazing relationship between “a healthy mind and a healthy body.”

We don’t need more research to show that healthy exercise, good education, good housing, healthy eating, sensible drinking, not smoking, a good job, good relationships all contribute to a longer, healthier life.

Obviously, the opposite is also true. Poverty is present not only in financial terms, but, equally important, in all other aspects that are the opposite of all the above positive aspects.

We need to ensure that we implement both components of this action plan to maximize the health and well-being of society and to properly treat mental illness.

We must also carefully evaluate different delivery options and, as always, prioritize performance and value for money.

It’s worth looking at what worked really well about our Nairn model for mental illness. First, we decided that the greatest progress in health care we could make would come from improving outcomes for patients with mental illness. Again, our well-established model of early and appropriate intervention involving a comprehensive care team has been known to work. In general, early correct intervention is known to produce better results than later, often radical intervention.

Some very important examples: It is easier to prevent the development of anorexia nervosa in young women through early intervention and sensible discussion with them, and often with their parents, than to try to treat established and often difficult to treat anorexia nervosa in later stages.

Likewise, the DRAMS (Drink Reasonably and Moderately) work demonstrates positive benefits in early detection of excessive drinking before it develops into addiction.

So how did this all work? The team met every Wednesday morning to review all recommendations and pass them on to the most appropriate team member or even back to the therapist.

Our psychiatrist was a psychogeriatrician, but actually did all of our adult psychiatry. (I’m surprised by all this hyperspecialization). She was incredibly supportive of the entire team’s approach and was very vocal about, “What do you think is the wrong approach to an individual patient and, more importantly, what can you do as an individual to help yourself and get things figured out?”

We had excellent mental health nurses, social workers, psychologists, occupational therapists and excellent links with health visitors, midwives, community nurses, social workers as well as the practice team. This also applied out of hours when our local nurses and GPs were on duty again. The mental health team could have left clear instructions on how to properly respond to emergency calls.

The results were very impressive: we went without patients for several weeks in a row in the Inverness mental hospital. When our psychiatrist was on call on weekends and making ward rounds, she saw patients who she knew could be better cared for in their own community with our team approach. We had a lot of external evaluations, and my favorite quote from a patient with severe mental illness was simply, “This is the best I’ve ever been.”

Patients who had previously been frequently readmitted to the hospital were doing well in their communities, with their families and friends.

So, as is often the case in medicine, correct early diagnosis and reasonable consistent treatment provide better results.

So what’s happening now?

We have a pretty incredible 814 social voluntary prescribing groups registered for a variety of reasons on ALISS for Nairnshire alone. It’s no wonder people struggle to find the right help. We also spend large amounts of money without any evaluation or long-term follow-up.

We need to bring some clarity and common sense back to our local, results-driven model. A recent article by Des McNulty shows how costs are rising exponentially while we have more referrals, longer waiting lists and, above all, more children suffering from poverty and mental health problems.

Nothing can be more harmful to a child than living in a family with an undertreated mental illness. I include drug and alcohol addiction here, as well as many serious forms of abusive behavior, even those that cannot be easily treated or prevented. It will help the injured child if you even let him know that you know what is happening and are trying to figure it out. There is nothing more harmful than when a child thinks that he is the cause, or feels responsible for not solving his parents’ problem.

So, back to my central point: we need to ensure we have the right integrated local team to tackle mental illness. We also need to use the same model for mental health that we use for physical health.

No one thinks you will get fit unless you exercise and exercise.

Why then do we allow so many mental health issues to escape such a fitness training program, returning them to full mental health functioning?

The thought “healthy body, healthy mind” has always worked both ways. We need to prioritize both and strive to ensure that as many people as possible in all our communities are in the best physical and mental shape possible.

Dr Alastair Noble worked as a GP in Nairn and was awarded an MBE for his work integrating health and social care in Nairnshire.