18 October 2018

Mental health – developing, testing and spreading what works

by Professor Peter Fonagy

The chance of any of us going through life without experiencing a diagnosable mental health disorder (excluding dementia) is just about 16%. In particular, there is increasing concern about the mental health of our children and young people, with suicide being the most common cause of death for both boys (17% of all deaths) and girls (11%) aged between 5 and 19 in 2015.

The flurry of announcements last week around mental health is part of a response to this growing awareness of just how widespread mental health problems are. With the promise of £1.8 million for the Samaritans, £2 million for the Zero Suicide Allowance, the appointment of a new minister for suicide prevention, and more support in schools, it is clear that the government is keen to signal that it is serious about improving our mental health.

As one of the group of political leaders, innovators, experts by experience and clinicians gathered at 10 Downing Street for the PM’s reception following the First Global Ministerial Mental Health Summit, I was struck by the conviction in the Prime Minister’s speech to put right the ‘historic injustice’ of mental health inequalities.

But of course, the proof of the pudding is not in a rousing speech or the creation of a ministerial post but in what actually happens on the ground at local level to both prevent and treat mental health problems.

Here at UCLPartners, mental health is one of our key strategic priorities. We are working with our partners in health care organisations and academia across north London and parts of Essex, Hertfordshire and Bedfordshire to develop, evaluate and spread new and effective ways to support our population’s mental health.

Some of our work has grown out of initiatives that have been developed within our local patch  –  for example i-Thrive, implementation of a model of care for child and adolescent mental health focused on shared decision-making and a needs rather than diagnosis-based approach to child mental health. Preliminary data suggests that implementation of THRIVE leads to improvements in access and increases in the number of children and young people seen. Forty-eight per cent of children in England now live in an area that is covered by an i-Thrive framework, and we are working with partners in our region to support the development and uptake of the model in our area, as well as supporting national implementation.

But we are also testing and spreading innovations that were initially developed and piloted outside our region. For example, as one of the 15 Academic Science Health Networks (AHSNs) in England, we are working as part of a national programme to spread the Serenity Integrated Mentoring (SIM) model. SIM brings together the police and community mental health services to support people with complex mental health needs who have frequent contact with services. Originally developed on the Isle of Wight and in Wessex, and supported by the NHS Innovation Accelerator, the SIM approach involves training police officers in high intensity behaviour, risk management, and basic clinical theory, and then embedding officers within the local community mental health team. At UCLPartners, we’ll shortly be starting a study designed to assess the feasibility and effectiveness of implementing SIM in the urban, ethnically diverse context of London.

Alongside this, UCL is one of seven universities across England that will, come January 2019, start training for a new role to support mental health in schools and colleges. Education Mental Health Practitioners will treat children and young people with mild-to-moderate mental health problems in school and help those with more severe problems access specialist NHS services. I have long argued that support for the majority of mental health problems experienced by children is best placed where children are (in other words, schools) rather than jettisoned in a mental health facility, so it is wonderful to see this initiative getting traction and to play a part in its roll out.

The very welcome and much-needed media and political focus on mental health has helped provide air cover for the development of a plethora of initiatives to improve it. The key to making the most of these initiatives will be to share learning and evaluate what works in different contexts, and then to accelerate the adoption of those initiatives with the most potential to improve the mental health of our populations. By working in partnership with others both within our region, nationally and globally, we hope to help make this happen.

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