How the mental health crisis, technology and the pandemic are driving real change
According to the Adult Psychiatric Morbidity Survey commissioned by NHS Digital, even in the more ‘normal’ times of 2014, one in six people in England had a common mental disorder in the week that they were interviewed for the study. According to a Public Health England national Covid-19 surveillance report, the pandemic has increased this by a third. Demand for mental health services outstrips supply, with the Department of Health and Social Care estimating that 75% of people with mental health problems may not get access to the treatment they need.
What is interesting is how this crisis is creating a talking revolution driven by social entrepreneurs working in the community. This quiet revolution is largely being pioneered by citizen-led initiatives that are delivering measurable results outside the formal mental health system. Combined, they are filling some of the gaps, responding to real human needs.
Talk for Health was part of the RSA’s Connected Communities project, which in the 2010s focused on the role of social capital in community resilience, including in relation to mental health. Talk for Health provides therapy without therapists by training key members of the community as lay counsellors, giving them the confidence and knowledge to take the therapists’ skills of empathy, non-judgemental listening and conversational support out of the doctor’s surgery and into the hands of the community.
An evaluation of the project in 2019 found that lay counsellors have proved as effective as trained therapists. Independently verified evidence shows that this form of fast access to therapeutic talk is long-lasting and empowering. Results among 687 participants show a large rise in wellbeing after taking part in the programme; this also reduced depression over the long term. Two-thirds of the participants were clinically distressed at intake, with a range of diagnoses, from depression to schizophrenia.
Talk for Health is based on three powerful evidence-based principles. First, that simply having the skills and opportunities to share inner feelings and experiences with supportive others improves mental health and prevents mental illness. Second, that effective therapeutic talk does not rely on professionals; and third, that it is good for mental wellbeing to give as well as receive support.
When the pandemic struck, a massive effort was made to quickly adapt to an online and phone format. Since then, the number of people asking for help has doubled; many were in dire distress. The online version has proved equally successful.
Another example is an online service called Moodscope. Invented by a creative patient determined to solve his own depression, Moodscope is unique in that it enables people to accurately measure and record daily mood scores, which are automatically tracked on a graph and – with the individual’s agreement – emailed to one or more trusted friends who have previously agreed to keep an eye on the user.
The quick and easy daily test is adapted from the proven scientific PANAS (Positive and Negative Affect Schedule) test developed in the US in the 1980s and involves flipping and twisting mood cards until they reflect how people feel. The score is added to a graph where people can add a daily comment. A reminder to take the test, written by users sharing their experience, is sent out each day. There is also an empathetic community where Moodscopers inform and support each other by sharing experiences and insights.
When people are more aware of their mood, and can see how it changes day by day, they become more sensitised to what drives their moods. Consciously and unconsciously they adjust their behaviour so that their mood score improves over time. Independently verified research on frequent users shows a 36% uplift in mood over 90 days. People who do not do the test regularly still seem to get support from the daily email and the knowledge that they can resume the test if needed. Many seem to get solace from having access to an honest, sharing community.
The 30,000-strong Moodscope community responded positively to lockdown by supporting each other even more; the average mood score of users held up well, and even slightly improved, as the pandemic spread.
A skilled helper
Gerard Egan, Emeritus Professor at Loyola University of Chicago, is author of one of the world’s most influential text books on counselling psychology, The Skilled Helper, and has more than 50 years’ experience as a counsellor, educator, trainer and researcher. Recognising the huge gap in mental health services exacerbated by the pandemic, and with the help of his co-writer and communications expert, Andrew Bailey, Egan set about making his proven methodology available to lay people through a new format.
The result is The Helping Conversation – Common-sense Counselling Skills for Everyone, which boils down proven wisdom and expertise to its essential essence, introducing an everyday, conversational approach to helping others with their mental health. It makes the basics of counselling accessible to anyone with a rational mind, some life experience and the right communication skills. The helping process becomes a sequence of nine conversations, each focusing on a different critical step of the journey from problem to life-enhancing outcome. Again, measurement is built in by capturing user responses online.
How will the system respond to these innovations? Creating a joined-up mental health services system has been an aspiration for decades, but is government capable of involving and accelerating solutions like these? Given the high level of unmet need, policymakers should market test a comprehensive and integrated mental health service involving the community and roll this out when it is proven to work.
This article first appeared in the RSA Journal Issue 1 2021.
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