It is well known that 1 in 4 people will experience a mental health problem in the course of a year, but it is less well known that those with long-term diagnoses will die on average 15-20 years younger. Aside from the moral imperative to tackle this, the financial costs of poor mental health have been estimated to be between £70-100 billion or 4.5 percent of GDP. We must develop new approaches in order to close the gap between mental and physical health.
Mapping publicly available data from across England, The RSA through the Open Public Service Network (OPSN) is demonstrating that the lack of attention paid to the physical health of mental health services users is having fatal consequences. We believe that by opening the lid on mental health service information opportunities will arise to close the gap through local action and fresh approaches.
OPSN is adding to a weight of evidence that suggests those in contact with mental health services are being failed by a system unable to adequately resource the interventions needed to deal with the scale of mental health challenges that the country faces. Challenges that this week were highlighted in a high profile letter, signed by leading civil society and government figures, urging for equal funding for mental health services in light of the Chancellor’s spending review.
OPSN has pulled together data demonstrating that having a mental health condition affects more than just your overall health. You are a third less likely to be in employment; less likely to live in stable accommodation and anywhere between 10-45 percent less likely to receive physical health checks like blood pressure, cholesterol checks as well as cervical cancer screening.
In terms of treament, not only will 75 percent receive no treatment but those that do are likely to experience huge inconsistency. In access to talking therapies we've found a take up as low as 5 percent among those with anxiety and depression in some areas, whilst the dropout rates for these therapies are up to 90 percent in others.
So given the recent attention these issues have received - how has this been allowed to go on?
Angela Slater, a co-coordinator from Time to Change, argued at the University of Sheffield pledge ceremony that this is a rights issue. “And like other rights campaigns, it takes decades to achieve your aims”.
Angela is correct to view it in these terms. Health inequalities relate to the experiences of other groups that experience discrimination. The over-diagnosis of schizophrenia amongst Black and Minority Ethnic groups, the levels of bipolar among Transgender people and the fact that women are 4-times more likely to be diagnosed with depression are all instances of how inequality gets “under the skin”.
A challenge so large requires us as citizens to help co-create health services which not only close the gap between mental and physical services but also convey the need for all public services to fulfil Michael Marmots’ two human needs: to foster control over and participate in decisions about your future.
There are live models that if better integrated into the health system would help better fulfil these needs and challenge inequality. The Hearing Voices Network (HVN) and the Young People’s Empowerment Project (Chilipep) in Sheffield and the RSA’s own Whole-Person Recovery project are leading examples. These are locally-based initiatives forming new models to challenge social isolation and barriers to health. Through focusing on developing positive, reciprocal and secure social relationships they give service users a far greater say in delivering co-production and help decrease health inequality.
The HVN allows those living with auditory and sensory hallucinations access to support groups. This allows patients - much like the Whole Person Recovery approach to substance misuse - to disassociate illness from sickness and develop strategies to manage illness as a part of a healthy life. “We’ll talk later” (referencing the group's encouragement of communicating with their voices) is one of its most inspiring maxims which encourages openness to an illness that historically has been highly stigmatised. It also strikes a fittingly ironic contrast to the high-profile ‘Time to Talk’ campaign.
This sort of targeted program of peer-led support should underpin all good service delivery. Chili Pep, funded by the Big Lottery Fund, with its health manifesto ‘On the Edge’ written by young people in Sheffield, encourages disadvantaged young people to increase their participation in health care decisions within NHS Sheffield Health and Social Care, and facilitated peer-to-peer support groups for those who experience anixety and depression.
We need to expand and increase resources to these locally and relationship-based iniatives. The RSA is providing a test-bed and calling for reimagined approaches to mental health and wellbeing to support this.
Our Connected Communities report, the result of a 5-year-long Big Lottery funded research programme, argues that connected, supportive communities are not only critical to building the kind of society that we'd all like to live in, but can also be mobilised to bring about better individual health outcomes. Programmes like these can not only increase quality of life but also extend lives, reduce pressure on the NHS and help close the gap between physical and mental health.
OPSN is demonstrating that in order to close the gap and reenergise social actors into co-producing fairer healthcare outcomes we must open access to information so that connected, supportive communities can organise around it. Only then can we invest in ‘community capital’ as a strategic health priority and create services that are built ‘with, not for’ people.
We’re reimaging wellbeing. Join the conversation: @theRSAorg #RSAwellbeing
Connected Communities: Mental Wellbeing and Social Inclusion report can be accessed here
OPSN’s web platform designed with and for mental health service users will be launching on November 18th at a reception event with invited guests from across government, the NHS and Mind at RSA House.