Working in Mental Health: Practice and Policy in a Changing Environment

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However, there are many areas in which we can and must do better. Our growing and changing population, increased awareness of mental health issues and changing pressures in society are increasing demand for services and raising challenges for communities. People who use, and work within, mental health services have been vocal about the need for change over many years.

The limitations in our current system have been made clear by research, mental health and suicide statistics, mortality reviews, service monitoring data and advocacy led by people with lived experience of mental illness. While some are calling for an inquiry into the mental health system, the Mental Health Foundation MHF considers this would not give us new insight and would divert funding, resources and attention away from the issues that need to be addressed.

Working in Mental Health Practice and Policy in a Changing Environment

The MHF believes that the challenges faced by the mental health system must be addressed by investing in positive mental and emotional wellbeing and preventing mental health problems and suicide. We must not continue to accept that individuals experiencing mental health problems will inevitably become so unwell they will need to be hospitalised.

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This trajectory can be averted for most people. We will not create better mental health within New Zealand by continuing with an imbalanced focus of resources on acute mental health services. Instead, New Zealand must increase its efforts in promoting wellbeing and preventing mental health problems from occurring. We must also improve access to quality, effective support for people who are mentally unwell. To do this, we need to give people a range of support options, and to address the pressure points within mental health services.

The MHF has identified 10 issues that are widely acknowledged by people with lived experience of mental illness, communities and people who work in mental health services as needing significant change. We intend to work with communities, the government, the health sector and the private sector to bring about change in these areas. Finally, the MHF emphasises that there must be political, community and individual will to tackle the social issues that can contribute to poor mental health.

Mental health problems are common, with 1 in 6 adults reporting a common mental health disorder, such as anxiety, in the last week - 1 and there are close to , people in England with more severe mental illness SMI such as schizophrenia or bipolar disorder 2. Problems are often hidden, stigma is still widespread, and many people are not receiving support to access services. Together with substance misuse, mental illness accounts for Mental health problems and suicide are preventable. Our mental health influences our physical health, as well as our capability to lead a healthy lifestyle and to manage and recover from physical health conditions.

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People with physical health problems, especially long-term conditions, are at increased risk of poor mental health - particularly depression and anxiety. Mental health problems start early in life. Social risk factors such as poverty, migration, extreme stress, exposure to violence domestic, sexual and gender-based , emergency and conflict situations, natural disasters, trauma, and low social support, increase risk for poor mental health and specific disorders. Across the UK, those in the poorest fifth of the population are twice as likely to be at risk of developing mental health problems as those on an average income.

Children who have been neglected are more likely to experience mental health problems including depression, post-traumatic stress disorder, and attention deficit and hyperactivity disorder. In there were 4, deaths by suicide in England. Men are 3 times more likely to die by suicide than women, and suicide is the leading cause of death in men under 50 and women under However, many people have had contact with other services.

People with severe mental illness SMI such as bipolar disorder or schizophrenia have a life expectancy up to 20 years less than the general population 14 , and the gap is widening. An adult aged 15 to 74 with a serious mental illness is 1. Healthcare professionals can provide advice and support to people of all ages presenting with any issue and work to:. This is part of a wider drive to secure an increase in the implementation of public mental health approaches across the whole system.

The Mental Health and Wellbeing JSNA knowledge guide provide an overview of the areas to consider when thinking about the mental health needs in a local area, with a focus on understanding place factors and population groups across the life course. Preventing mental health problems and suicide and promoting mental health will impact on overall life expectancy and healthy life expectancy. There are a number of indicators in the Public Health Outcomes Framework related to mental health and wellbeing.

These include:.

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The Everyday Interactions Measuring Impact Toolkit provides a quick, straightforward and easy way for health and care professionals to record and measure their public health impact in a uniform and comparable way. The ultimate measure of physical health outcomes for people with mental health problems is an increased life expectancy and healthy life expectancy.

The national Preventing Ill Health by Risky Behaviours — Alcohol and Tobacco CQUIN has the potential to reduce the risk of physical health conditions such as heart disease, as well as reduce future hospital admissions. Quality and Outcomes Framework for to QOF includes several indicators relating to the physical health of people on the primary care register, for people with serious mental illness patients with schizophrenia, bipolar affective disorder and other psychoses. Physical health screening and monitoring is no longer the sole responsibility of physical healthcare professionals, such as GPs and practice nurses in primary care services.

Every health and care professional has a role to look after the whole person. This integrated approach is supported by bringing together physical and mental health. Rise Above is a social marketing programme which aims to equip 11 to year-olds with the skills they need to withstand social pressures and build their resilience.

One You is a nationwide programme that supports adults in making simple changes that can have a huge influence on their health, such as through eating well, moving more, drinking less and quitting smoking.

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Neither was it a destination that participants had reached or hoped to reach. Rather, participants relayed stories of continued growth and a process or journey of striving towards recovery-oriented practice. Participants described a need to continuously develop and strengthen their recovery-orientation. In order to do this, they detailed an active and ongoing process consisting of four components: intentionally seeking out knowledge, working to find fit or synergy between recovery-oriented practice principles and their professional identity and roles, maintaining hope, and developing confidence in defending recovery-oriented practices by strengthening their clinical reasoning skills.

All participants emphasised the importance of having a clear conceptualisation of recovery and recovery-oriented practice. Cultivating this was an intentional and active process. Participant understandings were constantly developing in response to new experiences and knowledge. They all highlighted a need to seek out opportunities to develop their knowledge, including learning directly from people with lived experience of mental illness.

Mental health in the workplace

As participants learnt more and more about recovery and recovery-oriented practice, they described simultaneously integrating their developing conceptualisations with their personal and professional identities. All participants described a strong compatibility or synergy between recovery-oriented principles and occupational therapy philosophies. They talked about aspects such as person-centredness, supporting engagement in meaningful activity, empowerment of the individual, and taking a holistic and contextualised approach as being key and common facets of both recovery-oriented practice and occupational therapy.

Four participants suggested that recovery-orientation was more compatible with occupational therapy than other health professions. Therapists described grappling to find fit between recovery and elements of their occupational therapy learning and identity. Finally, while being not identified by participants as a challenge, a number appeared to define recovery through an occupational therapy or clinically based framework, emphasising independence and function as desired outcomes.

Having knowledge of recovery and recovery-oriented practice and being able to find fit between emerging recovery knowledge and occupational therapy were not enough for participants to practice in a recovery-oriented manner. They also stressed the importance of having and maintaining hope and holding a genuine belief in recovery. It will get better than this. I was [initially] a bit nervous… these people have been through the mental health service for such a long period of time, so how much change are we going to be able to achieve?

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In order to actively nurture this hope, some therapists sought connections with people recovering from mental illness outside of their immediate workplaces. To apply their knowledge and adopt practices they believed in, participants also described needing to develop confidence in their ability to make sound clinical decisions and to justify recovery-oriented practices when they conflicted with practice-as-normal.

They particularly highlighted the practices around positive risk taking, a central mantra of recovery-oriented practice. As they gained more experience and developed sound clinical reasoning skills, clinicians described becoming more comfortable and confident with advocating for recovery-oriented practice. Participants reported navigating, utilising, and, at times, struggling with both human and structural aspects of their environments in order to develop and sustain their recovery-orientation to practice.

Most participants reported currently or previously experiencing negative coworker attitudes towards recovery. Ava, describing a previous workplace, said the following:. In contrast, working with a team of like-minded, recovery-oriented coworkers was perceived as highly beneficial. In these supportive environments, participants described pursuing and using the advice and support of recovery-oriented colleagues, more senior clinicians, and supervisors.

There is a hierarchy and if your consultant is recovery-orientated it makes a world of difference… they still direct treatments and they can push for recovery-orientated practices and have more authority than any other clinician… So, having them on board with recovery is the biggest enabler of all.

Further Acas support on mental health in the workplace

Participants also repeatedly highlighted the benefit of having people with lived experience working in their service. Peer workers were viewed as valuable assets. Participants described peer workers as inspiring hope in consumers and clinicians alike.

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Importantly, participants did not see their relationship with the human environment of their workplace as a one-way transaction. Therapists also described taking action to enrich their workplace culture through leadership and example. These structural aspects were both workplace specific and generic to the mental health system more broadly.

Structural challenges included the biomedical outcome-driven and risk-averse nature of the mental health system, restrictive environments, and time limitations. First, participants described a clinical outcome-driven system that did not recognise or place value on recovery-based practices or outcomes. Participants viewed these as restrictive, coercive, risk-averse, and therefore incompatible with recovery-oriented practice.