Microsoft word - paul jenkins speech - 7th march event.doc
It’s a great pleasure to come to speak to you this morning. Extending access to people with severe mental illness to talking therapies is an issue of great importance to us at Rethink Mental Illness and this conference is important sign that after years of campaigning on this issue something is being done to address it. I want to cover three issues in my remarks this morning:
- Why access to talking treatments matter to people with severe mental illness
- What we have learnt from the work of the Schizophrenia Commission and the
National Audit of Schizophrenia about current levels of access
- What we might be some of the solutions to improving access
I am sure that I hardly need to describe to the audience today how devastating a severe mental illness can be for an individual both in terms of the symptoms of the illness and in terms of the impact which their condition has in some many cases on their life chances. And yet while this is true for so many individuals it does not have to be the case as many personal stories of recovery testify.
However, as we tried to say in the report of the Schizophrenia Commission last autumn, we have allowed conditions such as schizophrenia and psychosis to become diagnoses of despair. We tolerate dismal outcomes such as 15-20 year premature mortality or an employment rate for people with schizophrenia and psychosis of less than 10% as if they were an inevitable consequence of a mental health condition rather than something which can make a difference to if we changed the way in which we did things.
There were a number of issues both high level and more detailed which we identified in the Commissions’ report as central to this state of affairs and its not my intent this morning to go through them all.
However one issue stands out. We do not consistently provide people with what works and that point is very pertinent to the provision of evidence based talking treatments and other psychological interventions.
From lots of conversations I have had over the years with people affected by mental illness and from the evidence we collected for the Commission I am strongly convinced that timely access to talking therapies can be a real game changer in helping someone recover from a severe mental illness.
Take David’s story as an example. After developing schizophrenia as a postgraduate student David endured years of unrelenting distressing symptoms took on various occasions close to taking his own life. He was prescribed clozapine which helped reduce the symptoms but which he had to stop taking due to the physical side effects. He waited years for access to talking treatments but eventually did get access to CBT. The therapy gave him skills to cope with his voices and helped him overcome chronic problems with sleep. This intervention helped to lift the grip the condition had on his life and started him on a journey to start doing again the things in life he wanted to do.
This is not a unique story and it supports the evidence which has been built up and supported by NICE for the effectiveness of talking therapies such as CBT for helping people manage the positive symptoms of psychotic illness, develop better insight into their condition, deal with co-morbid depression and build the basis for taking back control of their lives.
People affected by severe mental illness and their families know this and it was hardly a surprise that CBT topped the list of interventions which the 2500 respondents to the Schizophrenia Commission on-line survey most valued alongside medication.
So against this backdrop it’s shocking that so few people still get access to what could make such an enormous difference to their lives. I was shocked by one estimate we were given during the course of the Schizophrenia Commission that perhaps only 10% of people with psychosis were given access to true CBT.
This concern was echoed in the report of the National Audit of Schizophrenia and while it’s not clear exactly what the gap is between who those who want and could benefit from access to talking treatments and those who get it, it is clear that we are talking about a very significant level of unmet need. I for one do not think it is acceptable that we can tolerate such a blatant level of lack of access to an evidence based intervention. When I was asked on the BBC Breakfast Couch on the day of the launch of the Schizophrenia Commission report whether I was being optimistic to think that it was possible to address this I said that this like saying to a cancer patient that we could offer them chemotherapy but they have to wait for radiotherapy and maybe the budget wouldn’t stretch that far. We all know what the public reaction to that would be.
This issue is a critical test of the promise to promote parity of esteem between physical and mental health.
So what are the practical solutions to address this?
I very much welcomed the work to set up the demonstrator sites on improving access for people with severe mental illness to talking treatments and I look forward to learning more during the course of the day about the progress they have made. It is incredibly important that in some form or other this programme is enabled to continue as we have move to the new commissioning arrangements for the NHS and that we are in a position to build a solid evidence base about effective approaches to extending access.
Within the work we did in the Schizophrenia Commission we favoured a view that the most promising way of improving access lay in reskilling the existing workforce and particularly nurses, in both inpatient and community settings, to deliver a range of psychological interventions whether formal interventions such as CBT or less formally being able to take a more psychological informed approach to their work with people using services. This would include the ability to better listen and interact more sensitively to people as well as being able to provide support and assertive encouragement to individuals to engage with activities which would support their recovery.
We were encouraged by evidence we heard in some parts of the country about the proportion of the wider workforce (50%) which had already had some training on talking therapies.
However training on its own will not be enough as we heard too many cases of how the structure of teams, the pressures of day to day caseloads, the lack of support and supervision meant that staff were enable to put their skills into practice.
My sense is that to make this model work we need some quite profound restructuring of how services are organised, some investment in clinical psychologists to provide resources for supervision and to deal with more difficult cases. Above all we need clear leadership from Boards, senior managers and commissioners that this should be a priority.
I believe there is a compelling case for this investment in terms of the improved outcomes it would deliver for individuals and the impact it could have in reducing the use of the most expensive parts of the system such as inpatient and secure care. It is shocking that we spend 20% of the whole adult mental health budget on several thousand placements in secure care and I believe commissioners, at both national and local level, need to address how their can be some rebalancing of priorities in the system which make a reality of the investment needed to transform access to psychological therapies.
- We know improved access to talking therapies can be the key to improved
outcomes for people with severe mental illness.
- We know it is something which people with severe mental illness and their
families value enormously but in so many cases struggle to access.
- It is a glaring example of the lack of parity of esteem between physical and
- We’ve recognised the issue and it is possible to do something to tackle this
I look forward to the day’s discussions and what we can learn about how to make a reality of improved access to psychological therapies for people with severe mental illness on the ground.
Mod 54 Biomedical Therapies Obj 1 Goals Biomedical therapy: prescribe medications or medical procedures that act directly on patient’s nervous system Drug therapies Psychopharmacology: study of effects of drugs on mind & behavior Since 1950's treatment of choice for those w/severe disorders Deinstitutionalization: due to drug therapy, minimize hospitalization as an intervent
The American Journal of Surgery 185 (2003) 26 –29Qualities of enduring cross-sector partnerships in public health Pfizer Medical Humanities Initiative, 235 E. 42nd St., New York, NY 10017, USA Manuscript received September 4, 2002; revised manuscript September 7, 2002 Abstract The social, economic and political challenges accompanying our rapidly transforming global health environments h