Following the NHS Five Year Forward View (5YFV) published in October 2014 work has been under-way to implement this. We are told from the foreword of the original document that this Forward View represents the:
“…shared view of the NHS’ national leadership, and reflects an emerging consensus amongst patient groups, clinicians, local communities and frontline NHS leaders. It sets out a vision of a better NHS, the steps we should now take to get us there, and the actions we need from others.” (p.2).
Bold words. In some places putting my critical hat on highly improbable words I’d say. However putting all that aside I stepped forward to be part of the recent consultation for how the 5YFV might look for Mental Health in particular following the Mental Health Taskforce public engagement findings. This was held in Cambridge last week but for one reason or another I couldn’t make it on the day. So I added my tuppence via email having scrutinised the Taskforce documents and commentary from the other consultants. This is what I said. It speaks more to what was missing then what was present in the current plan for mental health. (I’ve lightly edited this for grammatical clarity. Some would say I should edit this more heavily in this regard!).
I have been able to review the slides and the strategy workshop documents. I largely agree with much of my colleagues comments I have to say – I would like to add the following points:
Models of research – the need for more ethnographic and autoethnographic approaches as a research methodology is clear as a means of both challenging and complementing the more biological models of research. A strand of funding then and a significant one at that is needed, e.g. from within a respected research funder such as the NIHR that is dedicated to funding qualitative research would serve to (a) legitimise these chronically disregarded and marginalised forms of research (b) foster parity between the disciplines rather than division.
This would also speak to the liberal sprinkling of comments around social determinants. Social determinants are well established – now we need interventions based on our understanding of social determinants – e.g. Haslam et al.’s work as well as continuing to explore the specific social determinants and factors in place for people with mental health difficulties that are geographically and contextually relevant (see: http://www.sciencedirect.com/science/article/pii/S0165032714000573,) . Hence the ethnographic/autoethnographic approaches mentioned above.
There has been some research into the impact of the current welfare system on the mental health and lives of people with disabilities and mental health problems. The direction of travel of the current research is clear.
More research is needed on:
- income inequality and mental health
- in work and out of work benefits, sanctions and the process of assessment and mental health
- housing and mental health
- the efficacy, effectiveness and safety of recovery colleges
Policies and processes of benefit assessments should be subject to evidence-based scrutiny/direction. They are not. It seems that evidence is rarely the meaningful guide to policy direction and development in spite of the money spent on the civil service, evidence reviews, consultations and strategies. There is rising media, lived experience and scientific evidence of the distress and deaths (people killing themselves) due to the assessment and sanctioning processes. (see e.g. White 2016 https://kar.kent.ac.uk/59731/1/insights-32.pdf., Perkins et al. 2017 http://www.emeraldinsight.com/doi/pdfplus/10.1108/MHSI-12-2016-0039).
I would strongly suggest that a specific theme of social determinants and social interventions is merited to give due regard and credence to all of the above.
As part of the upcoming Critical Mental Health Nursing volume I am developing the argument that compliments my approach to mental health nursing education, namely that MHN’s must shift towards political-psycho-social activism. This represents in some small way a bit of that on my part. The bullet points with the exception of the final point on Recovery Colleges were raised by MH activist colleagues Recovery in the Bin.