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Working towards care of the whole person: investing in mental health

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Alice Hamilton, the MS Trust’s Policy Officer, looks at a new report on public mental health services and considers what It might mean for people with MS

‘Mental health’ always sounds remarkably scary. In fact, it’s a misleading umbrella term that covers a whole range of things from needing psychological support in coming to terms with an event or diagnosis, through anxiety and depression, right through to very severe conditions.
Mental ill-health can form a part of people’s experience of MS, and particularly common in MS are are anxiety and depression. MS is unusual in that these symptoms may be a reaction to the diagnosis of MS, but they may also be symptoms caused by the condition. But did you know – I didn’t – that these symptoms occur to a greater extent in people with any long-term condition, not just MS.

Knowing this may make you feel better, or worse: like so many MS symptoms, treating anxiety and depression is possible, but accessing suitable treatment may be difficult. And it seems that difficulties in accessing suitable treatment are not confined to MS, a subject that the Chief Medical Officer of the NHS in England has this year chosen to focus on. Her evaluative report on the current state of mental health services in England, Public mental health priorities: investing in the evidence, provides a comprehensive overview of the current state of mental health services, and mostly comments on the woeful inadequacies of the system in sorting these out at the moment.

The report makes 14 recommendations to improve services, but buried within the 340 pages of text are some important observations that don’t make it to the recommendations. Some that seem more pertinent to many people with MS include:

  • mental health services are exempt from the 18-week maximum waiting time for services stipulated in the NHS Constitution http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/... This results in very long waits for services such as counselling
  • people with long-term health conditions are two to three times more likely to experience mental health problems than the general population, yet the majority of cases of depression among people with physical illnesses go untreated
  • people with ‘common mental disorders’ (eg anxiety and depression) are more likely to live in low-income households, to be single parents, not to be in work, and to experience fuel poverty. [We know that all of these issues affect some people with MS.]
  • it’s not just the person with the condition: full or part-time carers are more prone to common mental disorders, partly because of the difficult emotions and broken nights that may arise from the caring role, and partly because of the results of the caring role, such as difficulties with finances, work, housing, and possibilities to get out and about
  • mental health care accounts for only 13% of NHS spending while being responsible for 28% of all morbidity in England. [If you add to this the woeful underspend in England on neurological services, the upshot is likely to be very poor support for people with MS]
  • mental ill-health is both a cause of unemployment (ie may cause you to lose your job) and a result of it (ie people who are not in work are more likely to have poor mental health). [We know work is a huge issue for people with MS.]
  • there are structural problems in improving provision of psychological support in general hospitals, even though everyone recognises that better provision of these services often results in shorter hospital stays and in reduced hospital admissions

All in all, the CMO’s collection of evidence paints a gloomy picture. To address some of these issues, the report makes 14 recommendations from the evidence collected. Possibly the two most relevant to MS are Recommendation 6, which is that whether an individual is employed needs to be a routine part of patient records, as employment is central to mental health; and recommendation 14, recommends developing waiting times standards for access across mental health services.

We know, from what you tell us, that getting help such as counselling is next to impossible. We can only hope that the Chief Medical Officer’s report may spur NHS England to take this issue on and start to tackle some of the historical issues that create such difficulties in services.