Scotland’s independent think tank
Scotland’s independent think tank

Mental Health and Child Poverty – Can we do Better? – Alastair Noble

I think we need to take a step back and look at what we mean and diagnose as mental illness and what Mental Health /Wellness and Mindfulness actually mean.

As a GP with a long-term interest in mental health, we prioritised appointments of our many essential professionally trained staff to allow our community to benefit from correct treatment of those with mental illness. This was alongside and in tangent with all the other essential building blocks of a successful and sustainable community.

The Greeks worked out several thousand years ago the fascinating relationship between “a healthy mind and a healthy body.”

We do not need any more research to show that healthy exercise, good education, good housing, healthy diet, sensible alcohol intake, not smoking, good jobs, good relationships all contribute to longer healthy lives.

The opposite is obviously true as well. Poverty is not just present in financial terms but as importantly in all other aspects of the opposites to all of the positives above.

We need to make sure we deliver both prongs of this delivery plan to achieve maximum community health and wealth, but also to target the correct treatment of mental illness.

We also must rigorously evaluate our differing delivery options and as always prioritise productivity and value for money.

It is worthwhile to consider what worked really well in our Nairn Model for Mental Illness. Firstly we decided that some of the biggest health gains we could deliver would come from improving the outcomes for patients with mental illness. Again, our well proven model of early and correct intervention with an integrated care team was known to work. Generally early, correct intervention was known to deliver better outcomes than late, often dramatic intervention.

Some very important examples – it was easier to stop young females from developing anorexia nervosa by early intervention and sensible discussion with them, and often their parents, than it was to try and treat established and often intractable anorexia nervosa in its late stages.

Similarly, the work of DRAMS (Drink Reasonably and Moderately Sensibly) shows positive benefits in early identification of too much drinking before it became addictive dependency.

So how did it all work? The team met every Wednesday morning to look at all referrals and allocate them to the most appropriate member of the team or even back to the GP.

Our psychiatrist was a psycho-geriatrician but in fact dealt with all our adult psychiatry. (I do wonder about all this hyper specialism). She was incredibly supportive of the whole team approach and very much in “what do you think is wrong approach to the individual patient and more importantly what can you as the individual do to help yourself and get it sorted?”

We had excellent mental health nurses, social workers, psychologists, occupational therapists, and excellent links to health visitors, midwifes, district nurses, social workers as well as the practice team. This also applied out of hours, when again our local nurses and GPs were on call. The mental health team could leave clear instructions on the correct response to emergency calls.

The outcomes were very impressive – we went for weeks on end with no inpatients in the psychiatric hospital in Inverness. When our psychiatrist was on call at weekends and doing a ward round, she saw patients who she knew would have been better cared for in their own community with our team approach. We had numerous outside evaluations and my favourite quote from a patient with severe mental illness was simply “this is the best I have ever been”.

Patients who had been frequently readmitted before were coping well in their own community with their own families and friends.

So, as often in medicine the correct early diagnosis and sensible consistent treatment delivered better outcomes.

So, what is happening now?

We have a rather unbelievable 814 social prescribing voluntary groups listed for various causes on ALISS for Nairnshire alone. No wonder individuals are struggling to find the right help. We are also dribbling out large sums of money with no evaluation or long term follow up.

We must return some clarity and common sense to our locality based and outcome driven Model. The recent paper by Des McNulty highlighted how the spending is rising on an exponential curve, at the same time as we have more referrals, longer waiting lists and above all more children affected by poverty and mental health problems.

Nothing can be more damaging for a child than living in a home with undertreated mental illness. I include in that drug and alcohol addiction and many serious forms of abusive behaviour-even if that is not easily treatable or preventable. It helps the affected child if even you can let them know you know what is happening and are trying to get it sorted. Nothing is more damaging than for the child to think they are the cause or feeling responsible for not curing their parent’s problem.

So, to return to my central theme -we need to ensure we have the correct integrated local team to deal with Mental Illness. We also must use the same model for mental health that we use for physical health.

Nobody thinks you will get physically fit if you do not exercise and train.

Why then are we allowing so many mental health problems to avoid a similar fitness training program back to full mental health function.

The “healthy body, healthy mind“ thinking has always worked both ways. We need to prioritise both and aim for as many individuals as possible in all of our communities being as physically and mentally fit as possible.

Dr Alastair Noble worked as a GP in Nairn and was awarded an MBE for his work in integrating Health and Social Care in Nairnshire

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