recommendations focused on commissioning for preventative and quality care, research and innovation for change as well as leadership ‘within the NHS, government and wider society’. In the same year, NHS England published its response, Implementing the Five Year Forward View for mentalhealth (NHS, 2016a), confirming that it accepted the recommendations and outlining its implementation plan. Three out of six key principles of the plan are directly relevant to this study: ‘co-production with people with lived experience of services, their families and carers’; ‘working in partnership with local public, private and voluntary sector organisations, recognising the contributions of each to improvingmentalhealth and wellbeing’; and ‘identifying needs and intervening at the earliest appropriate opportunity to reduce the likelihood of escalation and distress and support recovery’ (2016a, p. 5). The NHS Shared Planning Guidance (2015) promoted the development of joint proposals for implementing the Forward View through local collaborations. As a result, on a practical level, NHS and local councils are developing shared proposals about how to improve health and care in local areas (sustainability and transformation partnerships). These are based on the principles of collaborative work among local leaders, development of a shared vision, involvement of the local community, and learning and adapting. Yet, there is no specific mention of the potential for collaboration with adult community learning. With regards to a mentalhealth policy related to education, the Department of Health and the Department for Education published a joint Green Paper Transforming children and young people’s mentalhealth provision in 2017. This Green Paper prioritises early intervention and prevention linked to schools, general FE colleges and universities up to age 25. For young people in education aged 16–25, it describes a new national strategic partnership focused on improving the mentalhealth of this group of students.
Bev also spoke about some of the resources available when supporting those experiencing mild- moderate distress including the use of mindfulness, of hobbycraft, and directing to online self-help resources that promote mood tracking and cognitive behavioural techniques, as well as community peer support such as that provided on Twitter through #PNDhour. In addition, Bev highlighted the relevance of mentalhealth to all care providers and the need to value attributes such as kindness, just as we value ‘medical’ skills. She emphasised that this does not require specialist training and that all practitioners can make a difference through simple steps such as ensuring that at some point in any consultation they have put down their pen or turned away from their computer and actively listened to the individual and their concerns.
As Atmiyata champions and mitras were trained to detect and help people experiencing stress or CMDs, it was essential for Atmiyata champions to remain moti- vated and committed to the work that they do to feel supported by a broader network of health and social care professionals should a person’s care needs exceed their competencies. The local field staff team, consisting of two psychiatrists, a community public health expert, and non-governmental workers familiar with the pro- ject sites, worked closely with district and local level public health authorities to build a referral pathway for those who required more specialised care (e.g. severe depressive episode, psychotic episode, risk of suicide). Addresses and names of psychiatrists located at the dis- trict hospital in Nashik, and primary health care centre in Karanjali were provided to champions on paper as well as in the app. When the champion identified a person with a moderate or severe CMD, or someone they sus- pect might show signs of a severe mental disorder, they worked directly with the person in need and their fami- lies to go to the District Hospital. In the event the person was unable to financially afford transport, the champion spoke to village leaders (such as elected head of the local gram Panchayat, which is the local self-government organisation at the village or small town level) who then arranged transport. Champions accompanied the person to the district hospital for their first visit and liaised with the district psychiatrist or doctor which helped to ensure a smooth consultation, as prior linkages made by the project team between local psychiatrists and champions
In the Department for Education we want all children and young people to have the opportunity to achieve and develop the skills and character to make a successful transition to adult life. Good mentalhealth is a vital part of that. The challenges young people face are hugely varied – from stress and anxiety about exams to incredibly serious and debilitating long-term conditions. Everyone who works with children and young people has a role in helping them to get the help they need. That is why I am so pleased to be the first minister in the Department for Education with a specific responsibility for child and adolescent mentalhealth. And why I wanted the department to work closely with the Taskforce to look at how we can make a better offer to children and young people. I believe success in this area comes from Government departments working closely together. We want to make sure young people no longer feel that they have to suffer in silence, that they understand the support that’s available for them and that they see mentalhealth services as something that can make a real difference to their lives.
In addition, there are barriers to colocating child and adolescent psychiatrists and other mentalhealth profes- sionals in primary care settings. Physicians have a long- established pattern of extending access to their medical services through the employment of nurse practitioners and physician assistants in their offices to treat patients under a physician’s supervision. Medicare pays for these services as if they are provided directly by the physician as long as they are provided according to Medicare “in- cident to” ‡ regulations. Private insurance companies and
Unfortunately, the response rate in the school-based adolescent survey was lower than in the adult household survey. This was mainly due to difficulties in tracing adolescents from the target LSOAs into their schools be- cause the National Pupil Database, which was used to develop the sampling frame, lags at least one school year behind. In addition, some schools were reluctant to take part in the surveys because they were already taking part in a number of local and national surveys and felt ad- ministratively over-burdened, in addition to concerns about student welfare and educational disruption and potential stigma attached to taking part in the Well Lon- don survey if fellow students knew that the intervention was targeted at particularly deprived areas. This had a substantial impact on the response rate in LSOAs where the majority of pupils attended a single school if that school did not participate in the survey. We would rec- ommend better coordination of health and social surveys to reduce respondent burden and increase the efficiency of data collection. In addition, greater incentives are needed for schools to take part in area-based studies, where a few pupils across a number of year groups and schools are surveyed, because little useful information is generated about the student population at each school,
Good mentalhealth is the foundation for our lives; it helps us to flourish. Poor mentalhealth is a huge burden on individuals, families and communities in our region, both in the quality of their lives and the devasting early deaths of too many people. This includes around 250 deaths from suicide in the North East each year, but a further 1,500 deaths of people with serious mental illness who die prematurely from other causes. Improving public mentalhealth is not only the right thing to do, it also make economic sense. A recent report from Public Health England shows that for every £1 spent on identified prevention activities, the returns are often double that.
There needs to be more widespread understanding of what it means to be a Looked After Young Person. Participants repeatedly stated that the only representation of children in care that others know is the TV character Tracy Beaker and that they are tired of telling peers that they are ‘not like Tracy Beaker’. Discussions in school around equality and diversity should include conversations about where young people may live. Normalising the idea of Care so that all children understand that young people grow up in a variety of different settings, including foster care and residential care, will help to alleviate some of the stigma attached to children growing up away from the family home and will improve their overall wellbeing and mentalhealth.
This article deals with health care professionals working with people with a mental illness, involvements in rehabilitation, and highlights some important choices and activities which can lead this work in terms of better personal involvement. Mentalhealth care is a complex area and many categories of professionals are involved. Recent quality indicators derived from international standards to guide practice indicate the importance of person involve- ment, high quality competence, leadership, and ofﬁ cial policy (NDHSA 2005). In future health care and social settings, we will meet people with more complex problems than at present, which will require greater multidisciplinary cooperation. The organization of the mentalhealth service in Norway is currently undergoing a series of fundamental changes to meet these challenges. New legislation has been introduced with an aim to alter the structures, organizational practices, and coordination between professionals. Important changes imply that the focus will shift away from the domains of the health professionals to the services, and from health professionals to people with mental illness.
There have been concerns that in the industry mentalhealth is not talked about openly and carries a stigma preventing people from opening up about any problems and this is certainly acknowledged by some of the employees across levels. One employee, also relatively new to the industry, reported that “this workplace has a different mentality, I would like to see more openness and honesty within the culture” with this being agreed by a further report of “it’s a lot less talked about in our environment”. Some of the employees were very passionate about this changing however with comments including “we have to get around the stigmatism, we have to get past the ‘you’re a mechanic you should be hard skinned’ you shouldn’t have to just deal with it or take it”. This is very encouraging and highlights that employees are receptive to changing the misconceptions people have and improving avenues for discussing mentalhealth, so all employers should embrace discussing these issues.
The funds became available as the result of a large ‘underspend’ identified by the then director of public health. In a short amount of time, the city council and NHS designed a programme of work to spend the surplus funds. The programme they designed was consistent with one of the four principal missions for NHS Coventry, ‘Improvinghealth and reducing health inequalities in Coventry’, as well as meeting one of three strategic aims for Coventry set out for 2010/11-2013/14-Addressing lifestyle risk management issues (ALRMI) (Health Strategy for Coventry, 2010). In September 2009, the aim of CHIP was stated as the delivery of ‘...a major component of the Health Strategy for the City’ which represented ‘a delivery partnership between the lead Agencies NHS Coventry and Coventry City Council and a wide range of partners and stakeholders across the City’ (Simon & Barbosa, 2009). Eight projects were originally laid out as CHIP (Simon & Barbosa, 2009) with the ninth added later (Health Checks). The projects were described as ‘experimental or pilot projects as they are focussing on areas of intervention which are not well evidenced’ and that as a consequence, it was ‘...therefore important that in addition to informing future investment decision making a robust evaluation approach is instituted to identify and embed learning for the City’ (Simon & Barbosa, 2009). CHIP was still in development when the Health Strategy document for 2010/11 to 2013/14 was finalised on February 5 th , 2010.
The Well London program used a community engagement and co-production approach to design and deliver a suite of community-based projects with the aim of increasing physical activity, healthy eating, and mentalhealth and wellbeing in 20 of the most deprived neighborhoods in London. The projects involved a mix of traditional health promotion interventions, community engagement activities, and changes to the physical neighborhood environment. The same framework for community engagement was used in all of the intervention sites, although the exact combination of projects delivered was tailored to local needs, in line with current theory on the design and evaluation of complex interventions [52,53]. The intervention program was funded by the UK Big Lottery Wellbeing Fund and was delivered by a partnership of community organizations and practitioners, led by the London Health Commission. Further information about the Well London intervention can be found on the Well London website  and in the published protocol ; the trial is funded by the Wellcome Trust.
Therapeutic work and mainstream health and social care are seen as feminized; male facilitators can gain credibility from “lived [male] experience” (TTC, MTD) in areas that men can emphasise with, and areas that make it easier for them to empathise with the men; and from being a role model. Having male leadership was often important to ensure the male point of view is well understood and represented, although there could be advantages in prominent female involvement (CALM). For example, Mojo discussed the need for female staff to share their ‘struggles’ with the men in their lives as a way of creating a rapport with the men they are working with. A complex area concerns deciding who are the key influencers to involve, regarding access, communication and prevention, for example involving men-only barbers shops or also hairdressers to engage partners (MTD). There is vigorous debate on programmes about the desirable gender and skills mix of staff (MAC UK). “young people often say that it’s easier to speak to women about the more emotional, maybe psychological side of things and more practically orientated conversations with men, but not exclusively so and very much dependent on the individual and their own experiences of attachment figures” (MAC UK)
People living with mentalhealth difficulties or issues related to substance use are also less likely than others to be engaged in their communities and are more likely to experience difficulty accessing and maintaining housing, education and employment. They are often the most marginalised in our community and are particularly vulnerable to becoming involved in the criminal justice, youth justice or child protection systems. These disadvantages are compounded for people with exceptionally complex problems who experience multiple problems and interact with health and social services systems on a long-term basis.
Mentalhealth screening was also introduced for adults and children, reflecting UK processes and the expertise of Australian psychiatrists in identifying refugees requiring intervention and treatment. Onshore refugee healthcare providers have responded positively to the prompt linkage to mentalhealth services postarrival. An evidence based evaluation of Australia’s introduced mentalhealth screening is now being planned. In addition, more extensive collection of premigration health information has assisted access to required health services and appropriate accommodation immediately on arrival.
“Consideration should be given to making training on mentalhealth awareness and the protocols for reporting concerns available to all relevant staff. This includes academic and related departments, service and support areas, frontline and auxiliary staff, personal tutors/hall tutors and departmental disability officers. Such training could be cascaded to staff who have a front line role including cleaners, canteen and library staff, whether they are permanent contract or agency staff.” (p.7).
Adolescents are ill-equipped to provide help to peers suffering from mental illness. Around a quarter of a sample of 13–16-yearolds said they would directly engage an appropriate adult helper, and half said they would try to help their friend solely through positive social support. Similar results were found in research conducting by Dunham
Previous research has suggested an association between eating disorders and depression (Bauman, 2016). In attempts to reduce weight for racing, negative attitudes toward dietary intake have been suggested to make jockeys susceptible to developing maladaptive behaviours and vulnerable to eating disorders (Caulfield & Karageorghis, 2008). Disordered eating behaviours, including fasting and purging, have been reported in jockeys (Dolan et al., 2011; Wilson et al., 2014). Given that 50% of professional jockeys reported cutting weight up to 3 times per week compared to only 9.5% of amateur jockeys, it may be suggested that professional jockeys are required to employ disordered eating behaviours more frequently than their amateur counterparts. Difficulty making weight or the frequency of cutting weight were not identified as predictors of depression in this study and cannot be used as an explanation for the reported depressive symptoms in professional jockeys. Further research is required to investigate the impact of making weight and engaging in disordered eating behaviours on a regular basis on long-term mentalhealth in light of the disordered eating behaviours and attitudes towards food reported (Caulfield & Karageorghis, 2008).
The quality of practice for mentalhealth care in general needs to be improved for people with learning disabilities. The challenge for the NHS is to know how well they are doing. The CQC along with Health Quality Checkers would go some way to bringing a different perspective as to what is acceptable care. The Green Light Tool Kit (Turner and Bates, 2013) gives services the opportunity to review their own quality and share and replicate good practice. The Reasonably Adjusted Report (Turner, 2012) described the reasonable adjustments that mentalhealth services were already putting in place for people with learning disabilities and people with autism. The sharing of good practice and reasonable adjustments will offer ideas of positive practice that others can replicate. Hall et al (2006) demonstrated that a local service called the MentalHealth Service for People with Learning Disabilities (MHSPLD) can be effective in supporting and treating this group. It is a service development in keeping with UK government policy that promotes cross-agency working and access to mainstream mentalhealth services for people with intellectual disabilities. Community and inpatient groups were compared across three time points using a range of clinical outcome measures that assessed psychiatric symptoms, risk, needs and level of functioning. Inpatients and community groups had similar mentalhealth problems, but inpatients had higher unmet needs and lower functioning, and were at greater risk. There were significant improvements across the range of outcome measures in both groups.