Putting mental health first

Mental ill health must be treated in safe familiar surroundings where and when it is needed says Melanie Main.

A woman with a long history of mental health problems that severely affected her work and relationships throughout her life, recently returned to full time work and now runs a support group for others with mental health problems. Like so many others she had struggled for years to engage with specialist services, until she was offered all the help she needed in the safe, familiar surroundings of her GP practice.

But the sad reality for most Edinburgh residents with mental ill health is patchy access to services and long waiting lists. If a GP can’t help, ‘a referral’ can simply equate to joining a waiting list. The Scottish Government waiting time target to see a specialist is 18 weeks, but the reality for over thousand people on the Edinburgh list is that some will have to wait for over a year. For anyone in need of specialist mental health care, this is tantamount to not receiving care when it is needed.

To put Scotland’s services in perspective, a GP in Zurich working with those suffering substance abuse, often associated with severe mental ill health explained his concerns for patients dropping out and disappearing because of a waiting time of 45 minutes between arriving and receiving specialist services.

For Edinburgh’s young people access to specialist services is just as challenging. The Scottish Government’s way of cutting their long waiting times was to make it harder to meet the criteria to see a specialist. This head in the sand attitude is unacceptable.

Our hard-pressed doctors and nurses in local practice are at the sharp end of this sorry situation. Recently GPs across Edinburgh were asked what professional support they needed – unsurprisingly their top priority was Mental Health. So a new approach was taken, and Mental Health nurses were recruited for 14 GP surgeries. Early results indicate an astonishing success for patients and a huge drop in referrals to hospital.

But still across the city every day people are told they must join the waiting list. Recently one such patient, left their surgery downcast. Later that day he passed the Stafford Centre off Leith Walk, saw a sign ‘Mental Health’, went in and found himself being offered an appointment with a counsellor the very next day. Integration – meaning NHS and Council working together across services – didn’t happen in this instance: GPs and community services appear not to be aware of each other’s existence.

The Edinburgh Integrated Joint Board (EIJB) is tasked with ensuring integration does happen in Edinburgh’s Health and Social Partnership: 5 Edinburgh Councillors and 5 NHS Lothian Board Members supported by representatives from across all sectors, users and staff. In the case of mental health it is failing to deliver, despite some inspiring pockets of projects and dedicated staff in the NHS and Council

The Scottish Government decision to restore some previously cut funding for mental health is welcome, but Edinburgh’s share is only £2.7million per year. I am calling for joint integrated services available on residents’ doorsteps: access when needed for the steady stream of residents who present to their GP with mental ill health.

Hospital services must be part of this change, open to new ways of working within the community. We have ‘Hospital at Home’ for older people and those with long term conditions, why not for those waiting at home on those long psychiatrists waiting lists?

In the current financial climate the traditional silos and single initiatives in health care are not an option. We need to bring mental health services together where they are needed, literally into the home and into the trusted GP surgery. It is better for people, delivers a better service and will even be better for the public purse.