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You and Yours聽- Transcript 大象传媒 Radio 4 |
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TX: 26.11.04 - Mental Health PRESENTER: WINIFRED ROBINSON |
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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT.聽 BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 大象传媒 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON All this week we've been looking at the government's blueprint for a healthier nation.脗 Mental health is there, as you'd expect.脗 According to the White Paper a quarter of all GPs consultation time is now spent with people who are anxious, depressed or have more severe mental health problems.脗 Again, according the White Paper, stress has replaced backache as the most common reason offered for time off work. The Department of Health identified mental health as a neglected area five years ago.脗 The White Paper lists a series of initiatives already underway to try to reduce the number of suicides, to end racial inequality in the treatment of mental patients, to improve mental health in the workplace and there's an announcement of an expansion of the Sure Start nursery programme in poorer areas to try to prevent the neglect that can lead to mental illness in later life. So how's it all been received by the mental health charities?脗 This is Marjorie Wallace from SANE, it's an organisation which campaigns for better services for those with severe mental health problems. WALLACE We welcome the White Paper because it actually includes mental health amongst the other health priorities but we feel that it seems to be diverting attention to rather remoter issues, it seems a little strange to be flagging up programmes for toddlers to "put them on the right path in life to protect against later mental health problems", when we're having tragic stories such as the parents who made a suicide pact because they were driven to such desperation in not getting help with their daughter's mental health needs now.脗 We're failing to protect people now.脗 Another example is the supporting of what appears to be rather vague initiatives to challenge discrimination in the workplace.脗 Well that really seems rather a luxury when we still have hundreds of people who are too ill, they're under treated, they're living empty lives in run down accommodation and they're not being given enough help to even contemplate work, let alone have to survive in any workplace. ROBINSON Marjorie Wallace of SANE. Professor Louis Appleby is national director for mental health in England, he's responsible for both advising the government and for implementing its policy on mental health and he's in our Manchester studio.脗 We know from the calls and letters that we get to this programme that there are lots of carers caring for people who have severe mental illness who feel alone and unsupported, where then are their needs addressed in this White Paper would you say? APPLEBY Well what carers want most of all is good care for the people who they're looking after and that's the biggest need that they have.脗 The White Paper signals something very important - I think it's the moment at which we broaden out what we're trying to do on mental health policy generally from a particular emphasis on specialist mental health services - which is where we've been working particularly hard in the last few years - to the broader mental health of the community.脗 And I know when Marjorie Wallace from SANE is critical of how much progress there's been I understand that of course we're five years into a 10 year strategy, there are bound to still be difficulties.脗 But if you look at what the last five years have brought about - we've had an unprecedented increase in the money spent on mental health nationally, big increases in numbers of key staff, a large expansion in the availability of modern treatments, 500 specialist mental health teams that we didn't have a few years ago and we've got the lowest suicide rate on record.脗 Now that's not a bad set of achievements for the first few years.脗 But it does, I think, mean that we need to move from the care of people with acute mental illness - although that will obviously remain central to what we do - to the broader mental health needs of the community. ROBINSON But their point is that in many areas Professor that that basic care is not even in place. APPLEBY Well that's demonstrably false. ROBINSON So she's wrong then - Marjorie Wallace is simply wrong about that? APPLEBY The basic care is in place everywhere.脗 What we've now got are a development of additional specialist teams in most parts of the country - not everywhere but in most parts of the country.脗 And what the White Paper is about is about a broadening out of our mental health aims so that we are now tackling some of the additional problems.脗 And the long term mental health of people who are at the moment children and living in deprived families I think that's a hugely important issue and I don't think we should downplay it. ROBINSON So the point - the example that she raises about the couple who entered into the suicide pact because they could not cope with their severely mentally ill daughter what do you say to that then? APPLEBY Well I'm sorry I'm not going to get into discussing an individual case, except to say that when the case has been properly investigated locally I think we'll have a much better idea of what happened there.脗 If your point is that we need to do more in specialist mental health services then of course I agree with that, I said we're five years into a 10 year strategy.脗 But mental health - a few years ago when I first started out in mental health it was a very neglected sideline in the NHS and it's now at the centre of major government initiatives and we need to recognise that the starting point was a very low one and that quite a bit of work still has to be done but a huge amount of progress has been made, largely thanks to the hard work of people in local services who do a tremendous job, they're the people who set up the new services after all. ROBINSON Well as I said the White Paper where it mentions mental health is in the main a r茅sum茅 of policies and initiatives which have already been announced and this is what Sophie Corlett from MIND has to say. CORLETT We're glad to see that mental health is even included in this White Paper, we were concerned that it was going to be missed out altogether because of all the discussion around obesity and smoking.脗 Clearly those are important issues but mental health is an even bigger one.脗 We know that one in five workers - that's about five million people - are affected by work related stress.脗 We know that it's the commonest reported cause of sickness absence. 脗 We know that one in six adults, even the report says, at any one time has a mental health problem.脗 And it's the most common thing that you might turn up at the doctor's with.脗 So we're still flummoxed at the way that mental health actually doesn't really still have a central focus within the White Paper.脗 We're also concerned that it won't necessarily be delivered, even the things that are in this White Paper.脗 About five years ago there was a recognition by the government that mental health was a real Cinderella service in comparison to other areas of healthcare and they introduced a national service framework for mental health, which effectively was a big grand plan for how they were going to deal with this and how a lot of services within mental health needed to change.脗 And the plan was great but what we've seen is that five years down the line a lot of that still remains to be implemented. ROBINSON Sophie Corlett from MIND. Professor Appleby MIND says that people experiencing common mental health problems still can't get access to cognitive therapy and counselling and that is what she means when she says that many things still remain to be implemented, do you accept that? APPLEBY Well I think that is one of the areas where we have yet to bring about a complete change in the system - I do agree with that.脗 I don't agree with the suggestion that really not very much has changed, for the reasons I've already given you.脗 But there are, of course, some areas where we need more intense activity and an expansion of what we're doing at the moment.脗 And one of the key ones is in the availability of psychological therapies.脗 It's not quite as straightforward as it sounds, there are quite a lot more people in the system who can deliver psychological therapies, we've had a big expansion in clinical psychologists for example.脗 But there is also an enormous demand for psychological therapies and so we have to look at new ways of providing people with what they want.脗 So we're trying to bring in new staff who can be trained just to provide cognitive therapy for example, that's the primary care mental health worker initiative - you know the plan is to bring in a thousand workers.脗 We are keen to develop better models of self care because sometimes people once they've been through the initial phase of treatment can be their own therapist and we need to be much better at providing the support that people need to do that.脗 And we need to be better at using new technologies - there are CD ROM versions of cognitive therapy which haven't really had a big impact on the system and we probably need to promote that a little bit better than we have done until now. ROBINSON Well we also spoke to Andrew McCulloch from the Mental Health Foundation and he feels that the White Paper missed an opportunity to promote a wider awareness of mental health problems. MCCULLOCH It is a good start but there are still huge gaps.脗 Government hasn't said what it's going to do to improve public understanding of mental health.脗 I would like to see government saying what it can do to improve the national curriculum and ensure that children learn about mental health and to improve higher education so that all the different disciplines that help us with social issues, with education, the police - everybody who needs to be trained to have a basic understanding of mental health does so. ROBINSON Professor Appleby what do you say to that? APPLEBY Well those things are in the policy on social inclusion which was published a few months ago and is referred to specifically in the White Paper.脗 I think it might be just worth saying what's actually in the White Paper so that when people say that certain things aren't in it we just have the facts right.脗 You mentioned the emphasis on children's mental health and the Sure Start initiative expanding the skills of school nurses and so on.脗 There's also an initiative on health trainers who will have a mental health brief that it be their job to advise people on reducing stress as well as on their physical health.脗 But it emphasises the links between physical health and mental health and it talks about the Wellbeing centres which are being piloted at the moment where people with mental illness can get good physical healthcare.脗 It talks about the community issues, that Andrew McCulloch is raising - social exclusion but also ethnic minority mental health - another big priority area.脗 There's an initiative on stress at work which we very much need in the NHS itself.脗 And it ends by saying that although these are broad strategic initiatives we now need to produce some very specific actions for the next couple of years and it asks me to bring these forward in the next three or four months.脗 So I think it's unfair to say they missed out on certain things, it's a very broad mental health document within the White Paper and it's asking for more. ROBINSON Well before we wind up could I ask you to answer briefly - do you think it really is possible to protect workers from stress in the same way that you can protect them from industrial accidents? APPLEBY Well I think that's an interesting question.脗 The White Paper does actually say that stress isn't necessarily all bad and of course there's a lot of research showing that people when put under pressure also perform well and to their own satisfaction.脗 But there are clearly times when working patterns and the demands of work place people - make people vulnerable to mental ill health, make them more anxious than they should be, can make them feel depressed and can have knock on pressures on the family and on - therefore on family life, marriages and the upbringing of children which do mean, I think, that we have to regard stress as a potential enemy here, even though it's not absolutely as straightforward an area as sometimes we make it sound. ROBINSON Professor Louis Appleby thank you. Back to the You and Yours homepage The 大象传媒 is not responsible for external websites |
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