Public Health England’s (PHE) Mental Health Summit 2020 aimed to bring together major leads working in mental health both nationally and locally, to check-in on developments and opportunities for improving public mental health, and to discuss any key challenges in this area going forward. Like many other discussions pertaining to societal issues that day, talks at this event were dominated by discussions of social and economic inequalities, thanks to the publication of the Marmot Review, which highlighted a concerning erosion of progress in terms of quality of life and life expectancy for those living in the poorest parts of the UK. The Marmot Review pointed to austerity as a leading cause for this erosion, and there was no lack of demand when it came to ‘speaking truth to power’ at PHE’s event. PHE reserved spaces specifically for people with lived experience to attend (myself being one of them), and several appeals were made throughout the day from these voices to those working in leading roles within the sector to make more happen in terms of influencing government policy, with one attendee referring to efforts currently being made as akin to ‘re-arranging deck-chairs on the titanic’.
At the Our Minds Our Future campaign, we are acutely aware that with 75% of mental health conditions presenting at below the age of 25, young peoples’ mental health should be a strategic area of concern for public mental health. Currently, 16-25s are the worst served group by the mental health system; facing a postcode lottery of services, long waiting lists and a no-man’s land between child and adult care (1). Our Minds Our Future asks that government to take a human-rights based approach to rectifying this situation. This means delivering on international and national obligations that the UK has signed up to under law, rights that they have a duty to protect under the NHS Constitution. As a Rights Advocate for the campaign, I attended PHE’s event to see how the key principles detailed in the ‘NHS Mental Health Implementation Plan 2019-2024’ have been and are being translated into practice, and whether they align with a rights-based approach.
The event began with a promising start in terms of considering human rights in the context of mental health. Duncan Selbie, CEO of Public Health England (PHE) painted a grim picture of the situation that people with mental health conditions faced as recently as 30 years ago: mental ill health often meant institutionalisation, and only after losing everything we value in our lives would it be seen as appropriate for the health care sector to provide support. Selbie noted the impact of human rights campaigning and where that has brought us today, with our emphasis on care in the community, and he also mentioned that we should not be complacent – this is just the beginning.
One of the key principles in the NHS Mental Health Implementation Plan, outlined by Clare Perkins (PHE), is the ‘right to health’, and how a whole citizens approach is needed to achieve this, which is of course music to the ears of Our Minds Our Future campaigners! Kathryn Pugh, Programme lead for Children and Young People at NHS England and NHS Improvement also spoke about their vision that ‘no child or young person should be inhibited because they have a mental health condition’. Despite this rhetoric and passion, there is no mention of rights in the NHS Mental Health Implementation Plan.
Though people with lived experience were present, and often vocal, at the event, there was a lack of space made available for gaining insights from those who are experts by experience. Hearing about specific examples of approaches that different local councils are taking in their contexts was fascinating and a great learning experience, but the information covered here was not aimed at or intended for service-users to listen or feed back into. When one attendee asked the panel “how do we get services to move out of the way, so that people can do things for themselves, in a way that relates to their communities?” responses were sympathetic but by no means practical. There was an honesty and willingness to improve on this, with one CCG reflecting that they would like to have more active engagement from people with lived experience within the health sector in future.
An area that was relatively untouched throughout the day was people in higher education and mental health; schools and whole-systems approaches were discussed here and there, but considering that half of all young people now enter higher education, and, as mentioned previously, 75% of mental health conditions present during an age period when people tend to enter this level of study, there could have been more of a deliberate consideration of this group’s experiences and what the plan is for them.
One of the demands that we have at the Our Minds Our Future campaign is that support is community-based and informed by the very people that it is for. Greater Manchester provided an excellent example of what happened when government handed over responsibility for engaging people with long term mental health difficulties with the ‘Work Programme’ (gaining unpaid work experience through government approved placements). Using the radical approach of actually asking ‘service users’ (i.e. humans/citizens) what their problems actually are, they found a severe lack of self-confidence and a sense of systemic let-downs from the health care system to be the major barriers for this demographic in terms of entering work. After listening to the people affected and doing something about the things that those people said were hindering them, Greater Manchester’s devolved Work Programme outstripped the national success rate by double.
Public Mental Health is evidently a complex and nuanced issue, and as Selbie noted in his opening, we have only reached the place that we are today through campaigners belligerently fighting for their rights to be respected. Voices of lived experience at PHE’s event, though sparse, were steeped in frustration and confusion as to why it takes so long for change to happen. PHE panellists were acutely aware of and receptive to the long-term issues that plague the accessibility of mental health services, as well as the need for a whole-citizen approach. Many discussions, however, cycled back to the fact that whilst aiming for this public good, spending cuts often negate such activities. PHE panellists were eager for change to happen, and they urged campaigners and people with lived experience not to give up, and to make sure their voices ‘stay strong’; this is exactly what young people at Our Minds Our Future intend to do. We want our rights respected in reality, not just on paper. Make our rights reality by signing the #MyRightsMyMind petition now.
Zoe Maggs is a mental health campaigner who works with Youth Access as part of their Make Our Rights Reality programme. Youth Access is part of the Young People’s Health Partnership, a consortium of six national charities, part of the VCSE Health And Wellbeing Alliance. Through the Make Our Rights Reality programme, young people are demanding that government respect their right to good mental health, as government are obliged to do through a variety of legal documents, both nationally and internationally.