MENTAL HEALTH GAP INTERVENTION

Interview with Professor Scott Weich, Coventry and Warwickshire Partnership NHS Trust

Professor Scott Weich, Honorary Consultant Scientist with the Coventry and Warwickshire Partnership NHS Trust, argues by intervening in mental health problems such as chronic anxiety and depression, that may exacerbate physical problems (such as diabetes), then the costs of treating these physical problems can also be reduced.

The World Health Organisation’s Mental Health Day (10 October) is designed to increase public awareness issues surrounding mental health and 2010 marks the launch of their Mental Health Gap Intervention Guide (mhGAP). Mental health and physical health have often been viewed as separate entities. However, a combination of research evidence and the need for policy makers to reduce the demand on the NHS budget for long term conditions has seen a re-evaluation of this misconception. It has led to the realisation that these health issues are completely interwoven and both are important in achieving an overall state of wellbeing. Professor Scott Weich, Professor of Psychiatry at Warwick and Honorary Consultant Psychiatrist, Coventry and Warwickshire Partnership NHS Trust, believes that these interventions will help to reduce demands and spending on specific areas of the NHS and augment treatment for common acute illnesses, such as asthma and bronchitis, which are a huge reason for acute hospital admissions.

“‘Mental illness’ can be either pathological or neurological changes in the brain that are seen usually from post-mortem but also through imaging techniques, or functional mental illness where brain changes are less well defined. Mental disorders cover a range of different problems from depression, schizophrenia and bi-polar disorder, to autism and dementia. A lot of mental disorders are secondary to physical health problems; for example, diabetes is associated with depression and the toxicity of drug or alcohol substance misuse affects your brain.

People are seeing the whole spectrum; there isn’t just ‘mental illness’ but there’s also positive mental health and mental wellbeing.

“Traditionally, the study of mental health has almost always been preoccupied with ‘mental illness’: psychiatry, mental health and psychological medicine were interchangeable terms and all were concerned with the causes of and treatments for mental illness. However, now we’re moving into a different era in terms of policy, practice and research. People are seeing the whole spectrum; there isn’t just ‘mental illness’ but there’s also positive mental health and mental wellbeing. Up until now, health professionals and the public have thought ‘so long as you don’t have an illness, you must be well’ but there’s a whole hinterland out there that we’re still exploring to get a true sense of mental wellbeing.

“For decades, psychologists have studied ‘mental wellbeing’ in depth but in medicine, people have always stopped being interested further than the mental illness. But now the NHS and some of the research we are doing here at the Medical School is discovering that mental health is intimately interwoven with physical health. Findings have shown that the more robust and resilient you are to life circumstances (so having a better sense of mental wellbeing) the less likely you are to suffer from serious physical conditions. The NHS, being what it is, has to use a finite amount of money to meet the demand of the population. They are beginning to realise that by investing a little more in helping people with their mental health and wellbeing, the demand on acute medical services diminishes due to better physical health. So this is where we are at the moment, this is a turning point in history.

“On a social level people recognise that there are things to gain from positive mental wellbeing: in schools, the children who have better self-esteem have better peer relationships, emotional intelligence and fare better academically as they are more productive and resilient. Societies and communities can be improved upon and crime rates reduced if people function better in their ‘mental lives’ and in their social lives, so this area has great impact."

A lot of people don’t realise that living with a mental health problem could reduce their life expectancy by up to twenty years, due mainly to cardiovascular problems.

To understand this further, researchers have begun looking at what happens beyond the absence of pathology, when there is no illness but people have different levels of positive functioning. “Individuals have different coping abilities when dealing with stressful situations, and different capacities for social relationships. This is all part of mental wellbeing which historically the NHS has not been charged with treating. “In the past, treatment of anxiety and depression has mainly been restricted to medication like Prozac. However today, there’s much more emphasis on, and greater availability of, psychological treatments. The government has recently invested £50-60 million in the IAPT (Improved Access to Psychological Therapies) programme which has trained thousands of new cognitive behavioural therapists. Hopefully this will allow people to access help more effectively. These services use models of stepped care (a graded response) so it’s not just ‘have treatment or don’t have treatment’. This involves encouraging people to take control, like using the internet to understand more about mental health problems, embracing a healthier lifestyle and trying new psychological techniques without actually having to see a therapist. If this isn’t working we can step up the responses.

“If you look at illnesses like diabetes whose symptoms can be exacerbated by an individual also suffering from depression, these new interventions are vital. Depression might hinder compliance with diabetic treatment or cause unhealthy life styles that exacerbate symptoms. Often, this leads to people winding up in hospital. This is the case for many common illnesses and is one of the main reasons why people get admitted to acute hospital beds”. Some of Professor Weich’s research has been looking at the life expectancy of people suffering from mental health disorders; “A lot of people don’t realise that living with a mental health problem could reduce their life expectancy by up to twenty years, due mainly to cardiovascular problems. This is worrying when many people suffering from mental health problems don’t go to their GP because they might feel it’s silly; they hold a stigma about mental health.”

Prof Weich emphasises that many recent changes in mental health policy have been driven by the need to reduce spending across the NHS. Trying to convince ministers and commissioners of the need for better mental health services has often fallen on deaf ears in the past. “That doesn’t work. The big driver now is evidence which shows that by intervening in people’s mental health and treating these high rates of anxiety and depression, we can reduce the demands for treatment for people with chronic illness, which accounts for about 80% of the NHS budget. And as an added bonus, with more patient-centred, supportive treatment we can hopefully break down the stigma of mental health too.”

Prof Weich trained at Cambridge University and St Bartholomew's Hospital Medical School, before completing post-graduate training in psychiatry at the Maudsley Hospital and an MSc in Epidemiology at the London School of Hygiene and Tropical Medicine. He was a Lecturer in Psychiatry at the Institute of Psychiatry, before being appointed as a Senior Lecturer at the Royal Free Hospital Medical School (now Royal Free and University College Medical School) in 1996. He was appointed Foundation Professor of Psychiatry at Warwick Medical School in June 2003 and works as an Honorary Consultant Psychiatrist with Coventry and Warwickshire Partnership Trust.

By Olivia Isaacs