22 September - Mental health network webinar

This week, we were joined by Mark Yates, Chair, Herefordshire and Worcestershire Health and Care NHS Trust who spoke of his 30 years’ experience in the fire service and shared the following learnings regarding prevention:

• Central coordination and resourcing are strongly desirable, if possible. Whilst local action works, central coordination allows for the nation to act together.
• It is necessary to plan for the long term. There is no point in planning for less than 10 years. It takes significant time for people to change their behaviours.
• Telling people what to do doesn’t work. There is a need to role model, encourage, cajole and incentivize, as well as linking into the public’s emotional response to promote changes in behaviour. Public Health’s anti-smoking campaign has resulted in smoking dropping dramatically.
• There is a need to focus on priorities, rather than adopting a scattergun approach.
• There is a need to focus on the young.
• It is helpful to find a hook of some sort; a memorable but simple image or slogan that keeps prevention on the agenda.
• Hard hitting does work, if done in the right way.
• The public should be involved, including charities and volunteers. Much work in the fire service was done voluntarily by the public. Volunteers want to be associated with the NHS and feel they are doing good things for the community.
• Prevention must be mainstreamed – it must be part of the day to day, rather than an add on.
• Staff buy in is critical. It took 20-25 years for firefighters to change their mindset. The NHS may need to think about workforce and the skills required to deliver some of these messages.

Mark also noted there is a role for the Confed and other representative bodies to play to allow for change. He noted how things in the fire service changed as a result of campaigning, such as flammable furniture regulations and mandatory smoke alarms. Individual trusts won’t have this kind of success. To get this change in prevention into the NHS, there is a need for more global national policies around this to be changed or introduced. The government need to be sold on the upstream prevention agenda, which will be difficult.

"The cost saving benefits of prevention but the fact that this is beyond a political timescale."

The group spoke of the problems of getting staff on board, particularly around healthy lifestyles, which is an area that staff are not always the best at maintaining.

"There is a lot of unspoken resistance to some prevention measures, including how staff manage stress and self-management skills."

Mark noted an immediate response is often ‘that’s not my job’. This will be something to get over. If prevention is to work, it has to be everyone’s job. Role modelling is difficult and was slightly easier in the fire service due to pride around fitness due to the operational aspects of role. Prevention tapped into the emotions of fire fighters by retaining the firefighting aspect of the job but reducing the amount of death and trauma seen in the role.

"Prevention is a core aspect of policing, but it is often forgotten about by police officers." The group spoke of positive practice examples, where the police combined with the ambulance and fire services in the borough on a campaign with real victims of traffic accidents, which had a significant impact.

For the NHS, thought needs to be given as to where the focus is. Someone spoke about teams in schools and focusing on mental health prevention in this area.

"There is a need for further community engagement, including combining with neighbourhood watches. In terms of engaging staff, we ought to recognise initiatives that promote prevention, such as the mental health school teams, to embed this into the culture. The NHS is weak on engagement and there is a need for more connectivity with the community."

Someone felt that Mark's presentation around prevention should be made available to the Confed to see if they take up prevention as a core work stream.

"There is a lack of understanding of people’s roles regarding prevention. A culture of prevention can support other activities and has financial benefits. The NHS is complex and as such this issue has to be cross government, with schools, housing, and the need for a cross government minister to bring things together."

Someone noted that the fire service hold open days to make education more available and allow the public to see the impact of behaviours.

The group went on to discuss the visionary piece of work being undertaken by the Centre for Mental Health around mental health and learning disabilities and autism services in 10 years time, which is due to be launched shortly. The report includes a lot on prevention and as such will be a good launch pad for this conversation. Many participants noted frustrations around the changes in government resulting in delays to the 10 year plan – the MHPG will keep this on their agenda.

"Is a frightening message is needed to prompt change? There is factual evidence around the consequences of children who are obese, including resulting type 2 diabetes and a shorter lifespan."

"CAMHS are dealing with more low-level psychological issues." A participant advised local fire services are likely to be running week-long schemes for young people, which are usually to prevent criminality, and spoke of their experience with the Phoenix project in Cornwall. The ‘old fashioned discipline’ apparent made the young people want to be there and want to succeed.

"We must engage with local partners!"

In light of their background in the office of the Public Health Director, a participant highlighted that relationships with schools is key, although finding entry points can be challenged.

"I recommend tailoring approaches to the school curriculum to get into schools."