Analysis

Trusts initiate programme to tackle prejudices in the NHS

The time to Change anti-stigma campaign has started a groundbreaking pilot at two mental health trusts in England. It is intended to reveal the views of health professionals and service users in a bid to tackle discrimination reported in mental health services

The time to Change anti-stigma campaign has started a groundbreaking pilot at two mental health trusts in England. It is intended to reveal the views of health professionals and service users in a bid to tackle discrimination reported in mental health services.

The campaign is run by charities Mind and Rethink Mental Illness and is being piloted at Northumberland, Tyne and Wear NHS Foundation Trust, and 2gether NHS Foundation Trust, which provides services across Gloucestershire and Herefordshire.

The aim of the project is to have open dialogue sessions about changes that could make a difference to all parties involved and to highlight positive experiences where staff have successfully challenged discrimination.

Measuring attitudes

Evaluation of the scheme will involve measuring staff attitudes and behaviour both before and after the pilot.

Northumberland, Tyne and Wear NHS Foundation Trust deputy chief executive James Duncan says nurses will jointly lead

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The time to Change anti-stigma campaign has started a groundbreaking pilot at two mental health trusts in England. It is intended to reveal the views of health professionals and service users in a bid to tackle discrimination reported in mental health services.

The campaign is run by charities Mind and Rethink Mental Illness and is being piloted at Northumberland, Tyne and Wear NHS Foundation Trust, and 2gether NHS Foundation Trust, which provides services across Gloucestershire and Herefordshire.

The aim of the project is to have ‘open dialogue sessions’ about changes that could make a difference to all parties involved and to highlight positive experiences where staff have successfully challenged discrimination.

Measuring attitudes

Evaluation of the scheme will involve measuring staff attitudes and behaviour both before and after the pilot.

Northumberland, Tyne and Wear NHS Foundation Trust deputy chief executive James Duncan says nurses will jointly lead sessions, as well as taking part in them.

‘We want them to be able to shape the approaches we are taking,’ Mr Duncan says. ‘We are lucky to be involved in the pilot, so that nurses’ views can really be influential. This is as much about how we can support staff and how we can listen to them.’

He says the project is all about bringing service users and mental health professionals together.

Safe conversations

‘We want to be able to facilitate safe conversations to help people understand each other’s points of view. The enthusiasm from staff has been great. It has been amazing to hear about the positive work that staff have been doing in their communities to challenge the stigma that our service users experience, and we want to capture that.

‘The work that Time to Change has done is compelling. People who use services are clearly saying they feel that services don’t always support them in the way they would like. What is interesting is that we might all understand the term stigma in different ways. Some of the stigma that has been reported is about the inequalities between physical health and mental health services, some is about difficulties in accessing services. It is a complex picture.’

Recovery colleges

The trust is now making a number of changes to its services by introducing peer support workers (see below) and has set up recovery colleges offering free, recovery-focused educational courses for people with mental health experiences, their friends and families. But despite these changes Mr Duncan is clear that the project is not a criticism of mental health staff.

‘Everyone involved in the project at Time to Change, in the trust, and our experts by experience, are clear that staff are doing a very hard job, under huge pressure.’

A Time to Change event last year brought together 45 experts from the health and social care sectors to consider the role staff could have in tackling stigma and discrimination. They also explored the complex nature of the discrimination reported by service users.

Communication campaign

Along with the open dialogue sessions, there will be an additional communications campaign, aimed at a wider group of mental health professionals, which is being developed in partnership with NHS England.

More than 1.7 million people in England contacted NHS trusts that provide mental health services in 2013/14 and in June this year the Care Quality Commission (CQC) released a report detailing the experiences of 1,800 people who had suffered a mental health crisis and inspected services in 12 areas across England.

The CQC report found that while 86% of those who had received care and support from charities and volunteers felt that their concerns had been taken seriously, only 37% said that they felt this from emergency department staff. People often reported poor attitudes from staff towards their injuries caused by self-harm.

'Wake-up call'

CQC deputy chief inspector of hospitals Paul Lelliott said the findings should act as a ‘wake-up call’ to public services and highlighted that people in crisis often felt police and ambulance crews were more caring than the medical and health professionals they encountered.

Health secretary Jeremy Hunt has commissioned Health Education England (HEE) to set up the Primary Care Workforce Commission, chaired by University of Cambridge professor of health services research Martin Roland, to consider the primary care workforce of the future.

Its report (Primary Care Workforce Commission 2015) said that mental health care and care for people with learning disabilities are always at risk when budgets are under pressure and from 2010 to 2014, there was a loss of nearly 4,000 nursing posts in mental health services and more than 1,500 learning disability nurses.

Mental health advice

The commission pointed out that general practices need links to mental health advice for the wide range of psychological problems seen in primary care. It also recommends that practices have access to a named consultant psychiatrist and a named mental health worker, such as a community psychiatric nurse.

King’s College London clinical senior lecturer in psychiatry Claire Henderson told Mental Health Practice that themes emerging from research on discrimination in mental health services include organisational changes and issues with interpersonal relationships.

‘There may be decisions to cut or reduce mental health services that have an effect on service users,’ Ms Henderson says. ‘They know it may not be the direct fault of their psychiatrist or mental health nurse that they have a long wait to be seen or are no longer able to use services. However, there might be the underlying feeling that if they had a physical condition, rather than a mental one, they may have received better treatment.

Not listened to

‘Another key message is that service users sometimes feel they are not being listened to, or believed and treated with respect. People often complain of not receiving the care they need when their problem is in the early stages and only get it when they are at the point of crisis where they may be sectioned or have another serious intervention.’

Time to Change director Sue Baker says although there have been improvements in the way people with mental health problems are treated, the discrimination faced in mental health services and other parts of the NHS has remained almost static.

‘The pilot will work with staff and people with lived experience of mental health problems to find approaches to challenge stigma and discrimination that is reported within these areas,’ Ms Baker says. ‘We know it is important to create a non-judgemental space for open dialogue that will provide room to share positive examples of staff tackling stigma, as well as an acknowledgement of the many pressures staff face. The aim of the project is to bring benefit to people using services as well as staff, tackling stigma collaboratively.’

She says that if the pilots produce a model with a good evidence base that can change attitudes and behaviour, Time to Change would encourage other providers to adopt the pilot.

Reducing stigma

The 2gether NHS Foundation Trust chief executive Shaun Clee said: ‘Part of the work will be to consider ways in which practice can be enhanced to reduce mental health stigma. To do this, all participants will be invited to share their personal pledge to tackle mental stigma through, and in, their practice.’

RCN mental health adviser Ian Hulatt admits that it does seem like a paradox that people face discrimination within mental health services. ‘It is disappointing that there should still be discrimination in services and we support what could turn out to be a really good piece of work.’

The role of a peer support worker

Peer support worker Laura Ions-Chell joined the community mental health team at Northumberland, Tyne and Wear NHS Foundation Trust this year

after being a service user herself and experiencing discrimination first-hand.

‘I have a borderline personality disorder and two days after I took an overdose I was sent for counselling by a primary care provider. The counsellor was very unsympathetic and actually told me their idea of the best way to commit suicide. After that terrible experience I completely pulled away from NHS care and was taking medication every night, I wasn’t eating and was in an abusive relationship.

‘I saw a GP every week and was given a community mental health team referral. I didn’t get on with my psychiatrist and ended up in hospital. Eventually I saw a student psychiatrist and was offered a talking therapy called dialectical behaviour therapy. It worked because I felt I was being seen as a whole person and it wasn’t just about my disorder.

Perfectly placed

‘I was doing really well and she suggested that I should apply to become a peer support worker. My background is in administration, but because of my experiences, I have been perfectly placed to show others what it means to have a mental health disorder.’

Ms Ions-Chell has spoken at a psychologist’s conference and talks to medical students. She believes peer support workers have the ability to ‘shake things up’ in a positive way: ‘I encourage them to always look at the person they are treating as a whole - it is not always about just sticking someone on a ward and giving them medication.

‘I can understand that some mental health professionals can get stuck in their ways of working and it can be difficult to change, but it is important to admit mistakes and learn from them, we are all only human after all.’

She believes peer support workers could work well in GP surgeries as a link between services, and to offer advice to staff and patients.

‘I always hid my personality disorder from my employers in the past, but now for the first time I feel I can really be myself and that I am making a difference.’

 

 

 

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