Getting your facts straight

In 1999, the Department of Health published a National Service Framework for mental health. This sets out what local areas should provide in terms of mental health services, using seven standards:

• Mental Health Promotion
• Primary Care
• Access to services
• Effective services for people with severe mental illness
• Caring about carers
• Effective suicide prevention

If your local area is falling short of these standards, this is a good argument for change.  Read the NSF in full as well as other NSFs on older people and children's services.

Another very useful document is the Social Exclusion Unit report on Mental Health and Social Exclusion, published in 2004. Read the Social Exclusion Unit Report.

There is guidance on a wide range of issues on the Department of Health website and through the National Institute for Mental Health in England.

The National Institute for Health and Clinical Excellence publishes guidelines about treatment for different conditions, including mental illnesses like schizophrenia and depression. NICE guidelines are not just about what kind of medication is effective, but also cover talking therapies and issues such as physical healthcare. If your local health trust is not treating people according to these guidelines, this is a very good argument for change.

The Healthcare Commission regulates all national health services and reports on individual services. It conducts national patient surveys to see if people are satisfied with care or where there are gaps. Check the Healthcare Commission website to see if your area fell below standard in an area related to your change or if it is flagged up in a national report.

The Mental Health Act Commission inspects all facilities where people are treated under the Mental Health Act. It issues general reports every 2 years on general issues. See the Mental Health Act Commission website for their reports.

The Disability Discrimination Act covers discrimination on the grounds of mental illness. It says that public and commercial services such as health services, employment offices and shops should make ‘reasonable adjustment’ to allow people with mental illness to use their services. If services do not do this, they could be prosecuted and face major fines. For advice on the DDA,  visit the Disability Rights Commission website or call 08457 622 633 or, from October 2007, the Commission for Equality and Human Rights.

From December 2006, a new Disability Equality Duty will apply to the public sector, i.e. government departments, executive agencies and ministers, local authorities, governing bodies of colleges and universities, governing bodies of schools, NHS trusts and boards, police and fire authorities, the Crown Prosecution Service and the Crown Office.

All public authorities will have to have due regard to:

• promoting equality of opportunity between disabled people and other people
• eliminating discrimination that is unlawful under the Disability Discrimination Act
• eliminating harassment of disabled people that is related to their disability
• promoting positive attitudes towards disabled people
• encouraging participation by disabled people in public life
• taking steps to meet disabled peoples needs, even if this requires more favourable treatment. This includes people with mental illness.

The Human Rights Act has also been used to create change. Recently, a user-led mental health befriending scheme used human rights arguments to challenge a
hospital which repeatedly sectioned asylum seekers without giving them an interpreter. The key bits of the Human Rights Act to remember are:

• Freedom from inhuman or degrading treatment (Article 3).
• Right to respect for private and family life, home and correspondence (Article 8).

The British Institute for Human Rights holds information on the Act and its application.

What kind of solutions should you be advocating?

• Having a designated person lead on an issue creates a sense of responsibility
• Having an action plan which is regularly reviewed helps to ensure that necessary actions are identified
• Ringfencing funding will help ensure that money is spent on a particular service 
• Ensuring that the amount of money spent on mental health services reflects the number of people in the local population who experience mental illness
• Making sure that the mental health grant which comes from central Government is all spent on mental health
• Ensuring that the amount of money from the carers grant from central Government which is spent on services for carers of people with mental illness reflects the number of such carers in the local area
• Piloting new procedures
• Consulting with service users and carers
• Getting people to agree to evaluate any potentially negative changes after implementation and reviewing them accordingly
• Getting a local authority or health trust to pledge to take action on an issue – you can then check what progress has been made at a later date

Getting information that compares your area to the rest of the country is often a key part of your campaign. A good way to do this is to table a parliamentary question. Rethink’s campaigns department can help you to do this. Parliamentary questions can only cover matters of fact, not opinion. So, for example, you could ask what the bed occupancy rate is in your local hospital, but you couldn’t ask why there aren’t more beds.

Also, some information is not held centrally – but it’s always worth asking to find out.

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Rethink Campaigns can get you a summary of their recent activity. Phone 0845 456 0455, email Rethink campaigns or write to Rethink Campaigns, 5th Floor, 22-25 Finsbury Square, London EC2A 1DX

How many people…?
1 in 6 people has a common mental illness at some point in their life (Psychiatric Morbidity Survey, 2000).

About 1% of the population experience schizophrenia at some point in their lives (Mental Health Foundation, 1999).

About 1% of the population experience manic depression at some point in their lives (Mental Health Foundation, 1999).

1 in 200 people have experienced a psychotic illness in the last year (Singleton, Psychiatric Morbidity, 2000).

Who’s affected?
The average age of onset of psychotic symptoms is 22 (Department of Health, 2001)

Deprived areas and rural districts have the highest levels of mental health problems and suicides (ONS, 2001).

Race equality
People from Afro-Caribbean backgrounds are 3-5 times more likely than others to be diagnosed and admitted to hospital for schizophrenia. (Mental Health Foundation, 1999)

Recovery
About 25% of people diagnosed with schizophrenia will make a full recovery; about 60% of people will have fluctuating symptoms; about 10-15% of people experience long term incapacity (Mental Health Foundation, 1999).

Stigma
35% of people with mental illness are unemployed but want to work (ONS, 2003), the highest want to work rate of any disability.

Only 1 in 4 employers said that they would knowingly employ someone with a history of mental illness (Manning et al, 1995).

Three quarters of employers say that it would be difficult or impossible to employ someone diagnosed with schizophrenia (DWP, 2003).

Less than 5% of people who kill a stranger have symptoms of mental illness (Department of Health, 2001).

People with mental illness are more likely to be the victims than the perpetrators of violence (Walsh, 2003).

Health services
More than 1 in 4 people with severe mental illness report being shunned when seeking help (Rethink, 2003).

30% of GPs’ time is spent with people with mental health problems (Sainsbury Centre for Mental Health (Maudsley Monograph, 2002).

44% of people with mental health problems report discrimination from GPs, such as physical health problems not being taken seriously (Mental Health Foundation, 2002).

Carers
Up to 420,000 people in the UK care for someone with a mental health problem (ONS, 2000).

Almost 80% of carers for someone with a severe mental illness say that caring has had an impact on own their mental health (Rethink, 2003).

Almost 80% of carers for someone with a severe mental illness say that caring has had an impact on their own physical health (Rethink, 2003).

Only 48% of mental health professionals know about local policies on sharing information with carers (Rethink/IoP, 2006).

Cost of mental illness
Mental health problems cost the economy over £77bn per year through care costs, economic losses and premature death. (Sainsbury Centre for Mental Health, 2003).

Dual diagnosis
21% of people with schizophrenia have a dual diagnosis (Cantwell, 2003).

Up to half of people dependent on alcohol have a mental health problem (Turning Point, 2003).

Physical health
People with schizophrenia and bipolar disorder die 10 years younger due to physical health problems (British Journal of Psychiatry, 2000) and have double the average rate of heart disease (British Journal of Psychiatry, 2006) and five times the average rate of diabetes (Department of Health, 2004).

People with severe mental illness smoke twice as much as average, do half as much exercise and eat less fruit and vegetables than average (Running on empty report, 2005).

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