Boingboing blogs from… Spain

The ENMESH Conference, 1-3 October 2015, Málaga, Spain

by Angie Hart – Boingboing blogger

Angie here. Midday on a Saturday and I’m still dutifully sitting in the basement of a hotel in Málaga whilst the sun is shining outside. I’m at a mental health conference organised by the European Network for Mental Health Service Evaluation – ENMESH 2015.  The conference is teeming with medical researcher types and psychologists. Granted they are hard workers.  At 1.30pm the basement is still packed. I’m knackered and my ears are hurting from the talks I’ve listened to over the past few days. Some of them have seriously wound me up.  For example, I’ve heard people saying that we shouldn’t put in place any mental health ‘intervention’ without definitive research evidence that it works. How convenient. Lots of jobs for researchers there then… You wonder how such people ever manage to get through their day. How can they know what to have for lunch in the absence of a randomised controlled trial on the relative benefits of cauliflower soup as compared to a Greek salad? Look, I really do appreciate the value of some good research evidence, but the power some of these researchers now have over what does and doesn’t get implemented and funded is getting quite ridiculous.

Enough Ang. Back to the conference. I’ve not heard much about deep rooted inequalities and the effect of poverty on mental health outcomes. Although in this regard I should mention the lovely Cristiane Silvestre De Paula from Brazil who showed us that mental health treatment in Brazil was rarely available to poor children. Other kids used up all the resources, and of course their parents were more able to pay for care. Despite a national health service, private health care is rife in Brazil. There are hardly any psychiatrists in their public health system, but loads in the private sector. We’ve heard that so many times before. Calling public-spirited psychiatrists in countries where they don’t have many mental health services, can you defect to the public sector and just earn less? I’m sure you’ll do alright anyway and think how good you’ll feel about yourself…

A related and very moving presentation was given by Graham Thornicroft from King’s College London. He was very upset about the fact that the UN weren’t planning on including mental health in their post 2015 sustainable development goals. Now, rather than moaning about this to his dog when he got home from work (he may not actually have a dog, I’m merely using the idea to liven up this post), he got off his backside, or rather sat on it at his computer, and wrote an editorial for the BMJ. That’s a publication aimed at doctors by the way, if you’ve never heard of it. Well, doing that had a big effect and next minute all kinds of people are getting involved and to cut a long story  – and no doubt several expensive air trips to meetings – short, they’ve managed to get mental health in there as a focus. Good for them. There is still some work going on to develop indicators against which progress will be measured, so if you feel strongly about this then you can put pressure on the UN by writing to influential people – see the FundaMentalSDG website to do that. Graham told us about the proposed indicators, one of which was all about reductions in mental health ‘disorders’. Now I totally loathe that word, and I’m a bit sceptical about all those psychiatric categories, so I can’t quite bring myself to do that much about it myself. But then, you have to start somewhere, so maybe I will join in and send off a supporting email.  Oh this is such a tricky issue.

Whilst I’m deliberating, let me tell you about a film from Robin Hammond (external link) which Graham showed. No doubt that people with mental health difficulties in some African countries are routinely treated in the most shocking ways, including being imprisoned, tied to trees etc. I had a bit of a cry when I watched it, and I could see a few other people dabbing their eyes, so be warned. Robin said that one of the worst things is that most of those people in his photos are still in their terrible situations, so I doubt they will be reading this post. But it feels a bit odd to be writing about people who you can actually see on photos and who you know have no capacity to tell their own story on the kind of scale that Robin can second hand. And yet as Robin says, we should know about this. Oh gord, the ethics of informed consent etc. here are so complex.

Of course when watching things like that, it is tempting to set high income countries up as marvellous leaders in mental health care. And certainly Robin’s film brings home to me just how privileged we are. But from recent task force reports such as ‘Future in Mind’ (external link) we know that in the UK at least we really don’t have too much to boast about. And whilst in general, attitudes towards disabled people and those with mental health difficulties have improved, how come our prisons are still full of people with learning difficulties and mental health difficulties?  Also, how to develop the right mental health support without over-reliance on medical models of diagnosis and ‘treatment’ is a real conundrum at home. I’m hoping that some of the less advantaged countries go down more of a community development route, rather than simply copying what we’ve been up to – employing lots of expensive professionals and helping them to develop their elite careers – I should be in for the sack here too by the way…

Enough moaning now. Let me share some of the things I’ve learnt that made me think we are on the right track in our Boingboing work. A presentation from Vanessa Pinfold at the McPin Foundation (which is a research organisation) made it worth my coming to Málaga to hear about it. She’s a passionate, some might even say an activist, researcher on practitioner roles in supporting clients with serious mental health issues to connect with other people on a daily basis. For people who like the academic lingo – it was about bonding and bridging social capital in people’s lives.  Loneliness and social isolation are massively relevant issues as they are major causes of poor mental health, and indeed suicide. So you’d think that addressing these would be somewhere near the top of the list of what practitioners do to support their most vulnerable clients?  Nope. Got you there. People with lived experience of mental health issues said that it was mostly family and friends who helped them connect with people. Of all the people on her chart, practitioners were least likely too.  How shocking is that?

If you’re even a little outraged, let’s go to one of the presentations I heard this morning at ENMESH. This is a large study about supporting people with mental health difficulties to undertaken physical activities. Again, we know that physical activity is massively connected to good mental health. So you’d think that addressing this would be near the top of the list of what practitioners do to support their clients? Nope. Got you there again. Hardly any of them did. They said they had to do paperwork instead or else they would get into trouble with the bosses. Or they simply didn’t think it was part of their job so wouldn’t do it. Even in a project designed to support them to give it a go.

The researcher presenting this study (I think it was Melanie Lean) certainly pointed out that this wasn’t a good state of affairs, and that commissioners and managers needed to be more involved when setting up intervention studies so that these kinds of interventions are perceived to be as important as others. We didn’t get to hear anything about what the other interventions were that they were so busy doing, apart from filling in paper work, so I’m still dying to know.

What she didn’t say, and neither did the fabulous Vanessa from McPin, is that some of this is surely tied up with professional elitism. Many professional psychiatrists, psychologists, nurses etc. simply don’t want to be doing these kinds of simple things – like helping people get a few friends in their lives – because other professionals will look down on them for rolling up their sleeves and doing what they see as basic stuff, and they won’t get the top jobs and will feel failures. You might think I’m making this up, but I’m not. There is the occasional consideration of these issues in the literature, starting with Ivan Illich’s work, which was a bit rhetorical, I’ll grant you.  If you want more solid empirical evidence hear me out. Some professionals have admitted as much to me that their interventions are often tied up with status and identity issues. But most only say this after a few glasses of wine. Any chance you think I could get research funding to conduct a randomised controlled trial of practitioners’ reporting of whether they will get cracking with some of these basics? One group randomly assigned to a hefty glug or two of wine, the other drinking an alcohol free version that tastes exactly the same. We could interview them all with the same interview schedule and see who owns up to what. Anyone fancy chucking us a bit of dosh for this one?

It’s nearly over and out from me, but before I go I should state that of course there are loads of fabulous mental health practitioners out there who do a marvellous job in difficult circumstances. They understand all this stuff about social isolation and physical exercise and help with basic material necessities too. If I don’t mention this, my friend Claire, one of the loveliest mental health practitioners on this planet, may never speak to me again. And there are lots of fabulous practitioners and other citizens working with the kinds of resilience-based approaches that we have spent years developing. Take a decko at our Resilience Framework if you haven’t already – connecting up with others and getting active are important components of that.  So to end on my new little ditty, which doesn’t quite scan but you’ll get the idea:

If you’re feeling glum, turn to a chum.
If you’re feeling blue, find a snooker cue.
Sorting all this out, it has to be you,
Your mum, your dad, or sister too,
Because practitioners have more important things to do,
Or they’re off with the flu,
Or inputting something new,
Or standing in the printer queue…
(Except my mate Claire obvs)

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