Charity Insights

I can hardly believe that today is my second last day. On one hand, the last four weeks have flown by incredibly fast, and on the other hand, it feels like I’ve always worked here.

This last week has certainly been eventful! My survey (which was originally meant to go online last Thursday, then Friday, Monday, Tuesday, Wednesday) is now being promoted through Facebook and Twitter! As you can see, it was being pushed to the next day a number of times – that is because Rethink tries to limit its activity on social media, especially Facebook, so that each individual post gets enough attention. So for almost a week, it seemed as though there was nothing to be done about the survey – until an hour before it did actually go out, I got feedback from the Associate Director and changed a lot of the wording. Additionally, technology failed me (I am even worse at it than I thought, apparently), and the link we passed on to other charities was broken – and ended up on Twitter for about an hour.

So, as you can see – the last few hours before getting the survey online were actually quite hectic. You can imagine my reaction when, after 3.5 weeks of re-phrasing and re-ordering, I saw my survey being promoted online! For the rest of the afternoon, I was sitting in front of the screen, watching the numbers go up – by the end of the day, I had 300 responses, and two other major charities haven’t even started promoting it yet! With their help, I am optimistic that after 3 weeks we will have 1000+ responses.

I think at this point it is only appropriate that I advertise it! If you or somebody you care for has accessed mental health care from their GP, please tell us what needs to change here: https://www.surveymonkey.com/s/538RYW2 !

I am going to analyse these results mid-August, when – unfortunately – I won’t be working at the Rethink office anymore. The findings are going to (hopefully) inform them about specific changes people would find useful, and Rethink can base their campaigns around those. So, if everything goes as planned, my work and your potential contribution will have a long term effect, and can direct help direct mental health care in a positive direction.

I will leave here tomorrow with a feeling of fulfilment. I learned and did more than I could have hoped for during my time at Rethink. The last four weeks have not only informed me about everything that is going wrong in mental health care, but also inspired me to work on that. I have come across so many people who have an interest in mental health – colleagues at Rethink, campaigners with lived experience, doctors, carers, and more – and it is fantastic to see how passionate people are about this topic, once they overcome the stigma that is, unfortunately, still attached to it.

I am, now even more than four weeks ago, considering psychiatry as a field I would like to work in; in this sense it might have a major effect on me beyond the scope of the internship. I cannot recommend Charity Insights strongly enough to everyone; it gives you the opportunity not only to choose a field that you are passionate about, but also to work for a charity, which is completely different (and of course much better) than working for a for-profit company!

Thank you for accompanying me in this, and I hope my blog inspired you to rethink mental illness.

Read Rethought Mental Illness in full

This week has flown by. Wow. I also have to apologise for always writing and writing and writing (I lose myself in the process sometimes, which is why my posts end up as short stories). To make this week’s blog entry a little more endurable, I’m adding some colourful images!

So, what happened at Rethink this week? Again, I spent much of my time perfecting the primary care survey. I am quite amazed at how much time and thought goes into a piece of work that will only take 5 minutes to fill in. I have been rephrasing and slightly altering the order of questions so many times, because it has to be perfect – thousands of Rethink’s followers will (hopefully) see and respond to this survey, and the same applies to the other organisations we are collaborating with. So every question has to be perfectly clear and acceptable, especially considering the delicacy of the issues around mental illness.

The survey will be publicised through Rethink’s and the other organisation’s Facebook and Twitter pages, and (hopefully) circulate through the world of social media. This is exactly what we want, because it means that it will have a wide reach, but at the same time we have to be really careful about the statements we make, and how those could be interpreted. This is where you’ll be able to access my survey on Monday, where almost 90,000 people will see it:

What adds to the level of difficulty is that I personally have somehow managed to avoid Twitter all my life – until now. I am familiar with the Facebook, but generally not a master of social media and technology – which I am using as an excuse for the sobering, plain appearance of my blog. Twitter however eludes me. How am I supposed to explain an issue about which I could write an entire thesis / bestseller book / unusually wordy Charity Insights Blog in 140 characters?! This is madness!

But rest assured – I found the courage to face this new challenge, and although it broke my literature-loving heart to cut down on words here and use abbreviations there, I came up with my first Twitter post! So the survey, which I am starting to develop motherly feelings for after investing so much time in it, will finally enter the big wide world!

Okay, I’ll be serious now, I promise. I also went to another conference yesterday. It was hosted by South London and Maudsley (SLaM) NHS Foundation Trust’s Psychiatry Physical Healthcare Committee (PPHC) under the name Psychiatry Physical Health Conference. As you can tell from the name, unless you were as overwhelmed by it as I was, the conference was about the physical healthcare of people with mental illness.

As I mentioned in my last post, antipsychotic medication often causes severe weight gain, high cholesterol levels, and mental illness is associated with high smoking rates – all of these contribute to an enormous burden of diabetes and heart disease in people affected by mental health problems. This explains, at least partly, why this group of people dies on average up to 20 years earlier.

Everybody agrees that this is an unacceptable state – and yet it is widely accepted at the moment! Many of these patients don’t receive appropriate support to quit smoking, and their cardiovascular risk factor aren’t recognised and treated.

As I explained last week, the new CQUIN gives a financial incentive to do regular physical health checks on mental health patients, and then treat risk factors like high blood pressure (it’s not ideal, but at least effective). Issues like this were discussed at the conference yesterday, with my supervisor here at Rethink giving an introductory talk.

Now I am thrilled to see my survey going online soon, and really excited to get the first responses in! Yay!

Read My survey’s going online! in full

Shocking news – I can now no longer go without at least a cup of tea every two hours. I am also adapting to working in an office – I no longer find it odd to share information with people sitting in the same room by email! Having said that, I have had countless very constructive conversations about general issues in the mental health sector, as well as more specific ones about my project. Everybody on the Campaigns team that I am part of has been incredibly supportive and always prepared to provide me with feedback on my work.

I can hardly believe that my second week at Rethink is almost over. It is a bit frightening to watch the days fly by, but at the same time incredible how much I have already learned and done.

This week, I have worked a lot on the survey that we and other mental health organisations will be sending out through our networks. The questionnaire is targeted at people affected by mental health problems or their carers. It includes a whole spectrum of illnesses, ranging from Schizophrenia to Anxiety Disorder. I have fiddled around a lot with the phrasing and emphasis of the questions, to make sure that the data we collect will provide us with information on the issue we are trying to address – what practical changes in primary mental health care would be most useful, and how can we implement these?

We are now in contact with the organisations we intend to work hand in hand with: Mind, NSUN, The Mental Health Foundation and the London Strategic Clinical Network (who hosted the primary care conference I attended what feels like years ago). I expect to receive some input from them, and will make final changes to the survey according to their feedback – and then the questionnaire is ready to be sent out.

In addition to this, I have been working on another primary mental health care-related piece. Rethink is, in collaboration with others, working towards something called a CQUIN (Commissioning for Quality and Innovation). This is a payment which service providers receive if they can show that their patients have received a particular treatment outlined in the CQUIN.

In the case of the 2014/2015 Mental Health CQUIN, there are two objectives to be met by service providers in order to qualify for the payment. One is that they need to make sure that mental health patients receive regular physical health checks (because antipsychotic medication causes significant weight gain, diabetes, high cholesterol and hence heart disease – these people die on average 15-20 years younger than the rest of the population) and then treat those risk factors. The other objective is to improve communication with the patient’s GP and share information with them, in order to avoid a duplication of work, and make sure all professionals involved in the person’s care are aware of important details.

At the moment, I am designing an information sheet for health professionals, outlining the content of this programme, why it can make a massive difference to patients, and generally encouraging the staff to realise these improvements. This leaflet will be distributed around mental health services.

Next week, I will attend a conference around physical health of people with mental health problems, where exactly these issues will be discussed.

I am starting to see how all these different aspects of mental health care – the role of the GP, physical health problems, communication between primary and secondary care providers, etc – are interconnected and make up a bigger picture. The different parts of the puzzle are slowly coming together, and it is a great feeling to see how my work fits in there.

Read The pieces of the Mental Health Puzzle are coming together in full

Here I am, sitting at my desk in the Vauxhall office of Rethink Mental Illness, after months of anticipation and preparation! It is my fourth day today, and after the strange feeling that overcomes oneself when entering unknown terrain, I am beginning to settle in. The occasional tea break allows me to enjoy the sensational view out of the 15^th floor windows, with MI6 to one side of the building, and Big Ben, the London Eye and the City of London to the other. Having a chat over a cup of tea also really helps getting to know the team (and so did a 5-hour post-work picnic in the park yesterday!).

Of course, they don’t just consume hot drinks here, but they’re engaged in some fantastic projects. Rethink is a mental health charity, focusing mainly on severe mental health issues such as schizophrenia, bipolar disorder, and psychosis in general. They play a two-fold role in this field; they are both the direct providers of mental healthcare services such as recovery homes and psychiatric wards, and also run campaigns, work on policies, increase awareness and reduce stigma around mental illness.

This week so far was characterised mainly by briefings about projects which the Campaigns and Policy team are currently running, one of which will be my main undertaking during the next month. My main project will be looking at mental healthcare provision in the primary care setting. The first thing most people do when they feel unwell, and that includes mental health issues, is that they go see their GP. There are a number of problems associated with this.

Firstly, it often takes many weeks to even get an appointment, and if you’re in an acute crisis, immediate care is crucial. Of course you can go to A&E, but the staff there are mainly trained and prepared to deal with physical health problems, and in most cases patients presenting with a mental illness are not treated appropriately.

Secondly, if the patient finally manages to see their GP, the clinician’s knowledge of mental health is often so limited that they misdiagnose and mistreat the condition. If a mental health condition is not recognised, that obviously makes it less likely that they will be referred to appropriate specialist services, too.

Since mental illness is not a short term problem, but will often have to be monitored and treated for a lifetime, specialist secondary services are often overwhelmed by the amount of work, and when they discharge a patient after an acute crisis, they are rarely able to follow them up. They are also constantly experiencing budget cuts, and therefore not always as accessible to patients as they would be in an ideal world. Therefore, primary care provided by the GP should play a crucial role in the form of regular follow-ups. It would massively improve the experience of patients with mental health problems if GPs received better mental healthcare training.

My project will involve gathering data on the satisfaction of such patients with primary healthcare, most likely in the form of a survey, to support this argument. Eventually this will be used to write a report and bring forward a campaign regarding concrete advice on how to improve primary care of mental illness.

I started gathering some ideas for this project at a conference on primary care which I attended today. Some GPs with an interest in mental health spoke about policies they implemented in their local area to improve primary care mental health, and passed on their experiences. One idea I found particularly promising was one put forward by Dr Sheila Hardy from UCLPartners, who led a project where mental health nurses received training workshops and then in turn trained community nurses. These mental health-trained community nurses were then able to provide some basic services to patients, thus relieving the burden on the secondary healthcare system. This training system appears to be a cost-effective, efficient way to reach and train many professionals in a sort of pyramid-model, whilst meeting the patients’ needs and centring services on their expectations.

Generally speaking, there is increasing awareness of mental illness in our society, and people are realising the scale of the problem. It was fantastic to see how many different positions were represented at the conference today (clinicians, the voluntary sector, service users, police staff, and more) since that illustrates the diversity of people thinking about these issues and trying to address them. Seeing so many people who are passionate about improving mental healthcare makes me very hopeful that my project will contribute to a positive change in the long run, and I am really excited to see where the next few weeks will lead!

Read Rethinking Mental Illness in full