Wednesday 10.05.17 Challenges, inspiring stories andpublicpolicy Mental health theguardian.com/mental-health-challenges Supported by 2 The Guardian | Wednesday 10 May 2017 The Guardian | Wednesday 10 May 2017 3 Mental healthcare Local government

Inside ental health population gets increasingly older, 05 Only the lonely Mental found its way we reveal the simple solutions that Combating chronic loneliness on to the front are helping ward o depression Getting it all together pages again and loneliness. 06 07 The problem with men Male suicide, and tackling demons health last week The UK’s  rst inpatient mental with the news health centre designed by The devolution of powers to the regions has seen an unexpected rise in the pro le of mental 09 ‘They’re the experts’ that England service users or “guests” opened A patient-designed mental health centre Solutions international footballer Aaron last month in Pontardawe, health provision. As Mary O’Hara reports, it’s the economic bene ts that are focusing minds 12 13 Not so smart? Lennon has been detained under south Wales. Is this a model Social media, bullying and depression the mental health act. The story for the future? And we talk to few months ago if asked to problems illustrates once more that mental a former England rugby union what do Prince Harry, the 14 15 Out of the woods ill health can a ect any of us at international about the di culty former England football How working outside cleans minds that a ect any time. that alfa males like him have in captain Rio Ferdinand 16 17 Lessons in gender diversity What this supplement shows confronting their demons. and Lady Gaga have in Changing attitudes in the classroom time and again, is that innovation A primary head teacher admits common, most people us all and commitment from that his pupils worry about Brexit would have answered their celebrity 19 A di erent view those working in mental and Trump and tells us what help status. But today mental health is the Aimee Challenor on trans issues health services is is available. While the assistant burning issue that links these three 20 21 Policy improving the quality head of another tells how it helps high-pro le individuals. All have Crisis in community mental healthcare of life of all those pupils, confused about their spoken out about their battles with they care for. sexuality, to talk about it. their own personal demons. 23 Early release There is optimism We look at how a walk in the While their insights have been Mental healthcare in prisons that regional woods is improving the mental heralded as a watershed in changing Editors Debbie Andalo, Sarah Jewell devolution may o er health of people in Scotland and public attitudes towards mental health, Cover Getty Images Contact george. a more joined-up way how one Welsh prison is tackling others working to shape the future [email protected] of improving mental mental ill health. We consider of frontline services have also been This content has been supported by health and boost the the impact of the UK shortage of breaking new ground. Mind (whose brand it displays on the economy at the mental health nurses and,  nally, Theresa May’s government’s cover). All content is editorially inde- pendent. For information on supported same time. how to protect our mental health commitment to taking power and by content, visit: Debbie Andalo And as the while living in the digital world. money away from Whitehall and giving theguardian.com/sponsored-content it to new regional organisations in England opened up new, unexpected, possibilities for mental health services. “We felt we had an opportunity to do something di erent,” says former health minister Norman Lamb, a key Heads up: Prince Confederation, which has applauded health lead for West Midlands police, player behind the changes. Harry revealed the work being done in the West has been seconded to Thrive West Originally it was envisaged that that he sought Midlands. Its chief executive Sean Midlands for two years. He says the the new organisations – regional counselling Duggan says: “The best available plan’s implementation will depend councils made up of at least two local nearly 20 years evidence supports the idea that changes on a holistic approach with a focus on authorities – would focus on jobs and after the death in housing, schooling and other areas prevention. The intention, says Russell, economic growth. However, those of his mother, can radically bene t mental health, is to try and introduce “scalable” leading this devolution revolution in Princess Diana especially if they are well integrated models that will make a di erence the West Midlands, Greater Manchester Getty Images with other services.” locally and nationally. and London recognised the economic Integration has been key for WMCA One of its  ve key planks is to work importance of mental health, pushing since it launched last June. Today with employers “to help them see that the issue to the top of their agenda. it involves 18 local authorities and investing in wellbeing is a win-win”. Sarah Norman, chief executive o cer four local enterprise partnerships But there is also a focus on other areas, for wellbeing at the West Midlands representing business. The authority such as creating sustainable housing, Combined Authority (WMCA), says looked to the US and around the UK to reducing the number of people with research and consultation across see how it could involve key players, mental health problems in the criminal the NHS, and criminal justice and not just in health and social care, but justice system and tackling the stigma employment sectors produced evidence also in the criminal justice systems, the associated with mental ill health. that a mentally healthy population was voluntary sector and local businesses. But do these nascent regional not just a “moral issue” but one that It decided to set up a mental approaches have the potential to bring would have “clear economic bene ts”. health commission, chaired by Lamb, about a real change in mental health? Individuals with better mental health composed of national and local leaders Andy Bell, the Centre for Mental outcomes are more likely to  nd from areas such as health, housing and Health’s deputy chief executive, says employment which in turn boosts local Changes in the police, and, crucially, people with that the challenges are complex, but productivity, Norman says. experience of the services. Lamb says regions are learning from one another: Improving mental health services, housing, that the commission was determined “It’s an opportunity to focus on [ways] she says, was a “good example” of schooling not to produce a well-meaning report to do things di erently.” bringing multiple bene ts at a time with a list of recommendations That is a view shared by Duggan, when the region had to tackle the “big and other “gathering dust” on a shelf, but rather a who says that all eyes are on what is challenges” of devolution – increasing areas can speci c action plan. happening in the West Midlands: “It productivity, and  lling the  nancial bene t The plan: Thrive West Midlands, was will be an essential test case for how gap between the money it received published in January. Duggan calls it other regions might innovate and join through taxation and what it actually mental an “unprecedented example of a region up services. needed to spend on services. health unifying very di erent services to “We are looking forward to … sharing That view is shared by the improve mental health”. its learnings with mental health services Mental Health Network of the NHS  Superintendent Sean Russell, mental across the country.” The Guardian | Wednesday 10 May 2017 5 Older people Loneliness: a new epidemic

With millions of older but, according to the Royal College  24-hour, free helpline for information of Psychiatrists, 85% of older people and companionship. In addition, British people living in isolation, with depression receive no NHS help Authorities Red Cross community connectors are Saba Salman asks what at all. The spotlight on older people need to volunteers who identify and attend local initiative – a group of nine older activities with lonely older people. is being done to help? people’s organisations led by the Jo Cox develop The Campaign to End Loneliness Commission on Loneliness – says that clear plans is developing a national initiative to more than half the users of over-50s tackle loneliness through community weekly phone call or social networking site Gransnet who say to reduce collaboration. Laura Alcock-Ferguson, visit from a volunteer are they are lonely have never discussed loneliness the campaign’s director, adds: “At among the solutions to loneliness with anyone. in their local a local level across the UK, health help ease the loneliness But solutions do exist, says authorities should be developing clear epidemic affecting 1.2 Abrahams: “There is no quick fix or areas plans to reduce loneliness and social million older people in single policy solution to eradicate  isolation in their local areas.” AEngland, according to campaigners. loneliness but there are reasons to Dr Amanda Thompsell, chair of Age UK, says that 1.2 million older hope that we can change things for the the old age psychiatry faculty at the people are chronically lonely and that better.” An Age UK and Campaign to Royal College of Psychiatrists, says this has an adverse impact on mental End Loneliness 2015 report, Promising organisations developing support health, and the challenge will increase Approaches to Reducing Loneliness projects must also include older people as our population ages. In the next 20 and Isolation in Later Life, reveals and carers as well as psychiatrists, GPs, years, England’s over-85 population is good practice. For example, it says and the social care sector. Thompsell set to rise from nearly 1.3 million people interventions involving help with suggests awareness of loneliness could to just under 2.8 million. transport or technology “can be the glue also be incorporated into the school Caroline Abrahams, Age UK charity that keeps people active and engaged”. curriculum: “Inter-generational contact director says: “Loneliness can have an The report highlights successes such has been shown to be particularly impact on older people’s health and as face-to-face or telephone befriending effective in combating loneliness and wellbeing. And this is particularly true projects, including the Royal Voluntary we often forget how much children can when it comes to mental health, with Service’s Dorset Befriending Service, learn from older people.” older people’s depression often brought offering home visits to older people. The Ignoring the challenge is not an on by, or exacerbated by loneliness.” project began after a local GP’s concerns option, as Thompsell says: “Failure NHS figures reveal that depression that older patients would visit the doctor to tackle loneliness will lead to more affects around 22% of men and 28% primarily because they were isolated. pressure on services which are already of women aged over 65 in England, Another initiative, The Silver Line, is a overwhelmed.”

someone might listen … a voice at the Roy Warman other end who could sympathise.” ‘I met the daughter Today he has weekly phone calls with a volunteer he describes as “like the I never had through daughter I never had” and he also has regular visits from another volunteer a telephone as part of Age UK’s face-to-face befriending scheme. befriending service. The impact has been extraordinary, It changed my life’ says Warman, describing the experience of support as “like being in a desert Roy Warman’s wife, Phyllis, died in  January 2015. Buoyed by well-wishers in the first few weeks of bereavement, It was so nice to think the visits and telephone calls gradually that someone might dwindled, and he felt increasingly alone. Many of his friends have passed listen ... a voice who away, he does not have any family nearby and the couple never had could sympathise

children. He explains: “The longer it rle

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as “one of the hardest things that you Am and coming across an oasis”. He has will encounter in life”, likening feeling Warman credits Age UK with helping to turn his life around joined a singing group and developed low to “living in a void”. his IT skills: “I think it partly affected The 84-year-old from Wiltshire that matches older people with like- my decision to join a local choir. And spotted information about Age UK minded volunteers for friendship or Age UK introduced me to the tablet, it’s in a local magazine a few months phone calls. like a giant library.” Crucially, he senses after Phyllis’s death. He got in He recalls the first time he spoke to his self-confidence has returned: “I feel touch and was referred to an Age a companion on the phone: “It opened good about myself and feel able to UK telephone befriending service a new door. It was so nice to think that cope now.” SS 6 The Guardian | Wednesday 10 May 2017 The Guardian | Wednesday 10 May 2017 7 Male suicide Dealing with depression

Simon Gunning ‘Gender should not be a death sentence’ ‘I didn’t belong any more’ After his playing career a bereavement. Your sense of worth Damian Hopley RFU and some club owners so Hopley goes out of the window. I didn’t belong won three caps began his project without being paid. The Campaign Against Living Miserably through bad times without societal the royals’ mental health campaign ended, Damian Hopley any more. Your personal life then goes playing for But today, he runs an organisation that (Calm) is the leading UK charity permission to open up or seek help. Heads Together (Calm is a partner became depressed. into freefall because you become so England before has about 700 current professional dedicated to preventing male suicide. C alm’s research shows that while 67% charity of the latter) – is a massive self-obsessed. I had a girlfriend at the injury cut short players, both men and women, and Here, its chief executive o cer, Simon of women tell someone about going step forward. Historically, the alpha- Now, he helps other time and she walked out on me. Quite his career about 400 former players on its books. Gunning reveals what is being done to through depression, only 55% of men male archetype has had no time rightly, because I would have been a Outside the sport, the perception of encourage men to open up about their do the same. for conversations about emotions men discuss the issue nightmare to live with.” elite rugby players is one of steely emotions. The result? Men are three times more but, in recent weeks, this has been At 27, Hopley began working alpha males, but the reality is often likely than women to take their own dismissed by men such as Stormzy , Rio amian Hopley knows from in the media and tried to get di erent. Several players have talked e take a two-fold lives and suicide is the single biggest Ferdinand, and Calm’s patron Professor bitter experience that being a his life back on track. He met about their battles with depression, approach to Historically, killer of men aged between 20 and Green – strong, famous, tough men professional athlete can exact other sportsmen including linked to the end of a career in the changing and 49 – something the Duke of Cambridge explaining how communication has, a heavy price on the mind as the former Coventry City sport. The RPA has a new campaign, saving lives:  rstly the alpha- describes as “an appalling stain on in some way, saved their lives. well as the body. Rugby players have footballer David Busst and the Lift the Weight , which includes a providing support male our society”. There is still much work to be always been in harm’s way and Hopley former Gloucestershire and 24-hour counselling service. With for men who But the tide is turning. Since Calm done. The emphasis now is to move discovered this as a young man 20 England cricketer David “Syd” chilling timing the initiative was are down or in crisis, and secondly archetype was founded 10 years ago, awareness beyond the rallying cry to open up. years ago. Playing at centre for English Lawrence, whose careers had launched in the week that Dan Vicker- campaigning for culture change to tackle has had no of male suicide has trebled. De nitively, We must better equip ourselves, our Premiership rugby team Wasps, he also been cut short by gruesome man, a recently retired Australia lock, outdated stereotypes of masculinity that men are talking more. Calm alone mates, our workplaces, schools and won what looked like the  rst three injuries . Meeting them, Hopley was found dead at his home in Sydney. prevent men seeking help. time for has taken 200,000 helpline calls health services to support those who of many England caps in 1995. Rugby says, helped give him a fresh The 37-year-old had taken his own life. We do this in the face of a problem discussing to date, and prevented more than need it. And we start by building a union had just stopped being an sense of perspective. Lift the Weight aims to encour- that is deeply entrenched. Many 1,000 suicides. generation who believe that society’s amateur sport and the Cambridge In the summer of age men – and not just men feel forced to stoically “man emotions The work of organisations and ideas of your gender should not be graduate had given up his job in the 1998 Hopley set up elite rugby players – to up” (whatever that means) and grind  campaigns such as Lift The Weight and a death sentence. City to ride this  rst wave of profes- the Rugby Play- talk about the issues. sionalism, but Hopley found himself ers’ Associa- “Once people get in troubled waters. tion (RPA). “I to share the stories In 1996, playing for England at the was pissed o of their frailties Male suicide The biggest killer of men aged between 20 and 49 Hong Kong Sevens, Hopley injured his with the way it makes all the knee. He saw a surgeon but he injured I had been di erence,” says the knee again and nine operations treated and Hopley. “ Jonny and two reconstructions later his that was the Wilkinson, for professional career was over before it catalyst,” he instance, has % Suicide rates for men in Northern had really begun. “The hardest thing says. There been very 6,188 75 Ireland were up to twice as high is the huge dent in your self-esteem was initial frank about his suicides in the UK in 2015 of suicides were male as other UK countries in 2015 and purpose and realising that you opposition demons.” are not a rugby player. It was like from the By Ian Malin Single biggest killer of men in the UK aged between 18 and 45 of men in the UK between the % have contemplated taking their own life age of 20 and 49 42 % % % The hardest thing is the 22.3 21 55 30 31 huge dent in your self- deaths per 100,000 deaths per 100,000 of men who felt of men compared of men who felt population of UK population of men very depressed with 21% of women suicidal said they esteem. Realising I was men aged 45 to 59 aged 30 to 44 talked to somebody say they are too didn’t discuss how not a rugby player was about their feelings embarrassed they were feeling compared with 67% to discuss their because they like a bereavement Highest regional Lowest regional of women depression with didn’t know how  male suicide rate in male suicide rate others to talk about it 2015 in England in 2015 in England ?

17.9 14.5 The most common reasons men feel low are: suicides per 100,000 suicides per 100,000 Failing at work or school / Money problems population in Yorkshire population in the Death of someone close / Personal appearance and the Humber east of England

Sources: ONS; Calm In the UK. Find support: the Samaritans can be contacted on 116 123 MICHAEL THOMAS JONES The Guardian | Wednesday 10 May 2017 9 Service users Power to the people

The patients who use the Gellinudd Recovery Centre have a say in everything from policy to the decor. Could co-produced innovations be the future for mental health care? By Rachel Williams

oft, neatly folded blankets hang invitingly over the backs of the modern but comfy armchairs in the Gellinudd Recovery Centre’s communal living room. In Sthe en suite bedrooms, there are white waffle slippers and dressing gowns embroidered with the centre’s tree symbol. Staff and guests – those who stay are not termed patients – join forces to cook, clean and tend the fruit and veg they then sit down to eat together at Gellinudd, which is the UK’s first inpatient mental health centre to be designed by service users and their carers. “If you’re a psychiatrist you’ll still be expected to be in the kitchen chopping vegetables alongside everyone else,” says the centre’s director, Alison Guyatt. Over three years, via consultation meetings attended by up to 50 people Staff at the was therefore critical. Members met ask for co-produced innovations,” Berry and annual general meetings attracting Gellinudd the architects in the earliest stages, and says. “But the money to match that as many as 300, service users and Recovery Centre Guyatt arranged for furniture makers isn’t always there because funding is carers who are also members of the in Wales to bring chairs, tables and beds to reducing. We as a provider can say we’ll Welsh charity Hafal, which runs the consultation events to be tested. implement a whole range of innovative centre, have influenced everything Hafal believes co-produced, services. But to prove they work we from the policies and procedures to the recovery-focused services improve want to evaluate them, and evaluation decor, facilities and recovery-focused outcomes for patients and reduce costs. costs money.” Berry has no doubt that activities on offer. It has estimated that Gellinudd, which services designed with users bring “They’re the experts,” says Guyatt. was developed with Big Lottery funding better outcomes: “They give power to “They can say how it feels to be on the of £1m and £500,000 from the Welsh the people who understand recovery receiving end of care, how anxious you government’s Invest to Save scheme, the most.” would be, what your concerns would At the National Survivor User be. They have such powerful stories to  Network (NSUN), a charity which helps tell.” The lack of privacy and dignity mental health service users shape in hospital settings, together with old Service users are the policy and services, managing director and decrepit buildings that provide experts … They can say Sarah Yiannoullou believes the extent little access to fresh air, were common to which service users are listened to themes among those who gave input. “A how it feels to be on the remains patchy. “There are some really lot of them feel very clinical, rather than good examples where the rhetoric is homely and welcoming,” Guyatt says. receiving end of care starting to become the reality, but it’s Ensuring a different atmosphere at  not consistent,” she says. Gellinudd, which opened in April 2017, “I think we’re still in a system where the medical model is dominant and will generate year-on-year NHS savings there’s this culture that the professional of £300,000 in Wales. still knows best. The problem for the Could the model be copied voluntary sector is that quite often what elsewhere in the UK? Commissioners you say works and helps is regarded as are increasingly interested in anecdotal or dismissed as not credible.” co-production, according to Grazina But it is crucial service users are Berry, director of performance, quality listened to: “Meaningful, effective and innovation at the Richmond involvement can transform people’s Fellowship, a voluntary sector mental lives, improve the quality and efficiency health support provider that involves of services and develop the resilience its users in shaping services. But the of communities,” says Yiannoullou. “If resources to make it happen are not commissioners and clinicians really necessarily available. listen to us, respect us and treat us as “We’re seeing many more equals then our experience of services Gellinudd service users or ‘guests’ chose the centre’s chairs opportunities coming up which directly will improve.” 12 The Guardian | Wednesday 10 May 2017 The Guardian | Wednesday 10 May 2017 13 Technology

being bullied in daily life that then cross over into their digital lives, says Marc Switch o , stay cool Bush, chief policy adviser at Young Anxious about Minds. “For instance, victimisation in Top tips for staying digitally healthy: the school playground is replicated on their Facebook pages or their WhatsApp • Limit your time online. Remember or Snapchat groups, so they relive the there’s a real world you’re living in. social media? distress they’re experiencing in real life Social media has its place, but should on the digital platform.” not become a substitute for face-to- So, what’s to be done? Bush says face contact with friends and family Disagreement continues are pervasive. Stephen Buckley, head industry has an important role to play. members. of information at the charity Mind, Today, if you search certain hashtags over the e ects of social acknowledges these risks: “It is vital on Instagram, for example, a helpline • Turn your phone off for half an hour media on mental health. to recognise the huge danger created pops up. He also cites the report from or more before you go to sleep to create by any site or social media trend that mental distance from the pings of status Sarah Johnson reports promotes self-harm, suicide or eating updates, text messages and alerts. disorders. They can be hugely damaging or all the bene ts to mental and possibly dangerous to someone in Victimisation in the • Avoid sites you know prompt negative health a digital world can a crisis .” school playground feelings and if you see something that bring, such as a sense of This has come to the forefront over upsets you, close it immediately. belonging and information the past decade as more and more can be replicated on and support for those with children use smartphones and tablets. Facebook or Snapchat • Try not to read too much into things. problems, there are also A Young Minds report, Resilience For Misunderstandings can happen easily myriad dangers associated with online the Digital World, says half of Europe’s  online because the signs we use during activity. In the very worst cases, people nine- to 16-year-olds now own a face-to-face conversation, including have live-streamed their suicide and smartphone; the vast majority go online tone of voice or body language, are not had people cheer them on in the at least once a week, and most daily. the House of Lords communication available on-screen. comments section. Buckley says that people are now committee, Growing Up With the Meanwhile, cyberbullying and used to following their friends on social Internet, which calls for a national • Look out for other people’s safety – trolling, along with communities and media and sharing news of a new job, digital champion who can look at the people talking about being depressed, groups on social media that foster, relationship, or a holiday presented in rights of young people online, educate saying they’re feeling suicidal. Know glamorise or even encourage self-harm the best possible light. But this can have parents and teachers on how to look out where or who to refer them to because for warning signs, and support young that is really important in intervening an impact on individual self-esteem. Half of Europe’s people to understand the consequences and making sure nothing escalates. “While low self-esteem is not a mental nine- to 16-year- of bullying someone online. health problem in itself, the two are olds now own a The greater part of the solution, • Take responsibility for your actions closely linked. If lots of things are smartphone though, lies with young people online and try and think about how your a ecting your self-esteem for a long Alamy themselves. “Ultimately,” says Bush, words could aff ect other people. Think time, this may lead to depression or “young people are active in the creation, about whether you would be willing to anxiety,” says Buckley. consumption and distribution of these say it directly to the person and if it is a Pressure on young people may also images or forms of behaviour, so they fair, compassionate thing to tell them. SJ come from situations where they are have to be part of the solution.”

racist or Islamophobic, or attacking was wrong and told me to do some Tamanna Miah my appearance or the way I acted – exercise. It wasn’t until university that anything. People would  nd a fault and I was diagnosed. ‘I developed severe take advantage of the situation. Now I try and be careful when anxiety after being I was a very shy, quiet child, I using social media, but I also use it couldn’t stand up for myself, or look for networking and meeting people. bullied online and people in the eye. I would be bullied I’ve been through bullying online and at school, come home and log on to o ine, but I’ve also had a wealth of o . Now I speak up the laptop and it would continue. opportunities through social media. You wake up in the morning to I make sure that my personal activity, for those who can’t’ check again and it’s never-ending photos and comments are restricted, torment and hate. I couldn’t to avoid anyone attacking me publicly Tamanna Miah, 23, is a campaigner escape. I hated school and or harassing me. I don’t want to and public speaker from Kent. She my time in education. I was experience more abuse so I’d rather describes how she coped with being never happy. keep personal things private. I’d say to bullied on social media and what it has I developed severe others in similar situations to always be been like to grow up in a digital world. anxiety and depression careful about what you post and where. as a result. I tried to get Your online life is always going to be “I grew up in Sevenoaks, Kent, which support from my school present. Google yourself to see what’s is a very conservative, middle-class and was unsuccessful. I out there so you can check your settings area. I su ered from severe bullying visited my GP and they and change them if needed. If someone and racism from primary school to dismissed me and didn’t is bullying you, always tell a responsible my all-girls secondary school until take me seriously. person as soon as possible. Make sure university. When I went home, the They said nothing you have evidence of everything. Take abuse continued online. It happened on screenshots or make audio recordings. my social media networks – Facebook, Tamanna Miah is Whatever happens, don’t give up – Bebo and MSN. People would comment now a prominent just keep going. We absolutely need to on photos, status updates, anything anti-bullying speak about these issues, because if we that I was doing. Sometimes it was activist don’t, who will?” SJ 14 The Guardian | Wednesday 10 May 2017 The Guardian | Wednesday 10 May 2017 15 Mental health in the workplace

Sue Baker ‘We need to open up in the workplace’ A new prescription, a new life

Social prescribing, where patients are referred to non-clinical activities , is producing positive Sue Baker is director of Time to Change, can do to create a more open working in recent years to target male- the anti-stigma movement run by Mind environment. Senior leaders have dominated workplaces, such as outcomes. But, asks Rachel Williams, can the voluntary sector keep up with demand? and Rethink Mental Illness charities Employees a pivotal role to play in leading by construction. Our research shows at all levels example – being open about their own that men still don’t consider mental gardening, arts and sports, normally ooking after the wellbeing mental health experiences sends the health relevant to them. Men try to delivered by the voluntary sector – is of employees bene ts need to talk strong message that this isn’t a sign be self-su cient, keeping problems growing, with many schemes tackling everyone – no matter your honestly of weakness and doesn’t limit your to themselves. But mental health mild to moderate mental health role, seniority, and whether ambition or aspiration. Employees at problems don’t discriminate – they problems. Studies have suggested a you have a mental health about all levels talking honestly and openly can a ect anyone. range of positive mental health and problem, or not. mental about their experiences has contributed Many of the biggest UK construction wellbeing outcomes. Working with employers over hugely to a cultural shift in how we  rms have signed our pledge, and they But in January a report health the past six years means we have think about the topic. tell us that for them it has been crucial commissioned by Natural England a good indication of what works to  When employees feel their work is to have people “on the ground” in the warned that the lack of a standardised ensure a mentally healthy workplace. meaningful and they are valued and form of employee champions who referral mechanism, or funding for the Those elements are incorporated supported, they tend to have higher challenge workplace stigma, normalise activities o ered in the majority of into the Time to Change employer wellbeing levels. We often talk about a conversations about mental health and services, posed “fundamental barriers” pledge, which gives organisations three-pronged approach that employers encourage those who need help to feel to the NHS’s ambition to increase the the opportunity to demonstrate can adopt: promoting wellbeing for comfortable asking for it. scale of social prescribing. their commitment to opening up the all sta ; tackling the causes of work- With the right support from those It identi ed Rotherham’s service conversation about mental health. related mental health problems; and around them, people with mental for people with long-term health More than 500 organisations have supporting sta who are experiencing health problems can recover and have conditions, which started in 2012, as made that commitment. mental health problems. equal opportunities in all areas of life – There are multiple things employers We’ve made a conscious e ort including work. It’s so di erent from your normal life. You go out there and all your worries leave you  Are you, or is someone you know, Mental Health Nurse? contemplating suicide? having many of the ingredients for Join our Family. good practice – including a simple and e ective referral system, well-informed Maytree is a National Charity. We provide a unique Are you passionate about reducing mental health distress, link workers to help patients choose an residential service for people in suicidal crisis so they can supporting physical health needs and increasing your patients’ intervention, and, crucially, funding for talk about their suicidal thoughts and behaviour. sense of wellbeing? We are looking for talented mental health nurses to join our family those interventions. We offer a free 4-night/5-day one-off stay to adults over at LPT. In return, we offer an attractive package of benefi ts and the The report also highlighted the chance to be at the forefront of innovation across a range of service Rotherham has since started for the age of 18 from across the UK. Our aim is to provide services. The Branching Out programme in Scotland uses the outdoors to help people build con dence Jane Barlow people with mental health issues, which a safe, confi dential, non-medical environment for our Along with being able to offer a specialist role within a given area, our staff also have the opportunity of being began as a one-year pilot in 2015 and guests. Somewhere our guests can explore their thoughts able to move between different teams to broaden their roup therapeutic work had “I enjoyed it straightaway,” says has just been extended for a third year. and feelings, and feel heard with compassion and without clinical experience. never appealed to Kerina, Kerina, who now volunteers as a In an evaluation of its  rst year, 93% of Our services cover a wide range of inpatient and who was diagnosed with mentor with the Abriachan Forest service users reported progress against judgement. community services including acute inpatient care, mental health services for older people, acute borderline personality Trust, where she completed the course. at least one of eight wellbeing outcome Please visit our website for more information about our assessment and home treatment, day care, disorder and obsessive “It’s so di erent from your normal life. measures, and 64% reported progress charity www.maytree.org.uk psychological therapies, assertive outreach, as well compulsive disorder in her You go out there and all your worries on four or more. as a comprehensive learning disability service. 30s after su ering from mental health leave you. We built shelters, tables, While the service initially focused on Our teams are at the forefront of innovation to  Maytree is committed to supporting people that are feeling and issues all her life. “You sit there reading workbenches, a kitchen. We chopped those who had been using services for contemplating suicide, and we aim to offer as many people who feel improve the health and well-being of the people we paperwork and it feels like you’re in a wood, we cooked, we sat around  ve to 20 years and needed a support they would benefi t from a stay the opportunity to do so. However, due support, including our award-winning ECT app, our acclaimed mental health triage service, our internationally classroom,” she says. the camp re. network and meaningful activities to to a person’s medical needs or specifi c life circumstances it is not always renowned specialist Huntington’s Disease service. Also, we Then two years ago the community “It just seemed to really work for me. help with a successful discharge, it is possible to do so. Please read our “Guidance notes on a stay”, which is are pioneering ways of prioritising the physical health care on our website under the home tab. of mental health patients, and researching ways to cut mental health team in Mid Ross in I remember saying: ‘I feel like I’ve been now expanding to work with people falls and aggression among patients with dementia. the Scottish Highlands gave her a here for ages.’ I’d only been there a day.” earlier on. Reg. Charity No:1087668 Find out how you can grow as part of our family. “social prescription” – referring her to Though she still has good and bad days, But Janet Wheatley, chief executive Apply now at http://bit.ly/2qypqHs or visit our Branching Out, a Forestry Commission she says she now  nds her problems of Voluntary Action Rotherham, which jobs site below to see further opportunities. Scotland programme designed to help easier to deal with, and is working coordinates the programme, backs up people recover from long-term mental towards a formal award in volunteering. the warning in the Natural England health problems. For 12 weeks she spent The use of social prescribing report: “You can’t direct more and  ve hours a week in the woods doing – where GPs and other primary more people to use resources in the conservation work, bushcraft and envi- care professionals refer patients community without providing funding ronmental art. to non-medical activities, such as, to support that.” 16 The Guardian | Wednesday 10 May 2017 The Guardian | Wednesday 10 May 2017 17 Diversity and inclusion in school

Celine Bickerdike Learning to respect difference ‘Teachers had to believe you had a problem before you Schools today are much more receptive to students’ gender and sexual orientation, and are could access the places where diversity is celebrated rather than scorned, as Linda Jackson discovers school’s services’ t was not long ago that LGBT pupils that more needed to be done to promote are openly transgender, gay, bi, lesbian at the Priory School in Hitchen, equality and diversity. Surveys of young or gender questioning. For those who Celine Bickerdike, 19, is an apprentice Hertfordshire, hid behind a mask of people who identify as LGBT revealed are transgender we have procedures in Leeds and has secured a university silence. Fellow students used the that many are at high risk of mental in place for name changes and work place to study history. She has had word “gay” to describe something health problems. together with the young person. That anxiety and depression since aged 12. that was rubbish. Faced with The 2016 Youth Chances survey, can mean getting people who have But it was five years before she sought Ihomophobic language, they felt unable conducted by the charity Metro in transitioned to come in and talk to professional help. to come out in the classroom and kept collaboration with the University of young people.” their true identities secret. Greenwich, found that out of the 6,414 LGBT role models have also visited “My first experience of being judged Three years later, dozens of students the school, including actor Sir Ian because of having a mental health have come out thanks to a “massive  McKellen, co-founder of LGBT charity problem was when some girls took culture shift” in school. Today, diversity Stonewall, who spoke to 35 student my antidepressants from my bag and and inclusion are celebrated across For children at primary members of the weekly LGBT drop-in started reading out the side-effects in all aspects of school life: from the level, the more we can group. “One sixth-former who is openly front of everyone. They humiliated me. setting up of an LGBT drop-in group gay said he wished the school had been How can people be so cruel? and appointment of an LGBT student do to non-stereotype as open when he was in key stage 3,” “There was some school mental champion, to changes in the curriculum them the better Southall says. health support, but teachers had to and the building of gender-neutral Meanwhile Arbury primary school in believe you had a problem before you toilets and changing rooms. Indeed, the  Cambridge is working hard to promote could access it. Most of my teachers school has established such a reputation diversity and has become a beacon of thought I was OK – one even said that I for equality it is attracting transgender good practice. It has adopted a range circle time highlighting the school’s Actor Sir Ian teacher Kathy Whiting says the school was stressed because I wasn’t working pupils from neighbouring areas. respondents aged 16-25 who took part of initiatives to stamp out gender golden rules. Displays of materials from McKellen advises other schools on creating a hard enough. I broke down during my Priory now has a resident counsellor in the survey and identified themselves stereotypes across the school, from Stonewall with the slogan: “Different speaking at the trans-inclusive environment, including mocks, which was when my history and has forged close links with local as LGBT, some 44% said they had abolishing pink- and blue-coloured families, same love” are posted around LGBT drop-in training on the use of inclusive language. teachers, who I was really close to, told child and adolescent mental health considered suicide. name badges for reception children, to the school, which also celebrates LGBT group, Priory Headteacher Ben Tull says: “It is me to go and see a doctor. services. Sixteen staff have also been Southall says: “We realised from an having a non-gendered school uniform. history month. School, Hitchen really important that a school is ready “I put an enormous amount of trained in mental health first aid. annual survey on student wellbeing Children are taught to respect Staff are trained to understand how for anyone who walks in. For children pressure on myself to get the grades I Assistant head Katie Southall has that lots of students identified as gay or difference from the start in reception: stereotyped views of how boys or at primary level, the more we can do needed for university. I was anxious led the transformation. Responsible for LGBT, but didn’t want to be open about through picture books showing different girls should behave can prevent them to non-stereotype them the better. We about the future – and failure. student wellbeing, Southall realised it. We are now in a position where pupils types of families, and talks during from reaching their potential. Senior steer away from the binary model.” “I didn’t get into the university I wanted and this really took its toll. I felt completely lost. All my friends were at university. I had gone from having Working with 282 primaries and 50 of mental illness in adults has its a promising future to being on job Healing through the secondaries, the charity provides early roots in childhood. seeker’s allowance. intervention support in schools to The prime minister said, before “I think initially, my parents didn’t children who are troubled and unhappy. the election was announced, that she take my mental health problems The charity is not the only one wanted every secondary school to be seriously; they thought it was just art of conversation working with schools. The Art Room offered mental health first aid training, ‘hormones’. I’d always been a bit of charity supports five- to 16-year-olds as well as new ways introduced to a worrier so they assumed that my who are experiencing emotional and strengthen links between schools problems were small because of that. behavioural difficulties. and NHS staff alongside more online “Nowadays I find it easier to talk to The spaces that help Place2Be. But as well as worries over There are eight Art Rooms in schools support services for children and people about my mental health because friendships, bullying or problems in Oxfordshire, London and Edinburgh, young people. May’s recognition of I’m more confident and don’t doubt my children talk through at home, headteacher Paul Harris supporting 500 children a week by the crisis in children and adolescent condition as much. People’s conditions their anxieties provide an reveals that a growing number of offering art as therapy to increase mental health has been welcomed. should be believed as soon as they children are suffering from anxiety as their self-esteem, self-confidence But headteachers say that cuts of £3bn develop so that it’s easier to prevent oasis in uncertain times a result of Brexit and the election of and independence.  to school budgets threaten existing them worsening like mine did.” LJ Donald Trump. It is this kind of partnership that Children are in-school care and want mental health Fortunately, pupils at Curwen Theresa May, the prime minister, said in funding ringfenced. t could easily be a child’s bedroom. primary and its sister school, January that she wanted to see more of. suffering Harris, who is also executive head In the centre is a large mat, while a Kensington primary in Manor Park, She said then that one of her priorities from of three other primaries in the London selection of dolls and soft toys line can speak to a counsellor before their was children’s mental health, which has borough of Newham, says the proposed the walls. It is hard to believe that problems become overwhelming. long been recognised as in crisis. anxiety school funding cuts mean losing the this nurture point in Plaistow, east The lunchtime drop-in – known Statistics show that one in 10 caused by service of 17 teaching staff: “I believe London, aimed at helping children as Place2Talk – is part of a package children – or an average three children Brexit and support needs to start young in primary Ideal with their emotional problems, of support services offered by the in every classroom – has a diagnosable schools to build resilience before was once a school staff room. charity, which includes one-to-one mental health problem, and that 75% the election children go on to secondary. Youngsters aged five to 11 can drop counselling and play therapy for of Trump “Cash needs to be earmarked for this in three days a week and speak to a children suffering from more serious Soft power: the charity Place2Be from health budgets, otherwise we will Celine is a young champion for the trained counsellor from the charity mental health issues. provides drop-in centres for childen  lose this vital service.” LJ mental health charity Time to Change The Guardian | Wednesday 10 May 2017 19 Growing up transgender

‘I wish I could have come out younger’

Aimee Challenor knew reach my potential and my education Growing up, it was unnecessary attention seeking; suffered as a result.” Aimee Challenor they said it made the school look she was different aged It wasn’t until her school graduation felt anxious and stupid. But I dug my heels in. I was 10, but it took years prom that she decided to come out depressed as a incredibly nervous on the night, but as trans: “It was then that articles result of feeling it felt so positive – for me it reinforced to come out as trans about trans started to appear and I pressure to be what was right.” discovered that there was a word for someone she Challenor is in the process of rowing up is tough enough for it. I found the trans guide published was not transitioning from male to female any young person approaching by the Tavistock and Portman NHS but feels “in limbo” as she waits puberty. But for Aimee foundation trust and decided to come to continue adult gender identity GChallenor the challenges she out at my prom – it was the day before services: “I’ve been out now for three faced as a 10-year-old were much I was due to leave school.” years and publicly present as female, harder: “It struck me when I was about Her mum helped her with her but I wish I could have come out 10 or 11 that I was a girl. I couldn’t put dress and one of her school’s younger and not have had to wait until my finger on it but something wasn’t teachers did her makeup I completed puberty.” right. I was in year 6 and I left my on the night: “Some of Today Challenor speaks on LGBTIQ parents a letter on their bed before I the staff were very (lesbian, gay, bisexual, transgender, went to school one morning. When supportive, but intersex and questioning) issues we talked about it later they were they were not in the for the Green Party in England and very supportive, but no one knew school leadership Wales and also contributed to charity what trans was. So I went back into team. Generally, Stonewall’s Vision for Change report, the closet.” I didn’t get any published in April, which spells out During the next six years Challenor, support from my what still needs to be done to deliver now 19, felt anxious, isolated, lonely school – it wasn’t equality for the UK’s trans community. and depressed. “I spent my time at up to speed on the Challenor says: “I speak to schools secondary school feeling pressured Equality Act and about trans issues and I am the first by society to be somebody that I was they wouldn’t let openly trans person to work for a not. I wasn’t able to be myself; there me wear a dress political party. I think trans [people] was always that nagging feeling at to the prom need to show that you can be trans the back of my head, so I didn’t take because they and reach your potential.” opportunities and grab them. I didn’t thought Interview by Debbie Andalo

 I wasn’t able to be myself – there was always that nagging feeling at the back of my head  Jonathan Cherry Jonathan 20 The Guardian | Wednesday 10 May 2017 The Guardian | Wednesday 10 May 2017 21 Kaleidoscope learning Mental health nurses

Tony Draper Getting children into the right mental space Nursing numbers don’t add up NHS trusts are struggling here is a crisis in mental Water Hall primary serves the Lakes Kaleidoscope has had an amazing to ll vacancies for health for young people. Estate in Bletchley, a disadvantaged impact on the children’s emotional and mental health nurses. Is Services are operating area where external issues regularly mental wellbeing and their learning. in silos and they are not a ect children’s mental and emotional Exclusions have fallen, attendance and a fresh approach needed? working for overtested, wellbeing. The school has used the behaviour has improved, children have overstressed young people. Kaleidoscope programme for eight years. taken responsibility for their learning Kim Thomas reports Much emphasis has been placed on The support system enables children to and results have shot up. Kaleidoscope teenagers with low self-esteem, with forget the things worrying them at home works, it gives children the tools to ommunity-based teams care behavioural and emotional issues and or elsewhere when they are in school. enable them to raise their self-esteem, for 97% of mental health how we can support them. Seven di erent stages make up a with the accompanying improved patients. And nurses play At Water Hall primary school in Kaleidoscope session: relax, visualise, outcomes for the school. a pivotal role, building up Milton Keynes, we believe in the need to express, move, build, explore and Our work proves that unless the trust between patients and identify and address these issues early a rm. A designated room is used for child is in the right place emotionally their families. to be able to implement intervention sessions for either small groups or and mentally, learning will not take However, since 2010 the total Taking strategies as soon as possible. one-to-one sessions. Interventions last place, however good the teaching and number of NHS mental health nurses in Taking action early enables action early six to eight weeks. leadership in the school. England has dropped by 15% – in parts vulnerable children to rebuild their enables The programme is used in all classes of London, about 20% of job vacancies self-esteem and take responsibility every day. Each morning starts with a Tony Draper is headteacher of Water are un lled. Helen Gilburt, a fellow in for their emotions, behaviour and children to session enabling children to be in the Hall primary, chief executive o cer health policy at thinktank the King’s learning. The outcome will be that they rebuild their right frame of mind to learn. Lights of Lakes Academies Trust, and the Fund, says: “Community mental health re-engage with education, perform are low, relaxing music is played and immediate past president of the school teams are supporting people to stay well and are con dent and happy self-esteem children are taught various calming leaders’ union, the National Association well, so if you haven’t got su cient young people.  techniques that they can use anywhere. of Head Teachers. workforce to deliver that care, people are more likely to relapse.” The shortage of mental health nurses means it is di cult to do all the things you aspire to 

The nursing shortage is caused partly by an ageing workforce that is not And a review of psychiatric care by the Sta shortages: Trusts are struggling to deal being replaced quickly enough. In 2013, Commission on Acute Adult Psychiatric the number of with the shortages. Many, says Neil more than 32% of mental health nurses Care found that most mental health mental health Brimblecombe, director of nursing were aged over 50, and the abolition wards were treating, on average, three nurses has at South London and Maudsley NHS of bursaries for student nurses may patients who could have been cared dropped by 15% in foundation trust, are employing also have had an adverse e ect on the for by other services, including crisis England Alamy agency nurses, meaning that patients number of new recruits. houses and community services, if they “have less opportunity to develop As a result, individual nurses are had been available. long-term relationships with individual taking on a higher caseload. Research nursing sta ”. last year found that some community Mental health nursing Headcount Instead of “chasing an increasingly mental healthcare coordinators – not all diminishing pool of nurses”, of whom are nurses – have caseloads as • The number of nurses working in NHS acute and community Brimblecombe believes trusts should high as 50 patients. mental health and learning disability services in England, take a di erent approach to workforce Ben Hannigan, reader in mental December 2010, was 45,172. Six years later it was 39,308, design. His own trust has joined two health, learning disabilities and a fall of 13%. neighbouring trusts to develop a new psychosocial care at Cardi University, NHS Digital assistant practitioner role to take on who co-authored the study, says: “You some of the work traditionally carried will  re ght with that number of people • In England, in 2013, 32.3% of mental health nurses were out by registered nurses. – it’s very di cult to do all the things aged over 50; in Northern Ireland that fi gure was 30%. In In the long term, Brimblecombe you would aspire to.” Therapeutic care, Scotland, in 2014, it was 38%. believes the community mental health aimed at helping people to recover, will Royal College of Nursing workforce should include more peer be harder to provide, he says. workers with “lived experiences of The shortage is a ecting the whole • There are 3,000 mental health nurse vacancies. Figures from mental health problems” and more service; a 2015 report by the Care the England National Quality Board state that in 2015-16 the occupational therapists: “There will be Quality Commission revealed that only vacancy rate for mental health nurses was 13%. an increasing range of new roles. The 14% of mental health patients said they Source: Health Education England days when we have doctors, nurses and received appropriate care in a crisis. social workers, and that’s it, have gone.” The Guardian | Wednesday 10 May 2017 23 Prisons Prison mental health in crisis

A rise in prison suicides has cast a light on mental healthcare needs behind bars, says Sarah Johnson

ental health problems in the prison population have long been a matter of concern. Suicide rates in prisons in England and Wales are at an all-timeM high; a record 119 people killed themselves in 2016 – an increase of 29 on the previous year, according to figures from the Ministry of Justice. The rise in prison suicides has been accompanied by a 23% increase in incidents of self- harm, to a total of 37,784. “It’s a huge issue because lots of people in prison have mental health problems,” says Dr Steffan Davies, consultant forensic psychiatrist and likely to worsen existing mental health Hard landing: 72% Up to 10 participants could attend. co-chair of the Community Diversion problems that are often the key drivers of male prisoners Training included positive thinking, and Prison Psychiatry Network at the for offenders to commit further crimes experience two or goal setting and problem-solving. Royal College of Psychiatrists. A study or become violent while in prison.” more diagnosable Fifty prisoners filled in the Warwick- by the Prison Reform Trust found that Davies adds: “It does feel like things mental disorders Edinburgh mental wellbeing scale at 72% of male and 70% of female prisoners are getting worse and I’m hearing it’s Getty Images the start of the course and a month experience two or more diagnosable hard to recruit people to prison mental after its completion: the mean score mental health disorders. Research by the health services. People are leaving, and showed a significant increase in the National Institute for Health and Care quite a few find it an extremely stressful prisoners’ wellbeing. Excellence found that 7% of male and environment to work in.” Lauren Chakkalackal, senior research 14% of female prisoners have a psychotic While the general outlook is bleak,  officer at the Mental Health Foundation, disorder – 14 and 23 times the level in the projects such as the self-management It’s hard says: “A number of positive stories came general population respectively. training programme at HMP & YOI from the project. It was an opportunity The situation looks set to get worse. Parc, Bridgend, south Wales, hold out to recruit for people to feel listened to and express In recent years, staff numbers have some hope. Developed as a partnership for prison how they were feeling. dropped significantly, budgets and between the Mental Health Foundation “A group of prisoners produced staff training have been cut, the prison and G4S, and funded by Big Lottery mental resources to better support the mental population has more than doubled, Fund Cymru, the aim was to improve health health needs of new prisoners. The and the introduction and rising use prisoners’ mental health through self- prisoners themselves took ownership of of new psychoactive substances has management and peer support. services, that group.” contributed to increasing violence. The programme was delivered and people Plans are afoot to develop similar Jacob Tas, chief executive of the between September 2013 and December are leaving models in other prisons and the project social justice charity Nacro, says: “The 2016, and involved two to three hours’ is being redesigned to support older overcrowded prison environment is training one day a week for four weeks.  prisoners and young offenders. A problem locked in Mental health and prisoners

• The number of male prisoners total prison population of 85,442 – • More prisoners have been killed, transferred to hospital under the Mental have bipolar disorder, depression or committed suicide, self-harmed or Health Act 1983 grew more than 20% personality disorders. assaulted in 2014/15 than five years ago. between 2011 and 2014 in England and Wales. • Some 448 young people aged 15–24 • In 2015, women prisoners accounted have died in prison in the past 20 years; for 23% of self-harm incidents, yet • The prevalence of mental ill health 87% of these deaths were classified as represented 5% of the prison population. and substance misuse is higher among self-inflicted. prisoners than the general population. • Studies show that about a quarter of Estimates of mental health problems • In the year ending December women and 15% of men in prison have among prisoners are as high as 90%. 2014, there were 18,995 incidents reported a psychotic episode. The rate of self-harm among male prisoners – among the general public is about 4%. SJ • It is estimated that about 21,000 almost a third higher than the year to Sources: Criminal Justice Alliance; Mental Health people – approaching a quarter of the December 2010. Alliance; Prison Reform Trust; Ministry of Justice