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The Royal College of Psychiatrists Improving the lives of people with mental illness


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20/06/2018 17:29:09

Clean Air Day

With Clean Air Day being marked across the UK on 21st June 2018[i], anyone interested in mental health might like to consider the links between poor quality air and poor mental health. The connection between air pollution and deaths from respiratory and cardiovascular causes is well established in the UK and elsewhere, but Clean Air Day presents us with an opportunity to think about the direct ways in which air pollution might be contributing to poor mental health outcomes too. Is it too farfetched to think that air pollution could actually cause mental illness?

In 2015, it was estimated that 7.6% of all global deaths were attributable to the presence of fine particulate matter in the air[ii]. In the UK, up to 40,000 premature deaths from air pollution are estimated to occur per annum and up to 6 million sick days are attributable to unhealthy air[iii]. With a current mortality gap of over 10 years in the UK between those with and without major psychiatric illness[iv], at the very least psychiatric patients are likely to be disproportionately affected by mortality and physical morbidity attributable to poor air quality.

However, there is now emerging and compelling evidence that air pollution may directly influence adverse mental health outcomes, certainly as far as suicide, dementia and anxiety are concerned. Good quality environmental epidemiological studies have recently started to emerge from across the world outlining a link between suicide and air pollution - particularly pollutants such as fine particulate matter and Nitrogen Dioxide. Recently published research from the Far East[v], Europe[vi] and the United States[vii] show a small but important effect of short term increases in air pollution on completed suicides, although the neurobiological and neuropsychological mechanisms that could underpin this are speculative at this stage and largely unexplored[viii][ix].

Anxiety appears to be associated with exposure to high levels of small particulate matter[x], whilst there is increasing evidence that Emergency Department attendances for psychiatric reasons are related to high levels of air pollution[xi]. Finally, a widely reported[xii] study published in the Lancet in 2017 showed a substantial increase in the incidence of dementia in people living close to major roads[xiii] - the implication being that air pollutants from vehicles were the main mediating factor.

As evidence for the health benefits of cleaner air accrue, it becomes easier to push policy makers into action - this was highlighted earlier this month by the Mayor of London in conversation with the Royal College of Physicians[xiv].

Of course, an added benefit of reducing air pollution is that CO2 emissions will also fall - taking the UK nearer to its goal set out in the Climate Change Act of 2008 to reduce carbon emissions by 80% by 2050. Significant physical health benefits have been predicted if we can manage to meet our CO2 emissions targets[xv], perhaps we should be shouting about the potential mental health benefits too? So, as psychiatrists why not use Clean Air Day 2018[i] to promote the health benefits of a cleaner, less polluted environment for us, our communities and our patients.

For more information on the health impacts of air pollution see the UK Health Alliance on Climate Change, of which the Royal College of Psychiatrists is a member.

Dr Lisa Page

Consultant Liaison Psychiatrist, Sussex Partnership NHS Foundation Trust,


ii. Cohen et al. Estimates and 25-yer trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet 2017; 389:1907-18



v. Kim et al. Air pollution and suicide in 10 cities in Northeast Asia: a time-stratified case-crossover analysis. Environmental Health Perspectives. 2018

vi. Casas et al. Does air pollution trigger suicide? A case-crossover analysis of suicide deaths over the life span. European Journal of Epidemiology. 2017 32:973-981

vii. Bakian et al. Acute air pollution exposure and risk of suicide completion. American Journal of Epidemiology. 2015: 181:5

viii. Chen & Samet. Air pollution and suicide risk: another adverse effect of air pollution? European Journal of Epidemiology. 2017 32:943-946

ix. Raguett et al. Air pollution, aeroallergens and suicidality: a review of the effects of air pollution and aeroallergens on suicidal behaviour and an exploration of potential mechansims. Reviews in Environmental Health. 2017: 323(4): 343-359

x. Power et al. The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study. BMJ. 2015: 350:h1111 doi:10.1136/bmj.h1111

xi. Oudin et al. The association between daily concentrations of air pollution and visits to a psychiatric emergency unit: a case-crossover study. Environmental Health. 2018 17:4 DOI 10.1186/s12940-017-0348-8


xiii. Chen et al. Living near major roads and the incidence of dementia, Parkinson’s disease, and multiple sclerosis: a population-based cohort study. Lancet. 2017; 389:718-726


xv. Williams et al. The Lancet Countdown on health benefits from the UK Climate Change Act: a modelling study for Great Britain. Lancet Planetary Health. 2018: 2(5): e202-213 doi: 10.1016/S2542-5196(18)30067-6

26/03/2018 15:19:17

Sustainability Scholar leading in education

One of our RCPsych scholars, Jamie Richardson, has been leading the way with ensuring that learning about sustainable healthcare is available to all psychiatrists:

"I have been one of the two sustainability scholars working at the college for the last year. In previous years the scholars have worked on local projects, but this is the first year we have worked directly with the college on sustainability scholarships. As well as attending the sustainability committee, I have been spending my weekly special interest day working on a project for the college with a sustainability theme.

My project have been focussing on integrating ideas related to sustainability into the educational life of the college. This has taken two different, but connected approaches;

Firstly I was involved in proposing changes to the college curriculum to including sustainability as intended learning outcomes. Focussing on the core curriculum initially, I searched the curriculum as it stands looking for areas which include sustainability already, and areas which could easily be changed or adapted to do so. This led to the production of a proposal document with potential changes to the curriculum, including three specific areas where I felt effective changes could be implemented. I was lucky enough to be able to attend the college curriculum committee to present my proposal, giving me a valuable opportunity to experience a college committee meeting first hand, and to present my case for change to the members.

The second element of my work, and my current focus, is writing an online teaching module on sustainability as part of the CPD online system. The college has approved the inclusion of a sustainability module into the CPD online collection, and I have been working on creating the initial draft of the document for inclusion. Although I have reasonable experience in producing and giving presentations as teaching, I have found the approach needed to write the module more challenging and stimulating than I expected. Aside from getting to grips with the material available on sustainability, I have also had to adapt my writing style to make sure I am able to clearly express my points in a written format without the opportunity to explain my thought process to the potential module users in person. The initial draft is nearing completion, and following this I shall be liaising with colleagues on the committee and further afield to provide multimedia for inclusion to improve the interactive experience of the module.

Although more half way through the scholarship year, I still have much to look forward to before I finish. I hope the module shall be completed shortly, and I will also be returning to the curriculum changes to see what progress has been made there. As well as the summer sustainability committee meeting at the college, I am due to attend the medical psychotherapy conference in Cardiff to represent the committee on the sustainability stand. For those of you attending the conference please feel free to come and talk to me about sustainability in mental health and the work the committee is doing at the college.

I applied to be a sustainability scholar at the college as sustainability and the environment are particular interests of mine, and have certainly had opportunities to expand my understanding of the concepts and the solutions to making a more sustainable healthcare system. What I did not necessarily expect, was the opportunities I have had beyond my projects, for example at committee meetings, which has given me a greater understanding of not just sustainability, but also the running of the college and the healthcare system more broadly."

Dr Jamie Richardson



Dr Daniel Maughan

RCPsych Associate Registrar in Sustainability

Consultant Psychiatrist, Early Intervention Service, Oxford Health NHS Foundation Trust

12/02/2018 11:48:25

Thinking sustainably about mental healthcare; let’s start at the beginning

The grey and cold start to 2018 has inspired a look towards a brighter and optimistic future for Daniel Maughan, Chair of the RCPsych’s sustainability committee, who has given his thoughts on opportunities to make mental healthcare more sustainable for this month’s blog:

"There are also lots of opportunities to improve the sustainability of mental health care. These include the strong evidence base that nature-based interventions can improve a variety of mental health conditions and the fact that low cost and carbon interventions such as talking therapies, group-based interventions, exercise and mindfulness as well as psycho-education can all provide clinical benefit as well as positive social outcomes.

A major carbon footprint issue for mental health care is that of medications, particularly given those with severe mental illness have compliance rates of about 50%. This potentially means that around 10% of the carbon footprint for mental health is thrown down the toilet – not good. The trouble is that the issue of non-compliance is thorny and many have tried to address this issue for reasons other than carbon footprint, without much success. Although awareness of this waste of resource should add weight to this already pressing issue and I have found it tends to be a good way to impress upon mental health clinicians the importance of thinking sustainably.

I think the biggest opportunity to improve the sustainability of mental health care currently is by addressing the second principle of sustainable health care, that of empowerment. Empowering those with mental illness, their families and their local communities, be they proximal in a geographic or online sense, to manage the illness independently has much scope for improvement. The current dogma of the medical model is limiting both patient benefit and potential financial and carbon footprint savings. Many common mental health problems such as milder forms of depression and anxiety can be successfully managed without the need of medical input. Provision of appropriate psycho-education, adequate social support, availability of locally based meaningful activities and reducing stigma are all vital if a shift is going to be made away from the dominant medical model. Where primary or secondary mental health services are needed, there are already many strategies in place to provide high value care with as little waste as possible. But it is the step before services are needed which is where the most benefits can be realised for improving sustainability. Providing the right social support with high quality engaging resources to help people help themselves is key."

Dr Daniel Maughan

RCPsych Associate Registrar in Sustainability

Consultant Psychiatrist, Early Intervention Service, Oxford Health NHS Foundation Trust


Dr Katherine Kennet

CT3 (Psychiatry), Barnet Child & Adolescent Mental Health Service (East)

01/12/2017 15:59:09

Sustainability in education: how we are changing psychiatry training to highlight sustainability at all levels

Introducing the principals and practical aspects of sustainability and sustainable practice is a key part of work of the RCPsych sustainability committee. In this blog post Jamie Richardson, one of the College’s Sustainability Scholars, explains the exciting project he is currently working on. Jamie is a higher trainee in Intellectual Disabilities in a Leeds community LD service and is a Psychiatry Tutor at the University of Leeds where he is involved in teaching undergraduate medical students:

"Over the summer I was pleased to be appointed as one of the two 2017–18 Sustainability Scholars at the Royal College of Psychiatrists. The scholarship is currently in its third year, and for the first time as a scholar we will be working more directly with the College, in particular with the sustainability committee, on our particular project. As a scholar I shall be focusing on sustainability and education within the College.  Prior to my appointment as a scholar, I had an interest in the environment and climate change, and I hope this appointment will allow me to further my understanding of these issues in relation to mental health, but I have also seen how sustainability encompasses much more, and I look forward to developing my understanding of sustainability more broadly.

The project I will be working will be focusing on the development of sustainability within the educational aspects of the college. To improve sustainability within mental health services, it is important to improve the understanding of sustainability by psychiatrists and other practitioners. My project will focus on two parts; firstly I am currently in the process of writing a proposal for changes to the core trainee curriculum. This proposal aims to suggest changes to the curriculum which will include sustainability concepts, so that core trainees, in seeking membership, will have to develop an understanding of sustainability and sustainable practice as a part of Royal College membership. The College is currently undertaking a review of all the training curricula and I hope this gives us a good opportunity to have sustainability included in the curriculum. The second part of my project involves the development of an online sustainability module for the College's CPD Online series. The college has approved the creation of the module, and we intend to cover sustainability, in general and specific to psychiatry, as well as the concepts of green care and the impact climate change will have on mental health. I hope this module allows current members to improve their understanding of sustainability for their practice, and to allow trainers to develop their understanding when working with their trainees.

This year as a sustainability scholar is set to be an exciting and stimulating opportunity, with a chance to make a significant impact on the way sustainability is taught within the College. I look forward to working with the Sustainability Committee and the College over the coming year and will be sure to keep readers updated with the progress we have made."

Dr Jamie Richardson

ST5 Higher Trainee (Psychiatry of Intellectual Disability)

Psychiatry Tutor (University of Leeds)


Dr Katherine Kennet

CT3 (Psychiatry), Barnet Child & Adolescent Mental Health Service (East)

18/10/2017 14:23:52

Climate change and mental health: why is it important and what are we doing about it?

In the summer of 2016 the RCPsych’s Sustainability Committee met for the first time, and since then has been hard at work ensuring all parts of the college’s work incorporate the key values of sustainability. Sustainability and psychiatry are linked in innumerable ways and each post on this blog will highlight this, using one aspect of our committee’s work. With Ophelia, the tropical storm, expected to arrive in England this week, it feels very appropriate to invite Dr Lisa Page to comment on mental health and climate change, and the recent devastating extreme weather events:

Hurricane Harvey"Hurricanes Harvey and Irma will undoubtedly have had major impacts on the mental health of affected populations in Texas and the Caribbean this autumn. Indeed, an increase in the number and scale of natural disasters is just one way in which climate change is likely to adversely affect global mental health in the decades ahead. Unfortunately, the latest IPCC report was unequivocal in its conclusion that we are already seeing more heat waves and flooding events as a result of climate change – this is bad news for public mental health. For example, unduly hot weather leads to increased mortality and morbidity in psychiatric populations – an effect that is substantially greater than that seen in general populations - whilst in developed countries at least, the main health effects of flooding are on peoples' mental rather than their physical health.

So, as psychiatrists we are right to be concerned about the impacts of climate change on public mental health. At College level, the recently established Sustainability Committee is drawing together research findings that outline the challenge to global mental health presented by climate change. Firstly, the Sustainability Committee aims to be a resource for interested College members wishing to understand more or educate others in this area. Secondly, the committee acts as a conduit into other campaigning health organisations interested in the links between climate change and health.

Hurricane OpheliaFor example, have you noticed the high profile media coverage on air pollution and health over the past year? Or the subsequent policy announcements about the phasing out of coal fired energy by 2025; and diesel / petrol cars by 2040? We have the highly successful advocacy and lobbying work of the UK Health Alliance on Climate Change to thank for much of this progress on air pollution policy - see the landmark 'A Breath of Fresh Air' if you are in any doubt. It seems there is mileage in the health community boldly setting out the links between adverse health outcomes and climate change, whilst also spelling out the co-benefits of action in a way that policy makers cannot ignore. The College is now an influential member of the UK Health Alliance on Climate Change, offering us an organisation a unique way of bringing important issues related to the environment and mental health to public attention.

Please do get in touch with us on the committee if you have evidence to add about the link between climate change and mental health, or if you want to discuss advocacy in this area."

Dr Lisa Page

Consultant Liaison Psychiatrist, Sussex Partnership NHS Foundation Trust,


Dr Katherine Kennet

CT3 (Psychiatry)

14/07/2017 11:43:29

#UnmaskMyCity: why psychiatrists should care about air pollution

Unmask My City is a campaign led by healthcare professionals to call on governments around the world to act on air pollution.  It launched globally in 10 cities on the 1st of May 2017 and is coordinated by The Global Climate and Health Alliance (GCHA) and its international partners. It acts as a platform where doctors, nurses, public health specialists and other allied health care professionals can share air pollution data, evidence on health impacts and advocacy tools. 

As a junior doctor, and a future psychiatry trainee, I was glad to have been asked to get involved with the London campaign. It was a little bit tricky to explain that I was currently getting more experience working in physical health and that I actually wanted to be a psychiatrist in a simple visual, so for the purposes of the campaign I was simply an A&E doctor, and they used an exciting quote.

However, my interest in the integration between mental and physical health, and coming up with joined up ways of working is one of the main reasons why I believe that psychiatrists should care about air pollution as well.


Air Pollution has both physical and mental health impacts

There is now more and more evidence that as psychiatrists we need to act on behalf of our patients to protect their health. Air pollution is now responsible for over 6.5 million premature deaths per year, and impacts from fine particulate matter in particular, have been linked to increased risks of heart disease, respiratory diseases, lung cancer and stroke. More recently  there has been both epidemiological data showing an association between living close to a road and Alzheimer’s disease, and neurobiological research from animal models that breathing air pollution affects brain tissue directly and can lead to abnormal protein deposits, cerebrovascular damage, and cellular stress. Work has also began to explore impacts on depression, and behavioural development in children.


Prevention is better than cure

Action on air pollution is an opportunity rather than a burden. A robust Air Quality Strategy will support local authorities to increase cycling and walking accessibility, promote electric vehicles and restrict the most polluting vehicles. Through this investment in local infrastructure we also have the chance to strengthen local health networks and reimagine what our hospitals, gp practices, schools, roads and parks could be like for future generations. It is a positive change towards making our cities and communities better places to live for everyone.  There could be more of projects like the The Lambeth GP Food Co-op, featured in the London UnmaskMyCity Campaign FactSheet.  It connects the dots between chronic diseases, food security, and the NHS supply chain, and aims to cut food transport miles and improve patients’ physical and mental wellbeing.


Time to act

The Government Air Quality Strategy is to be finalised by the end of July 2017. Health professionals are calling on the UK government to support the implementation of Clean Air Zones in UK’s major cities. As Psychiatrists we should join that call. We have the potential to ‘ tackle climate change, reduce the burden on health services and create new economic opportunities’.


Written by Shuo Zhang

12/05/2016 10:38:41

The CSH and RCPsych sustainability scholars

CSH  and RCPsych have four sustainability scholars who are advanced Trainees in psychiatry. They are using their special interest day to work with their local CCG to improve the sustainability of commissioning. They are now half way through their scholarship. They have each started working in their own ways to embed sustainability principles into the redesign of mental health services commissioned by their respective CCGs. Mike Pearce at Oxfordshire CCG has undertaken a sustainability appraisal of a 'Young Person with Dementia' service, evaluating the service from an environmental, financial and social perspective. Arif Ahmed is developing sustainable outcomes for a MH liaison service in Liverpool. Oliver Bashford's work is on redesigning of City and Hackney CCG's crisis pathway and Suhana Ahmed's is working on a new mental health homeless service with Brighton and Hove CCG. Please see below for their half term reports.

Dr Daniel Maughan

Suhana Ahmed

Half term report: RCPsych scholarship and Brighton and Hove CCG
Nearly midway through the RCpsych Sustainability Scholarship, I’ve been thinking about the last 6 months and where I am at the moment. Having been paired with Brighton and Hove CCG, the first few months were getting to meet the relevant people and gain some understanding about the sustainable aspects of the CCG by reading through their sustainability plan and the progress they had made so far. It was clear from early on that they were keen for me to be involved and highlighted a new service being commissioned and piloted called ‘Mental Health Hostels Link’. The aim of the pilot was to gain a greater understanding of the mental health needs of the homeless within hostel settings and to identify barriers to mental health treatment and support.

Whilst significant progress has been made to improve health outcomes of the population as a whole, inequalities remain for many socially excluded group, one of which is the homeless population, with evidence of lower life expectancy and poorer health outcomes. In March 2014, services estimated that 132 people were rough sleeping in one night in Brighton. In addition, there are approximately 400 people in emergency accommodation and the city has 288 hostel places, with a current waiting list of 125 people.

The first few months of the scholarship involved me carving a role for myself in this project, with the 4 principles of sustainability being key in this. Various possibilities were discussed including patient related outcome measures (PROM) and focussing on the restoration of social capital, leaner, more effective pathways and training and empowering hostel staff with training.

In the last few months, after some very informative and useful meetings with individuals at the CCG, we identified an area of focus for the project which would have a sustainable basis and also be helpful in developing the service. To research the evidence around mental health intervention from the 1st stage (every contact counts) and how ‘treatment’ could be incorporated into the engagement process which can be time consuming in this complex population. How does this link into sustainability I hear you say? Improving value – by ‘treating’ from the very first contact, we are delivering interventions that provide the maximum benefit for the least cost (in theory reducing the time spent in the service by ‘treating’ and engaging side by side rather than one after the other). Prioritising prevention – aiming to prevent this population from becoming homeless again by equipping them with skills to build resilience (there is well known ‘revolving door’ phenomenon in the homeless). Empowering individuals and communities – promoting self-management and independent living.

And there you have it, the first 6 months of my scholarship. Let the final 6 months proceed…


Oliver Bashford

Half term report: Sustainability in crisis pathways and the RCPsych scholarship
The first half of the RCPsych sustainability scholarship has brought fascinating insights into the workings of a CCG, and the steps involved in the commissioning of services. I was involved in a GP members engagement event in which priorities for commissioning were discussed and ideas invited from participants. I was part of a session on waste reduction in which we spoke with local GPs to generate ideas about how local services could be improved and waste reduced. I have also been involved with a review and redesign of the crisis pathway in the local area. I looked into best practice from elsewhere around the country to identify efficient models of organising services, which led to a recommendation that a Single Point of Access could be developed in alignment with a new service in another part of London. The work with the redesign of crisis pathways has led to the current project which involves analysing data about the users of crisis services in order to inform decisions about how resources should be most effectively focussed. If we find that particular demographic groups are over-represented in the use of crisis services in this locality, this may allow for focussed intervention to support these groups. Related to this we will be looking at social sustainability in relation to crisis care, including a review of models of services such as street triage, crisis cafe and a peer-supported 'open dialogue' approach currently being implemented in other parts of the world...

Michael Pearce:

The first half of the year has been a busy one so far in my role as a psychiatry sustainability scholar… As-well as collaborating and learning with the other enthusiastic scholars, attending and presenting at conferences and engaging with NHS colleagues in the ideas of sustainable healthcare, I have been undertaking 2 main projects: I have been working with Oxfordshire Clinical Commissioning Group to try to apply the principles of sustainable commissioning to the reviewing and commissioning of older adult mental health services. This involves working with the CCG team to review whether current services are sustainable, and to feed sustainability principles into the redesign to ensure all aspects are considered. Examples have included highlighting guidance on early identification of patients, generating guidance on specific risk factors and prevention strategies for functional illness in older age, helping to map which services or innovations/pilots might be best placed to tackle the risks, and others in the works. I have also been undertaking a sustainability appraisal (possibly the first of its kind!) of a young person with dementia service. This service is an innovative charity which uses sustainable methods such as group activities in natural settings, to provide respite to carers/relatives of the sufferers. The project has involved evaluating the service from an environmental, financial, and social perspective (the triple bottom line). I hope to use this as a template for other services to be able to follow… I hope to be able to provide further updates as my work progresses, and I’m looking forward to more collaborative work with the other scholars.



Arif ahmed

The main focus of my scholarship to date has been involvement with Liverpool Clinical Commissioning Group (CCG) on their liaison service redevelopment. This has given me an insight into commissioning, business cases and the importance of networking. I have been able to attend important meetings at the CCG about the project and introduce them to the four principles of sustainability.

I have visited a local liaison service in Liverpool which has given some useful insights into the current setup. I am helping Liverpool CCG on the outcomes section of their business case, introducing ‘sustainable liaison outcomes’. The latter has been put together as an abstract and submitted to the liaison faculty for a potential poster and stand at the conference in Birmingham in May 2016. This has involved some joined up working with my fellow scholar Oliver and expert support from Phil and Frances.

You might be thinking what benefits there are to thinking sustainably in liaison psychiatry. Actually, by looking at a service’s structure and outcomes through a lens of the 4 sustainability principles, one might expect improvements such as these:

·         Improved patient and family satisfaction with services

·         Greater patient resilience through education and linking up with community services

·         Improved access to local psychiatric inpatient beds, meaning less travel and more convenience for family

·         Better outcomes for vulnerable groups such as the homeless and asylum seekers

·         Reduction in unnecessary investigations

These are just a handful of the potential positive outcomes – keep an eye out on the Psych Susnet blog over the coming months for a more detailed report.

As well as engaging colleagues at the CCG in Liverpool, I have also given talks on sustainability in Cumbria (where I work) to the frail elderly pathway Vanguard group and at a dementia steering group meeting (given via teleconference!). I plan to further this with potential talks to trainees and medical students at educational sessions. There will hopefully be an opportunity to lead a session to my fellow higher trainees in psychiatry, which could increase awareness in sustainability and encourage others to take up future scholarships.

If time permits I would like to do a quality improvement project with Liverpool CCG on a selection of the sustainable outcomes. Another potential project is to measure the carbon footprint of the liaison service as a case study, possibly as a joint project with my fellow scholars. I am soon to work with Frances on the ‘improving value’ section of a mental health service review template.

At almost midpoint through this scholarship, I can genuinely say that I have been fortunate to have had this opportunity and enjoyed the journey so far. It has enhanced my training in psychiatry by opening my eyes to sustainability, commissioning and the impact one can have on the services we work in as psychiatrists. I look forward to the second half of the scholarship, collaborating with supportive colleagues and hopefully gaining further tools to be of greater benefit to my patients. For those doctors in training who wish to broaden their experiences and perspectives, I would recommend they consider a special interest in sustainability.



04/09/2015 11:39:28

The case for sustainable development in mental health care



Having come to the end of my two year RCPsych research fellowship in sustainability, it is time to do some reflecting…




I have found that sustainability is one of those words that people tend to slap onto the front of a new idea, service, or project to make it sound credible or perhaps ‘a la mode’. But sustainability is more than just a badge, it requires a broad understanding about the resources we use and impacts that we are having. But, does it have a place when thinking about mental health care?


Well, of course I am going to say, ‘of course it does’ given my role, but I do think the arguments for improving the sustainability of mental health care are compelling….



·         The NHS has run out of money

·         Expenditure on locums is vast

·         Mental health need is outstripping resources


·         Climate change has been heralded as the largest threat to human health in the 21st Century by the WHO and the Lancet Commission this year

·         The mental health effects of climate change are significant

·         The NHS is the largest contributor of greenhouse gases in the public sector in the UK, larger than a medium sized eastern European country such as Estonia

·         Flooding in the UK is becoming a larger problem because of climate change and this has significant mental health effects


·         Population mental health needs are changing

·         Patient expectations are increasing

·         Staff are struggling to cope with service cuts

·         Restrictions on and monitoring of health care professionals is growing

·         The internet is a game changer and services need to stay in line with how society is changing in this digital age


For evidence about these points, see the occasional paper; ‘Sustainable Psychiatry’ launched in March earlier this year.


Psychiatrists and all those working in mental health services need to think beyond the patient in front of them, beyond their standard practice and beyond next year to the bigger challenges that are going to affect mental health prevalence  and mental health services this century. Factors such as diminishing financial funds, ever increasing costs of care, unchecked population growth, food and water scarcity, climate change, ongoing wars and globalisation are already having a dramatic affect on mental health services in the UK and these issues will likely grow to dominate later this century.


There is much we can do in mental health….


1.      We need to think more broadly about the resources we have at our disposal. We shouldn’t just think of medications or psychology in our treatment plans but about local community groups, peer support, online education, activities with carers, employment support, volunteering, vocational skills training, adult education, natural settings and third sector organisations.

2.      As mental health professionals, we understand denial as a potent defence mechanism and we need to help society engage with the mass denialism that exists with regards climate change.

3.      We need to review our practice and reduce waste –as much as 10% of the carbon footprint of the mental health care is due to medications that are not taken.

4.      We need to utilise the internet more systematically in service design and think more creatively about how to use it to improve care.

5.      We need to be more aware about the importance of engaging with nature and being part of community. These are the natural setting for humans, are intrinsically beneficial to our mental health and need greater focus.

Despite my fellowship coming to an end, important sustainability work continues at RCPsych and across mental health in the UK. A JCP Commissioning guide on Sustainable Mental Health is being launched next month, aimed at getting CCGs and all other mental health commissioners to commission sustainable services. Three new RCPsych sustainability scholars, supervised by the Centre for Sustainable Healthcare, are lined up to start work with CCGs to develop new sustainable models of mental health care. Sustainable changes are happening across mental health, Psych SusNet continues to grow and evidence is emerging about the environmental impacts of mental health care.

How could you get involved?



11/05/2015 15:29:40

Mind games – why do we continue to ignore climate change?

Why is it that doctors, whose aim it is to improve health are, with the emissions associated with delivering healthcare, adding significantly to the health threat posed by climate change? One reason could be that climate change is too complex a phenomenon with which to engage, a circumstance which, combined with the complexity of mental health, has led to paralysis.


This problem is reviewed in an editorial published this month in BJPsych International by Professor Helen Berry and me. This issue of the journal had a theme on climate change and mental health and in two other articles, the evidence for the mental health consequences of climate change are discussed, which are both profound and worrying.


But what we can do about this as psychiatrists? One suggestion is made by a further paper in this themed edition, which suggests that non-attendance at clinic appointments is one factor that is potentially significantly contributing to wasted clinical resource, increased subsequent health care use and therefore an increased carbon footprint of mental health care.


We do not have to ignore this issue as psychiatrists.  There are ways that we can improve the quality of care that can have a dramatic effect on the carbon footprint of the services we deliver.

Mind games – why do we continue to ignore climate change?

More thought needs to be given to the principles of sustainable health care; prevention, empowerment, lean service design and lower carbon technologies.







25/03/2015 09:28:19

Sustainability in Psychiatry


Sustainability in Psychiatry Occasional Paper


Occasional Paper about Sustainability in Psychiatry on NHS Sustainability Day

It is a great pleasure for me, as sustainability fellow for the college, to be launching this Occasional Paper about Sustainability in Psychiatry on NHS Sustainability Day. It has been co-developed with the Centre for Sustainable Healthcare, who have been central in the development of the report and my whole fellowship.

Vanessa Cameron, CEO of RCPsych, who has been a crucial player in bringing about both this Occasional Paper and this focus on sustainability in psychiatry says that:


“the Royal College of Psychiatrists is committed to improving the sustainability of mental health care in the UK. We are delighted to be publishing “Sustainable Psychiatry” which is a key document setting out the principles of sustainable health care and what this means for mental health service delivery today.”


Sustainability is a new concept for psychiatry. It looks at how services can be more responsive not only to economic factors but also to environmental and social factors. Mental health care needs to continue providing clinically effective interventions, but to determine whether they are acceptable to patients and public, affordable for the NHS and responsive to the dwindling planetary resources requires a fresh focus on sustainability.


 This Occasional Paper explains how embedding the principles of sustainable health care can lead to services that are more person-centred and fit for the future. It provides an account of the carbon hotspots in mental health and what we need to do to reduce these aspects of care. It also provides several case studies of what sustainable models of care look like.


I hope you enjoy reading the paper. You can also join Psych Susnet the network for mental health professionals interested in sustainability.



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Sustainability blog

Sustainable healthcare is about making sure we provide good quality health care today without compromising the ability of future generations to give the same quality of health care. As clinicians, we need to be more aware of the impacts that mental health services are having on society and the wider world.

The Royal College of Psychiatrists Sustainability Committee was started in 2016 and is made up of psychiatrists and other members of the College who are passionate about the topic and are working to make the RCPsych and the work of all psychiatrists in the UK as sustainable as possible. The committee is working on a wide range of projects from improving sustainability in retention and recruitment within psychiatry to reducing psychiatrists’ impact on climate change.

About the author

Katherine Kennet

Katherine Kennet is a Psychiatry Core Trainee working in North London, a member of the RCPsych Sustainability Committee and the coordinator of the sustainability blog. Each blog post will explore the exciting projects and ideas that the sustainability committee are currently working on, with a different member of the committee explaining their work.

If you would like to contribute to RCPsych Blogs, please email an outline of your blog to: