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 RCPsych Associate Registrar in Sustainability

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

Dr Katherine Kennet

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