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Is mental health a social justice issue?

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Dr. Simon Newitt, Chief Executive of Off the Record (Bristol), gives his take

The central challenge facing both mental health services and those in distress today is the lack of adequate service provision, both in their design and capacity to meet demand. According to 2014 NHS figures, mental ill health comprises 28% of morbidity in the UK and costs us, as a society, over £100 billion a year. However, a 2013 report from the Mental Health Foundation shows mental health spending represents only 13% of the NHS budget, and funding for research accounts for a meagre 5% of the overall health research budget.

It is this basic inequality from which all other challenges flow; both for individuals who experience long waits for limited treatment options, and for services with diminished budgets trying to manage increasing demand for them.

There’s obviously a local flavour to this context. Although Off the Record (Bristol) is a non-profit organisation, we’re still part of the wider health service, and the key challenge we currently face is how to continue to offer a responsive and effective service to young people in the face of unprecedented numbers trying to access us -we get over 3,000 enquiries a year.

The feelings of anxiety, depression, anger and hopelessness young people express to us are often a result of their wider context, not just their biochemistry. The recession was devastating for many young people; this period broke all records for youth unemployment, while student debt was hiked to unprecedented levels and the labour market was increasingly de-socialised. At the same time the pressure on schools and thus young people to achieve academically has become increasingly acute, while the existential pressures of adolescent identity have been distorted and intensified by an online world that simply didn’t exist in the same way a decade ago.

Public services have withered under austerity and statutory mental health services are under immense pressure locally, which denies many young people timely support and increases the likelihood of crisis. Unlike our colleagues in statutory services; we’ve no thresholds. It doesn’t matter what the issue is, we’ll never turn someone away for being ‘too unwell’ or ‘not unwell enough’. This presents us with some enormous challenges, not least because many more vulnerable, complex and ‘high risk’ young people are now being signposted or referred our way. Sadly we’ve known three young people this year who have ended their life, while the incidence of suicidal feelings and deliberate self-harm have risen exponentially among our clients.

We are trying to respond to this context thoughtfully. We’ve grown significantly and we’re working on how to offer more personalised and creative support. We also do a lot of resilience-based work teaching young people in schools and colleges how to manage stress healthily and sustainably. We believe strongly that much of what drives individual suffering has a context. Equipping young people with that knowledge can be a powerful way of building resilience and shifting the aetiology (understanding the cause for a condition) of mental health from a preoccupation with ‘illness’ and ‘personal failure’ toward issues of inequality and social justice.

Bristol CCG recently re-commissioned community mental health services for adults (bristolmentalhealth.org) and Child and Adolescent Mental Health Services are due for the same treatment after the general election. Off the Record joined forces with AWP (local NHS Mental Health Trust) and ten third sector partners to take over delivery of community mental health services in Bristol. We did this because we believe that it’s only by working in an integrated way with our colleagues in other agencies and sectors that we’ll add enough value to one another to overcome our real challenge – the disparity in spending on mental health more generally.

Off the Record (Bristol) is currently celebrating its 50th anniversary year supporting young people in Bristol.

You can find out more about the charity at www.otrbristol.org.uk and follow OTR on Twitter: @otrbristol

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