E32 Mental Health

PLEASE NOTE: THIS TRANSCRIPT WAS LARGELY AI-GENERATED AND WILL CONTAIN ERRORS!

Introduction: What this episode is about

Munir Adam: Hi guys, welcome back to Primary Care UK. It's Munir Adam here and we're continuing our series looking at those who are in the vulnerable group. That's patients who might lose out on accessing care or effective care because of their condition or something about them. We started off by looking at those who were homeless and then we looked at those with learning disability and in this episode we look at those who have mental health problems.

Now, this is going to consist of a conversation between Irena from the Primary Care UK team, speaking to Matt, who is a specialist mental health pharmacist and national advisor on this topic as well. Mental health is a complex topic and includes a whole range of different conditions.

And as we thought about this, we realized that trying to provide any kind of Prescription or specific recipe for how to deal with these patients might be somewhat reductionist, might not be [00:01:00] appropriate, or be too simplified. And while we certainly do want to focus on the specific needs of mental health patients and how access can be affected and what to do about that, we thought it was quite important to think about this by taking a step back and trying to understand mental health a bit better. Some of the things in life that affect it, what people can do about it. 

So this episode is not about whether to start somebody on citalopram or risperidone, but we will be hearing about three important characteristics that we should live by to try and attain and retain good mental health. We'll also be looking at the five different things that we should be doing, or five categories of things that we should do to try and protect ourselves.

We'll hear about inequalities in access to care and poor health outcomes, about how to do the consultation better, some of the services that are available for these patients, and also, how 20 years from today, things could be better, and what we should be doing right now if we want that to happen. And that includes thinking about our children too.[00:02:00] 

The case is made that mental health is intertwined with physical health. And that the divide that we often place, you know, physical versus mental, is somewhat artificial. And I have to say, I agree with that. And therefore, this episode is relevant to all of us in all of our roles in primary care. So you may feel that you want to be one of those that bridges the gap between primary and secondary care, as Matt alludes to later on.

And yeah, it is about patients. But let me warn you, don't be surprised if you find that you start applying everything that you're hearing to yourself, like I did. Let's see. 

Anyway, this is season two of Primary Care UK, which is sponsored by Integrated Care Support Services. If you wish to sponsor an episode or multiple episodes, or you know an organization that may want to, for example, your local training hub, then please do get in touch with us on the email in the show notes.

 [00:03:00] 

Background of the Speaker

Irina: Hello, Matt, thank you for agreeing to come to speak to us today. Shall we start first with a bit of an introduction from you your background? 

Matt: Of course. Okay, so my name is Matthew Elswood. I like to go by Matt. I'm a pharmacist. I currently work in Nottinghamshire.

So I've been a specialist mental health pharmacist for around 20 years, on the register for about 23 years in total. I'm the chief pharmacist of a large provider organization. I work clinically in a community mental health team as a prescriber seeing people with severe and enduring mental illness, and I'm a National Speciality Advisor for Mental Health Pharmacy for NHS England.

I also have another job too to keep me really busy. I'm currently the Chair of the Clinical Advisory Group of Rethink Mental Illness, which is one of a number of really great charities to support people with mental health [00:04:00] problems. 

Irina: Wow quite a bit. So you've got vast experience in this department.

Understanding the Spectrum of Mental Health Issues

Irina: Shall we start briefly our chat today about mental health with a wider approach on how, how would you define mental health? How do you draw the line, for example, between someone who's just a bit sad because they've had their heart broken or because their best friend is moving abroad and, and then how do you get to someone with true depression? 

Matt: Okay, so I'm going to start, I suppose, by describing what really good mental health looks like. So really good mental health is about thriving in life.

It's about living a life with three particular characteristics. So living a life with gratitude is about living a life where you feel that you have agency and you can influence things in your life and living a with humility. So if you have gratitude, agency, and humility, you're likely to thrive and have really good[00:05:00] mental health.

And I think your question is really about, well, what does a life look like in the absence of those things? When you have problems with your mental health, problems with your mental well being, and you're right. So it really is a spectrum all the way from the tip of the iceberg, as I see it, which is people with severe and enduring mental illnesses like schizophrenia, bipolar disorder, more severe forms of depression, anxiety, personality challenges and things like that, but it goes all the way down to day to day challenges like you talked about.

So in life, we are constantly bombarded with little insults to our mental health and our wellbeing. So you talked about one, someone has broken up with a partner. So that would be a kind of a problem in the relational area. And often people will have difficulties in relationships with loved ones, friends, family members.

There are also practical [00:06:00] difficulties in life. It's not easy to have good mental health if the place that you live in is in a poor state of repair. You don't have a fridge, your house is flooded or it's too cold. Other real life issues that we all have to contend with. So. having a job that you're comfortable in is also really important for people, and having a purpose in life. 

There are also a number of psychological problems that people can have in terms of their personality or in terms of the way that they developed as they grew up and experiences that they might have had during their childhood and upbringing, traumas that have happened to them in their life; and all of these things shape you as a person and can kind of chip away at your your mental health and well being and tip you over from being someone that's doing pretty well to someone that's struggling and sometimes all the way to the far end, whereby, you know, through a series of events, you develop severe depression or an [00:07:00] anxiety problem or a severe and enduring mental illness like schizophrenia. So it's quite a lot in that. 

Irina: Well, yeah, yeah, it, it makes sense.

Genetics, life experiences and insulating yourself against the insults

Irina: Are some people more prone to being affected by this? Because you see some people who just managed to march through so you get all these horrible situation being thrown at them, they lose their homes, they lose the whole families and somehow they, they managed to stay positive. They have a good attitude towards life.

And then for some people, there's little and inconveniences, and they just become anxious and insecure. Is that to do with your hereditary legacy? Is that to do with how you were educated to have, to look upon life? Is it a mix of the two?

Matt: Right. Okay. Yeah. A really key question. So when it comes to conditions that I would characterize severe mental illness, like severe forms of depression, anxiety, schizophrenia, bipolar [00:08:00] disorder, there is some heritability. So there is a genetic link, although it's not a straightforward one. In fact, there may be as many as 200 or more genes involved in severe and enduring mental illnesses. So it's, it's quite a complicated picture but you can have the genetic deck stacked against you. Unfortunately, for some people, that's the case where you've got, you know, a strong hereditary pattern of severe and enduring mental illness through the family. Just one factor that we need to consider.

Another factor is someone's life experience, early life experience their upbringing and if they've experienced any difficult or traumatic experiences that have shaped them during their life. And that's another thing that really predisposes people to having some struggles, but it also can set people up to be very strong and very resilient.

It's a lot to do with the way that someone makes sense of and [00:09:00] processes their experiences in their life and whether they're able to turn difficult things into a positive, or whether perhaps they develop a set of ways of coping with life that are less helpful or unproductive or counterproductive in some way, for example, what they learn is to avoid all sorts of situations and to avoid risks.

Well, actually, I put it to you and the listeners that it's impossible to live a good life if you avoid all risks and difficulties. That life won't be fulfilling. So we all need to challenge ourselves and we all need to experience difficulties in order to thrive and live with that gratitude, agency and humility that I talked about.

So it's very individualized. It really is.

Irina: Okay. Thank you, that makes sense. I guess we'd all want, we'd want a magic formula sort of to say that if we do this, then we'll keep our sanity, but I suppose it's, it's very [00:10:00] individual., 

Matt: There are, there are some things that all people can do to insulate them against the challenges of, of life. So there, there are things that, that chip away at us every day, but there are things that we can all do to insulate ourselves against the kind of tragedies of life. I would broadly put them underneath five categories. So the first one is nutrition. Actually, there's an emerging science and field of study called nutritional psychiatry. And it's quite clear, actually, that your diet and what you eat on a day to day basis has inferences for your mental health and well being.

But also, as we know, has clear relationships with your general health and well being. And I put it to you, Irina, that If you have diabetes or cardiovascular disease or if you're much larger than you could be, those things [00:11:00] will erode your mental health. So nutrition is really important. So we start there. 

Physical activity is is incredibly important. So people need to be active. They need to use their bodies. And again, just thinking about this. After the age of 40, we all lose in the magnitude of 1 percent of our muscle mass every year. Eventually we go on to develop something called sarcopenia. So we all need to be taking steps to stay fit and strong so that as we get older, we can live the way that we would choose to live so, so that you can pick up your grandchild so that you can put your luggage in the overhead compartment so that you can walk your dog. So that you could do all of the things that will give you a good life for fulfilling life when you're older we all need to be physically active when we're younger. 

Next one. I would say sleep. And sleep is absolutely fundamental to staying mentally. Well lots of magic things happen when we're sleeping. Your brain [00:12:00] takes care of lots of business. It cleans itself. It organizes things and puts them away. It processes difficult experiences. So sleep is really magic. And if you've got good sleep, it's a superpower. 

Then connectedness Having great relationships with friends, family members, seeing people often,. That is much more protective of your mental health than you might actually imagine. 

And finally, purpose. Living a life with purpose. You know, again, it insulates you against many of the difficulties that you're going to experience. And I think lots of people struggle with their mental well being because They have a deficit in one or more of the five things I've just talked about.

Irina: 

Brilliant. Thank you, Matt. There's nothing new in there, is there? . It's just things that you would assume everybody kind of does and enjoys. But it's surprising when you look back how little balance we have between those five things in our lives. 

The Impact of Social Media on Mental Health

Irina: [00:13:00] Okay, my next question was going to be about normalizing discussions about mental health. We've seen increasing posts on social media about this commercials for free or paid apps to promote looking after your own mental health, celebrities coming forward and admitting to struggles with mental health and offering support.

Did you notice a difference in the service in the last year? Do people come forward easier and admit they need help? 

Matt: Okay. Yeah. So there is a tension to be managed here. So one of the things that I think that we all really want is if people are struggling with their mental health that they do seek the advice and support that they need on a really important first step is to try to get to the bottom of actually what's happening.

So that's a really key first step and, and one of the reasons why I'm glad to be on this podcast is because so much of that initial detective work happens in primary [00:14:00] care. In fact, you know, 90 to 99 percent of the mental health related care that's provided in England is in primary care.

 We do need to be mindful, however, that, particularly if celebrities and people who maybe people in society look up to, talk about having mental health problems and severe mental health problems in particular, it can create, a fashion or a desire. When someone you look up to talks about something hasn't experienced and then that experience can start to gain some cachet in the eyes of other people. So there can be some virtue attached. Absolutely anything that cuts through the stigma gets people talking about the subject is helpful. But we need to be mindful of the risk that's always there that we generate fads and fashions in mental health, which can take away from the challenges that we face and have always [00:15:00] faced in terms of finding and treating people with severe and enduring mental illness. 

Irina: I see that there's that fine line of where you actually do good and how other people can interpret it. Okay, thank you. 

And generally, we hear talk and we read articles about an increasing need of mental health services. What is causing this? Is this the post pandemic effect? Are people better at coming forward to ask for help and that's what's causing the increase? What is your comments on this? 

Matt: Yeah, it's very difficult to give a concrete totally evidence based answer to the question. We are certainly seeing an increase in referrals to secondary mental health services. We are seeing changes in the way that people are presenting and the nature of the conditions are being referred to us. But I think the, the answer really goes back to the, the five subjects that I set out before. 

So [00:16:00] when we think about the general population in England are they eating the kind of nutritionally complete balanced diet that they should be?

Are they under or overnourished; are people as physically active as they could be; people sleeping as well as they could be; people spend increasing amounts of time on devices like we're using a device. Now I've got another one right here. They're all around us. We have to learn how to live with these technologies. Certainly when it comes to sleep, what we recommend is that people don't take devices or have screens in their bedroom because of the way that alerts and lights that they provide can interfere with sleep. 

Then there's connectedness. You talked about social media. There was a time where I would have said that the jury was out on social media, but I don't think it is anymore. I think we're now quite clear that social media overall probably has a negative impact on people's mental [00:17:00] health, particularly younger, more vulnerable groups, particularly younger females. But we're starting to see an impact on young males as well, particularly around growth in eating disorders and body dysmorphia.

 And purpose as well. So are people living a life more. With purpose. Are they striving towards important goals that mean something to them? If people aren't ticking the boxes in those five things, they're going to struggle with their mental health and well being. 

Irina: Okay, I see. Thank, thank you for that. 

Prevalence of Mental Health Issues

Irina: And how common are mental health problems? ' 

Matt: Yeah. So let me give you some of the headlines. We've got a lifetime risk of one in four people having a mental health problem. So that, that includes all of the mental health problems, including dementia. Yeah. So one in four people will experience a mental health problem at some point in their life.

And at any given point, it's [00:18:00] around one in ten people will be contending with some kind of issue with their mental health. Now, the numbers of people with severe and enduring mental illness are lower. Maybe one in 40 people. And what that tells you is that there are maybe three or four times as many people struggling with mild to moderate mental health difficulties, problems in day to day life than there are struggling with things like schizophrenia and bipolar disorder. 

Irina: Okay. Okay. That's, that's quite high. So you're in, in a meeting with 10 people and two or three out of the people in that room will at some point probably struggle with, with something from their mental health. 

Matt: Right.

Absolutely. And this is, this, this kind of experiment plays out best when you're talking to 200 pharmacy undergraduates and you get every fourth person to stand up, and that's when people really appreciate the sheer weight of the number of people that will struggle at some point in their lifetime with a mental health problem.[00:19:00] 

Irina: Well that's a really good exercise actually to do in practice or at a team meeting. It brings 

Matt: it home. 

Irina: Yeah, it does. Maybe too close to home. 

Access: Addressing Health Inequalities in Mental Health

Irina: Let's try and talk a little bit about patients who suffer with mental health. We need to try and make the case of what makes this group special. What makes this patient group a bit harder to deal with? When they consult us what puts them at disadvantage in terms of accessing effective care.

Matt: Okay so let me talk here specifically about people with severe and enduring mental illness. I know you've already spoken to Alison about people with intellectual and learning disabilities, but we know that people with severe and enduring mental illness die 10 to 15 years younger than their comparators in the general population.

And there are a number of reasons why that might be, but in particular, they do seem to suffer with cardiovascular mortality, cancers. And we're all the same that they die from all the same reasons that the [00:20:00] general population does. They just die a little earlier, 10 to 15 years earlier. And one of the things that I hope will change over my lifetime is it will close that gap so that people with severe and enduring mental illness will live as long as the general population counterparts.

And there's something called parity of esteem. Parity of esteem is national policy. And what it says is that the treatment and management of mental health conditions needs to be considered as on the same level of esteem as general health problems. So our mental health is as important as our physical health.

 Your head and your body are together for a reason. Your central nervous system is not just within your skull. It's all through your whole body. It's your nervous system. It's everything. So everything talks to everything else. 

And the aim, I think, is that we find the [00:21:00] ways to work with. people with severe and enduring mental illness to address the things that we can address to address the health inequalities so that they can live as good a life and as long a life as the equivalent person in the general population. 

Irina: Wow, I didn't realize there's such a huge difference between the life expectancy of someone who suffers with a mental health condition from somebody who does not. But also what you said made me think of a discrepancy between how you consider mental health and physical health in a way. If somebody's going through a moment of depression or they need special counseling, you wouldn't see it as severe as somebody who's got a broken leg, but actually it could impact you as much, more potentially.

But you're right, and this was maybe how we grew up or built in us and maybe the newer generation will grow out of this.

Matt: I'd like to think I'd like to think that as time goes by, we start to see the two things as not really being two things. The distinction is artificial. [00:22:00] We need to think about people in terms of, uh, their holistic health. 

Irina: But what makes them have these poorer outcomes? Is it because they don't they don't think to access the service? Is it their is it the stigma? Is it because they don't know how to communicate? They don't understand that something's going on and they need to address it. 

Matt: I'll have a go at that. But it's a really key question and actually we need to know the answer because if we don't know What the factors are then we can't design the solutions to fit. So Let's take smoking as an example So there's been a very comprehensive effort a public health effort to reduce tobacco smoking in this country And it's being very effective for the general population. However adults with severe and enduring mental illness still smoking at the same rates they were before; so they've proven Resistant to the strategies, the public health efforts. So one of my questions is what are we doing to support adults with severe and enduring mental illness to [00:23:00] achieve the same benefit from smoking cessation services to to reduce their smoking like the rest of the general population?

There are also challenges in terms of one of the cardinal symptoms of a number of mental health problems is, is a lack of motivation and, and difficulties in terms of going and getting the things that you need in life.

Add on top of that, the fact that many of the medicines that we use to treat mental health conditions can be sedatives or that they can also reduce motivation because motivation is dopamine related in the brain. We're using medicines that impact on dopamine, so there's a compounding there.

But there are also other issues. So I don't want to blame people with mental health problems for this situation. I think that actually as health care professionals, we need to take a leadership role and grab the responsibility. So one thing that we do know is that when people with mental health problems see someone [00:24:00] about their health, something called diagnostic overshadowing can occur. So, and I can give you a real life example of this. So I saw a patient not too long ago. And he came to me and he was incredibly anxious. He was sweating, he had a fast pulse, he couldn't sit still, he lost weight. He'd seen his GP because he was feeling anxious and the GP to explain to him that that it was really, it was a feature of his psychosis.

And this, this patient also had substance misuse issues and there were concerns that he may have simply been trying to solicit benzodiazepines. Now I actually asked for us to perform some health checks for this gentleman, and what we found was that they had Graves disease. He had thyrotoxicosis, so he actually had a medical problem driving his psychiatric presentation and that was something that was amenable to treatment and was treated effectively.

So we know that sometimes [00:25:00] people's concerns can be dismissed. They can be interpreted as. part of or a feature of the mental health condition. And that sometimes shuts down the processes that could take place. And I think a useful golden rule for anything is I like to consider that something is a physical health problem until proven otherwise.

When someone comes to me and presents with anxiety symptoms, low mood, apathy, poor energy, any one of a number of symptoms, my first question before I go to this is a mental health problem is let's exclude the presence of a physical health problem that could be causing this experience. So I think that's really important.

Irina: Well, yeah, that's a very good point and actually quite a good thing to have in mind when you have your consultation.

Cause if you would actually have a patient without a mental health diagnosis sat in front of you, you would automatically think to run some tests and [00:26:00] investigate if they have that condition or the other. So yeah, very important point to have in mind.

Access to Mental Health and other support Services

Irina: There was also a few bits that I wanted to touch on. One of them was the waiting lists and the variation between the services that people can access depending on the part of the country you live and is there any way we can contribute to, increase that?

Matt: Okay. So one of the things that's happened over the last decade, I would say is that we now have, increased access to psychological therapies all across England. We now have more services for children and adolescents across England. We have services for people in the perinatal period. So what we've seen over the last decade is investment in mental health services so that there are more services all across the country to deal with specific challenges and specific populations of people with mental health problems.

And the Increasing Access to Psychological Therapy Service, or IAPT therapy, [00:27:00] is a really important one, actually, because it, sits in the space between primary care and secondary care, and it provides evidence based psychological therapies for depression, anxiety; conditions like obsessive compulsive disorder, but also in some areas it can help support people with traumatic experiences. So that's a really important service in, in any part of the country. 

And and wherever people are working when they're listening to this podcast, it's worth just taking 10 minutes at the end of the podcast to do some research to find out what's available from the local council, what's available on the high street, what charities are around you, what initiatives are going on around mental health and well being so that, you know, if you've got a familiarity with the services that are on offer around you, then you will be able to direct people to to access appropriate things for them.

And also we've seen a [00:28:00] proliferation of social prescribing pharmacy professionals in general practice, lots of new roles, lots of new service. And I think all of this, needs to be under consideration for people presenting with mental health conditions, . But that the real key thing here is taking the time to get to the bottom of the presenting complaint, getting a really good understanding of what the person is struggling with and then choosing the right pathway, choosing the right set of solutions and in the vast majority of cases, um, it's going to be the kind of services that I've just talked about that will be most important and most integral in helping the person through the period. It's, it's likely to be maybe only 1 to 10 percent of people who need referral to specialists for much more specialist high level consideration.

Irina: Okay. 

The Role of Consultation Skills in Mental Health

Irina: In, in a way you sort of kind of touched on my next question, which was going to be what, what practices [00:29:00] do to, to help with access to, to mental health help. And I suppose your advice about taking a few moments and actually checking what's available in your areas is quite a valuable point because you'd know where to signpost people to is there anything else that you should be aware of when you're, when you're in a consultation with somebody. 

What are the, let's say consultation skills or things you would need to, have in mind and bring to the table to offer the best care for your patients?

Matt: Yeah. Okay. I think that's a really key question. So I. I kind of alluded to the need to make a really high quality assessment of the situation so that you can get to the root of what's going on and you can pick the right pathway. I think my advice is to focus on rapport building and building the relationship between you and the person that you're seeing.

Mental health difficulties are, we know there's a stigma surrounding them. People aren't going to lead [00:30:00] with their problems. They're not going to come in and straight away tell you, I have this issue. It might be that until the person is comfortable with you, has spoken with you for a couple of minutes, that they might not reveal some of the most difficult or personal information that might be really key in interpreting and understanding the situation. So I think a focus on rapport and building the relationship to allow the necessary information to come out.

The number of times that most professionals have been in appointments and you've had, you know, seven minutes of fairly kind of standard perfunctory discourse. And just as the person's about to walk out of the appointment, they say, Oh, and by the way, You know, and and this is because it sometimes takes time for people to feel comfortable and confident to be able to talk about the subject that they're really there to talk about. And , it's not easy to, to do that I think in a primary care setting. So one [00:31:00] of the things that I would say is hold back from making a decision too quickly. Never prescribed first. We, we see prescriptions given quite often before a really good assessment is taking place, and that's because it's something that we can do, but also because at some level the professional writing the prescription feels as though they're being implored to do something.

You know, I said it when I was talking to someone the other day, but I'm for many years of working with people with mental health problems people will often present wanting a solution many times they will ask for a prescription. But most often what I find is that people value the rapport in the relationship more than the prescription and they won't sacrifice the rapport and relationship with someone that might help them to actually get to the bottom of and solve their mental health difficulty for the prescription. They will choose the former over the latter if you can develop that rapport and that relationship. 

So you [00:32:00] might need more than one appointment you might need a slightly longer appointment to get to the bottom of things. And you might need to think about whether you're the right person to be doing that or so you know, because if, if you're having a difficult day, if you've just dealt with some bad news if you haven't got the time now, maybe it's something that someone else could follow up on afterwards. Maybe you've got someone that works in your surgery that's got more experience in this arena, and maybe they would be able to get to the bottom of things. 

So sometimes we have to show that humility. We have to let our ego go, and we have to say, Okay I'm not the best person to help you with this. So I'm going to recommend that you see my colleague on. I've certainly had to do that on a number of occasions, and that's easy for me because What motivates me is to find the right solution, the right answer for someone to help them with their difficulty. It's about them. It's not about me. 

Irina: A lot of, useful points and you're completely right. How do you do that in [00:33:00] a 10 minute consultation with your GP? 

It's almost impossible, but I can't help commenting on this. This is a recurring theme. The rapport you build, the relationship you have with your patient. This is something that Alison. talked about. This is something that I heard in a previous podcast about patients are dealing with homelessness and how actually having a good rapport with your GP or the nurse that sees you is the only thing that's going to bring that patient back.

And it's the only way you actually can have those interventions that could save their life or get them on the right pathway or give them the right medication to, to, to help them and. Not just with their mental health problem, but with their general health and wellbeing. So very, very good points.

Thank you a lot for that.

It's okay. 

Matt: You made a really important point. 

The Importance of Continuity in Mental Health Care

Matt: I just want to steel man the point. Actually, you, you said that it's about the person coming back again to the next appointment and that is so critical. In fact, as a clinician. [00:34:00] I know that my primary objective in any consultation, whilst I aim to deliver a technically accurate complete assessment and consultation, actually, the most important thing is that the person comes to the next appointment. So my primary aim is to make the person comfortable enough and confident enough that they want to come and see me again in 6 months time. Because actually, for as long as we're working together, there is the opportunity for progress to be made. The person that doesn't come to their next appointment and ultimately is discharged from the service can't be helped. Yeah. 

Resources for Primary Care in Mental Health

Irina: Is there any resources for primary care that you can recommend to use for clinicians to educate themselves? Regarding mental health, obviously. 

Matt: Yeah, so I mean, this is one of the fundamental questions for all healthcare professionals around how do you do CPD in your, in your area?

And I think this is more of a challenge for a [00:35:00] generalist because there are so many areas that you need to remain abreast of. So I think NICE summaries are really helpful. And for example, in mental health, the British Association of Psychopharmacology guidelines are very helpful. So BAP guidelines are very helpful. They cover the main conditions and the BAP guidelines tend to set out what to do if a patient comes to see you in particular sets of circumstances. And they also cover the evidence base, which is really helpful. So that can be really good.

In, in mental health we use to sets of tertiary resources quite significantly. So we use the Maudsley guidelines and the psychotropic drug directory. So those are, I think, available as apps or online these days. So they can be very helpful for people who are more interested in getting into the specialist side of things. I think the websites of charities like MIND and Rethink have got [00:36:00] great resources. So I like to use those. There's a website called choice and medication which is where I get all of my patient information leaflets about different medicines that I use that those are the ones that I use. They're, they're specifically designed in a way that makes them accessible and easy to use. So I find that incredibly helpful and most of the mental health provider trusts in the country have access to that. So that's another resource. 

We can attend conferences, we can read journals. But what, what I think I would advise is that, you know, I, I'd like to think that in the future. In every PCN, there will be a small clutch of people who are interested and motivated to learn more about any given therapeutic area.

So, in a PCN, there might be one or two professionals who are more interested in mental health and what they could do is to make [00:37:00] contact with their peers in the corresponding specialist mental health service. And through doing that, they can build a relationship, they can become aware of CPD events and sessions that are happening in that organization that they could get invited along to.

So there's lots of different ways to do this. And I think it's very personal. I mean, one of my personal favorite ways to stay up to date is I like to listen to podcasts.

So I listened to podcasts by a number of people in, in this in this arena. So I'd like to shout out a few people. So. Andrew Huberman has got a very famous podcast, and I have a friend and colleague who's a psychotherapist called Richard Nichols who does a podcast also more on the psychological side. There are so many. So it might be worth trying a few podcasts. I really encourage anyone to find the approach that works for them. 

Irina: Okay. Brilliant. Thank you. 

Planning for an Ideal Future for Mental Health Care

Irina: You almost, almost taken me to my next question with your response for [00:38:00] this one.

I was going to ask you, how does the ideal mental health patient service look for you. And where do you see us in 10, 20 years if everything was going to go great, how does the future look like? 

Matt: Right. Okay. So what is my utopia?

Wow. Okay. One of the real challenges here is we know that public health efforts take time to yield results. So if we want things to be materially different in 20 years time, we need to be working on it now because that's the kind of length of lag time that we, we see. So if in 20 years time, people with severe and enduring mental illness are going to live good, long and, and healthy lives like the rest of the population we need to be taking steps now to mitigate the morbidity and mortality in that group.

And I think, you know, there's already work being done around that. So physical health checks and annual physical health checks for SMI [00:39:00] patients are really important Thinking about Initiatives to make sure that they're inclusive of people with severe and enduring mental illness and learning disabilities.

So we did that very well when we did COVID vaccination as a country, we had a particular focus on that area. So we can learn from the things that we did well at that time, and take that into other areas. What can we do to ensure that people with severe and enduring mental illness have the same access to effective public health initiatives, screening campaigns, immunization campaigns is everyone else. So it's really about making sure that all of the things that we're doing already work better for adults with SMI as a group that suffer with health inequalities. Mhm. It's about deliberately thinking about how we tailor those approaches so that they are inclusive, so that they get the job done [00:40:00] for those people, and hopefully that can take us to a place whereby we have parity of esteem and people are not dying younger.

And hopefully in 20 years time, more people in the population will be thriving in their lives. They'll be living with gratitude. They'll feel that they have agency and control over their lives and that the things that occur in life don't just happen to them. There aren't external forces attacking them.

If you have agency, you believe that you're in control and you can change things through your own actions and that there are always things that you can do. So hopefully people will feel more strongly that way and they'll live with humility and they'll be happier as a result, they'll have less difficulties with their mental health and living a life with purpose, working towards achieving worthy goals.

How about that? 

Irina: Sounds like a good plan and I think you're right. There is, there is work going on. There is more and more awareness on how to look after your own [00:41:00] mental health. Everybody encourages you to take breaks, to go for walks. a Focus on nutrition has been around for a few good years now. It's just how many of us actually implement that and how we do it. 

The Role of Parenting and Early Life Initiatives in Mental Health

Irina: A lot of us have become familiar with these notions in adulthood, but is it actually more appropriate to start from a young age and actually raise the future adults in 20 years to be people who know equally to look after their physical, mental health their relationships and, and put value on the right things in life. Should we maybe think about educating Children in this respect? what could we do now to make sure that we are better 20 years from now

Matt: Well, I think you've touched on a really important area. Parenting is incredibly important. So there have been efforts over the years to put services in place to help people who are having children with [00:42:00] parenting because we know that parents can have an outsized positive or negative impact on their Children one way or another. And often unintentionally. Yeah. Start parenting, early life initiatives. 

So another area that's developing that we're that we're seeing is mental health in schools and universities. So over the last five years, and I think this will continue, we've seen an increase in mental health support in schools and universities to help identify challenges earlier so that they could be addressed earlier, which I think is really good. 

We've seen investment in child and adolescent mental health services. So what we're really seeing is, and this has been happening for a while now, NHS England have been leading a program of work to, to try to identify and address mental health challenges and difficulties at an earlier stage. So I think that's really, really key and really fundamental. But what we need is the, the public health effort [00:43:00] as a country to address the things we talked about before.

We need to make the right choices for us, the easiest choices for us. We Need to align the incentives towards the behaviors that we want. So you know, you will have heard about people who want to start exercising. They want to develop an exercise habit and they start with a very small goal like they want to walk for five minutes each day.

So what they do,, because they know it will make it happen is they'll put their gym clothes next to their bed or they'll put their trainers by the door, or they'll put their gym mat on the floor, so they'll do something that makes it very easy for them to just do what it is that they're trying to achieve. So we have to actually try and line up the incentives to get us to the place that we want to get to. With healthy habits that give us a healthy life. Yeah, 

Irina: I was going to say we're going now into a conversation about habits and how we should actually implement healthy [00:44:00] habits to help us on in the long term looking after ourselves and our mental health and our general well being really. 

. Okay. I think we're gonna stop here.

Closing Remarks

Irina: Thank you very much for today. We've, we've heard about a lot of interesting things and thank you for spending time with us today. We might be in touch again because there's a few other topics that I would have really liked to touch upon and you've mentioned sleep, one of them. So thank you again, Matt. It was a pleasure to have you on the episode today. 

Matt: It was an absolute pleasure to do this. I'm so grateful for you for asking me. It's, it's been fun. 

Munir Adam: So there we have it. Did you find yourself introspecting and looking at yourself against the advice of nutrition, physical activity, sleep, connectedness, and purpose? I find that to be a really useful checklist when thinking about ourselves, patients, and when talking to colleagues.

In fact, it might remind you of the episode on well being that we did way back in Season 1. The truth is that mental health is a vast and [00:45:00] complex topic, and, you know, let's not pretend otherwise. But we hope that here we've been able to focus on providing you with some useful and practical tips, rather than going into the esoteric.

Anyway, I want to attend to my well being and go for a walk, meet some friends, and then try and get an early night. So just to say quickly, Show Notes is where you'll find useful links. Do rate us on Apple Podcasts or wherever you listen to your podcasts, it really does keep us going. If you know of a potential sponsor, do let them know.

And join us again next time. Until then, keep well and keep safe.

Disclaimer

Munir Adam: Primary Care UK was developed by Therapeutic Reflections Limited [00:46:00] to inform, educate, support, and unite the primary care workforce. Specifically, it is not for the general public or patients. All information and advice contained therein is time, location, and context dependent and is general advice only.

No guarantees are provided with respect to the accuracy of the content. The hosts, contributors, and the organizations they represent do not accept liability for any actions, consequences, or effects that result directly or indirectly from the content provided. Please refer to the episode description.

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