Mental Health Strategy

Thank you Monsieur le Deputé Baillie,

Members will be in no doubt, having read even the short report included in the Billet, that the subject of mental health is wide ranging. The sheer diversity of subject matter that most people approaching me on this billet has astounded me and the silence of other areas has been deafening.

The strategy shows a comprehensive approach that the HSSD can take in relation to this multi faceted problem, one that manifests itself in so many members of our society, but is still the illness that we dare not speak its name.

I remember watching a wonderful film as a child located on Brighton beach Brooklyn. The film, based in the thirties portrayed the life of one Jewish boy struggling to come to terms with life as he grows up in an overly populated house. I’ll never forget the scene where his mother and aunt are sat by the kitchen table, preparing food and talking about various friends and acquaintances. On each occasion that they talk about someone who had died or was severely ill, they would whisper the name of the disease. Afraid to say the word out loud in case God would hear them and smite them with the same affliction. Watching the film in the eighties it was a moment of great hilarity, well made and acted. But of course this persisted with certain diseases for a number of years, many of us will remember similar attitudes towards cancer not so long ago. But mental health continues to carry that stigma. We joke about people needing happy pills and if they’re a little too tidy we might poke fun that they have OCD, but the reality of discussing schizophrenia, bi polar disorder, personality disorder, bulimia, anorexia, self harm or severe depression still enters that category of hushed tones and whispered utterances.

It’s depressing to note that the vast majority of cases concerning ill mental health in Guernsey are as a direct result of neglect or abuse as a child. The children in turn growing to be parents and committing the same to their children is a well known and self perpetuating cycle of neglect, abuse and mental disorder. If we as a government want to see long term benefits to the island as a community, we must start by developing services to target those families that need assistance to overcome these circumstances. Early intervention in family life and assistance for those families that need it is evidenced to drastically reduce the rate of abuse and neglect that then in turn will reduce the number of people being seen for larger mental health issues. This break in the cycle could not only reap great benefits for the individuals, but it would also ensure a reduction in the demand of the services of HSSD, SSD and Home in particular. This would reap long term cost reduction and ensure greater wealth on the island. To continue on our current trajectory is to state clearly that we can afford to pay for neglect and abuse with expensive mental health services for our community. Surely we’re better than that and should encourage early intervention services, such as nursery care and preschool arrangements, as the cost of developing that type of service is much cheaper than funding the continuation of abuse and neglect.

Members may not have read the full research report on Mental Health and Wellbeing in Guernsey and Alderney, but I would recommend that they grab a copy and turn to page 61 of that report. There they will find startling evidence of the efficacy of the Child and Adolescent Mental Health Service and its outreach team that was established in 2011. The numbers clearly show that in 2008, 2009 and 2010 the average number of off island bed days, per annum was 1,508 coming in at an average cost of £922,376 per annum. In 2011, the first year of the outreach service, bed days off island were reduced to 615 with a price tag of £376,683  an astounding reduction in cost. Here I can’t help but indulge in my schadenfreude again and advise members that there is currently no primary care service associated with the Child and Adolescent Mental Health Service such as the service currently funded as a pilot by Social Security; given the resolutions of the FTP debate, no such service can now be started without making sufficient cuts to HSSD’s existing budget, therefore an opportunity to further reduce the cost of expensive off island placements is curtailed. No doubt we will pass this Strategy today, but when will we find members willing to put their money where their mouth is and end this short-term nonsense that is paralysing service development. No new services on this occasion will come with additional costs.

Whilst on the subject of costs, it is estimated that Guernsey incurs £40M annually in costs attributable to mental health absenteeism, a call to action from all of us and surely a call to action for all employers. Page 92 of the main report discussing workshops held with local employers states “Employers who attended the workshops indicated that they do not know enough about how employment impacts on wellbeing and mental distress”. Given this statement and the importance of increasing productivity for our island economy, I will be investigating with other members of HSSD the possibility of developing a general management course that could be made available through the Institute of Health and Social Care Studies to the business community. We have the knowledge and the skills to assist the private sector and we should recognise the opportunities that are made available to us through this strategy.

I now turn to the section on mental health and criminal justice. For too long in Guernsey have we been silent on the current practice of sending people with mental health disorders directly to prison. Sentencing mentally ill people to prison does little to improve crime on the island, little to deter the person from repeat offending and the most likely outcome is simply to cause an increase in the complexity of the mental illness. This in turn results in reoffending or finally, admittance into an expensive HSSD facility either here in the Castel or at even greater cost, off island. Much is to be complemented on the improvements of mental health services offered in the prison, but there is much work still to be done to ensure that we improve people’s lives sufficiently and reduce recidivism in the criminal justice system. The Mental Health Law coming toeffect on the 8th April this year, should members agree, will allow the judiciary to dispose of people with mental health disorders into appropriate mental health facilities and I sincerely hope that we will see a change in current sentencing practices in line with recommendations from the multiple agencies that advise the courts. But the damage that is done by our current short-term prison sentencing cannot be overstated and current provisions for community sentences with a mental health treatment requirement is little used by the courts. I urge the minister of HSSD and the minister of Home to give careful consideration of page 155 of the main report so that we understand why there is no procedure in place to support this style of sentencing and then promote its adoption given that it is viewed as the best course of redress and that it comes with a potential saving of £20K per case.

The diversity of the subject extends much further. On Monday evening at the St Peter Port Douzaine meeting I was asked about services offered to former members of the armed forces suffering from Post Traumatic Stress Disorder. It was highlighted to me that some former members, having fought for queen and country, are now facing greatanxiety, as we were unable to deal with their cases on island. Recognition of the debt owed to the armed services should extend further than standing in sombre silence for a few minutes on Liberation day and Remembrance Sunday.

We also face a great challenge with an increasing elderly generation. Dementia, in all its multi faceted and cruel manifestations robs people of their history, dignity and personality. I’ve seen first hand the cruelty of Alzheimer’s as have many more here, but this is the one area that we remain silent on. We’re willing to talk more freely on the illnesses that effect the young and the working age, but when old age arrives, who will speak up and ensure that we don’t consign people to the dust heap. Last year the former board of HSSD closed two wards at the PEH, one resulted in a delay to surgery and the other resulted in dementia patients having their services relocated. The outcry over a delay in surgery was deafening, believe me I was at the receiving end. But who here asked questions as to the provisions and care made for those that had services relocated. I would like to assure all members that the greatest care was taken and all family members were consulted before moving patients from Divette ward, but who here asked that question. It’s strange how the combination of old age and dementia results in being, as it were, behind a curtain, out of sight and out of mind. I don’t wish to dwell too long on this and my intention is not to stand here with an accusatory wagging finger, but I would hope to nudge your collective conscience.

Finally I ‘d like to return to my initial theme and talk about the stigma associated with mental health. In Wales recently there’s been a broad campaign called Time to Change Wales, a non profit organisation working to break the stigma of mental health issues,posting stories from sufferers on social media sites and encouraging open discussion about mental health. One of their campaigns was to have a debate in the Welsh Assembly where four members of the assembly spoke candidly about their individual mental health issues demonstrating to the community that mental health issues aren’t a barrier to public life. One in four people in their lifetime will suffer from a mental health issue; that means that in this assembly twelve of us will suffer mental health issues in our lifetime. I can confirm that I’m one of those twelve, which rather improves the chances of the rest of you, as I’m sure you’ll all be glad to hear. I suffer fromDepression, which intensifies in the winter months. Part depression, part seasonally affected disorder. Depression doesn’t mean that you just feel low, it goes much further.

Winston Churchill once said of his depression “I don’t like standing near the edge of a platform when an express train is passing through. I like to stand right back and if possible get a pillar between me and the train. I don’t like to stand by the side of a ship and look down into the water. A second’s action would end everything. A few drops of desperation.” Personally I can confirm that walking around St Saviour’s reservoir has a similar effect. There’s also the consuming anger and occasional bouts of uncontrolled crying for no apparent reason. For many years I believed that my emotional response was perfectly normal and that I was simply a little angrier than other people. Many a job have I had the joy of being enraged as to my boss’s actions and had great arguments with them. But you try explaining to your boss that you’re shouting because it’s January and you forgot to take your pills. Somehow the accusation of having an attitude problem is more comfortable. No surprise that my annual bonus was never that great given the correlation of winter and our culture of awarding bonuses at that time of year.

Eventually I was diagnosed with depression and offered pills, fortunately I questioned the wisdom of my GP in reaching so quickly for the prescription pad and went home to do some research. I now manage my depression with a combination of factors. Every now and then I still notice that I get overly angry for no apparent reason. Every now and then I feel the urge to cry, usually on the last Wednesday of every month. On those occasions I know that I need to up the dosage. Then there’s the opposite side where I feel hyperactive and decide to start cooking or baking at some ungodly hour of the morning and realise that its time to reduce the dosage. But these occurrences are now reduced to half a dozen occasions a year as opposed to a daily grind of attacking friends and colleagues. I’m now in a position to state that I live with depression and manage it very well. I’m not sure that being a Deputy would be classed by all as leading a productive life, but the cycle of self destruction that I seemed to be so busy justifying is now over.

It was years before I received diagnosis despite, in hindsight, the very evident behavioural oddities that I displayed. We need to educate people as to the manifestation of mental illness and anxiety so that a caring piece of advice is given rather than a round condemnation.

It’s interesting that so many people that we revere for their lifetime achievements suffered poor mental health. My personal heroes include Beethoven, who had Bi Polar disorder as does Buzz Aldrin; Jack Kerouac had Schizophrenia; Donald Trump has Obsessive Compulsive Dissorder as did Albert Einstein;  both Theodore Roosevelt and Winston Churchill suffered depression. We should recognise mental illness for what it is, it is a hurdle. For some the hurdle is so high that it will never be surmounted. For others, with assistance, the hurdle can be reduced and for many the hurdle can be removed. It is not a barrier unless we make it one.

A famous American psychologist called Rollo May once said that “Depression is the inability to construct a future”. Today we’re asked to start constructing a future, not only for the people who currently suffer mental health issues, but for the whole community, therefore I would urge all members to embrace this strategy wholeheartedly and ensure its consideration in all aspect of our future work.

Thank you.

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