When Claire Murdoch began her career in mental health it was 1983 and the Mental Health Act had just come into force. “I was deeply attracted to a job that would involve working with people and drawn by the fight against the injustice, fear and ignorance that people with mental health issues were facing,” she tells Spotlight.
Nearly 40 years later, the mental health system has transformed but is still facing challenges in tackling the causes of poor mental health, inequalities, and lack of parity with physical health. On top of these, the Covid-19 pandemic has placed unprecedent strain on the mental health of people and health services. Ahead of Mental Health Awareness Week (10-16 May 2021) Murdoch told Spotlight about how policy needs to adapt. The interview has been edited for length and clarity.
How did you get into healthcare as a profession? Do you have any particularly strong memories or experiences from earlier in your career that you still think of?
The memories that stick with me are of the small things in my career that taught me some of my biggest lessons. I remember leading a battle to replace the number of our ward with a name – something all staff and patients felt strongly about. In the end we compromised with administrators and ended up getting both a number and a name – Six Oaks – but it was a disproportionately challenging fight and it revealed the powerful dynamics that resist change. This experience gave me great insights into how to manage change. As well as driving major change in policy, funding and models of patient care, we need to value individuals and listen to them. My early days also taught me the importance of asking forgiveness and not permission, as myself and many other colleagues challenged so many aspects of care and decided to seize all opportunities given to us to drive change.
Another standout memory is how, as a ward sister, I was privileged to speak at the closing ceremony of the hospital I trained and worked at. It marked the end of the bed-based, institutional model of mental health care, and in my speech I talked about standing on the brink of a new era of mental health care. It was an important moment as we started moving away from a very hierarchical system, marked by significant stigma, towards a new one where patients had more power and care was more consensual.
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What were your highest and lowest moments in the past year?
The past year has been devastating, with many facing loss, grief and isolation. It has been a real challenge for the NHS too. From the beginning I felt ready to step up and play my part. For me personally, working in the NHS and having managed previous crises, although not on this scale, I felt privileged to help shape the NHS response to the pandemic. Being part of such a common cause, seeing the way that colleagues across the country focused 24/7 and that their families stepped up to release them to what was a totally immersive time, was just an experience I won’t forget.
The compassion colleagues demonstrated is extraordinary and I’ve been moved by numerous personal stories of coming to work every day despite feeling frightened for their older relatives, or worried about their children staying at home during school closures. One elderly gentleman died of Covid on one of our wards – our team had known him for years and he had no relatives. They went to great lengths to find out where his parents were buried, so he could rest in peace next to them.
It’s clear that Covid has laid bare pre-existing inequalities, and many people have experienced a difficult year that has taken a great toll on their mental health. We have constantly worried about our most vulnerable patients in the community, how we could support them with their carers and families, including, more recently, ensuring we get the vaccine to them. I’ve been impressed by colleagues across the board – not just in the NHS but our partners in the voluntary sector too – who have adapted their ways of working at pace to do that. In a matter of weeks they delivered changes that would normally have taken years to implement, such as new crisis lines across the country, innovative digital platforms, or online befriending services.
It’s worth recognising that it has not been universally bleak and many people have identified benefits from the lockdown and changes this has brought to their lives. We do need to understand what has improved for people during this time and what they have valued. For example, it would be interesting to know how many street and community WhatsApp groups sprung up, so that neighbours could help each other. This kind of local activation could leave a real legacy.
How has Covid-19 affected mental health in the UK? Are you concerned about the capacity of the NHS to meet this need?
From the beginning of the pandemic, after the initial shock of the first lockdown, services around the country started reporting increased demand and a rising complexity of needs, and emerging evidence confirmed what we saw on the front line: Covid-19 will have a long-term impact on mental health.
We are working closely with academics, and other bodies, to understand what the impacts will be as society resumes, albeit in a Covid context. For many, the return to work, resumption of studies, contact with family friends, and hobbies will improve their mental health, and we don’t want to pathologise what have been natural responses to an extremely worrying situation.
However, we are seeing some concerning trends in some specific areas. For example, the NHS is treating nearly double the number of children and young people with urgent needs than a year ago, so I was delighted the government awarded us £500m for 2021/22 to help us deal with the particular pressures services are facing during Covid, such as the rise in eating disorders.
That additional funding will help us keep on track our NHS Long Term Plan for mental health – so that by 2023/24 an additional two million people can access care in England – and even accelerate elements of the plan, such as achieving our target for 25 per cent of schools and colleges to be supported by NHS Mental Health Support Teams by April 2022, a whole year ahead of target.
What are the greatest challenges facing mental health services?
We just talked about increased demand for mental health services, which is definitely one of the main challenges for our sector, especially in the context of the pandemic. I’m delighted we had a major plan for expansion under way, but there are many more people who still need support.
The mental health workforce is absolutely critical to delivery of our plans. It takes time to train and recruit doctors, nurses, therapists and other workers, and we need to recruit several thousand new colleagues to achieve our Long Term Plan ambitions. I am pleased to see that Covid-19 has reinvigorated people’s interest in NHS careers, and the record numbers of NHS doctors and nurses working in England. There also seems to be more interest in pursuing careers in mental health, which is great and gives me confidence we will be able to recruit the people we need.
Looking to the future, what do you think are the greatest opportunities in treating and preventing poor mental health?
Prevention is key. The Every Mind Matters campaign has delivered fantastic resources to help young people improve their mental health. Many charities have also developed really useful information and self-help programmes, and we really need to ensure that people know what’s available.
The NHS absolutely stands ready to play is part. By 2023/24 we will be investing an additional £2.3bn in mental health services each year, which will see not just a large expansion of services, but a significant transformation in services. For example, a few years ago there was a postcode lottery in specialist perinatal mental health support, but there are now services in every area of the country that are improving the lives of whole families; we’re introducing gambling addiction clinics; 186,500 additional children and young people will get support from the NHS this year, including through dedicated Mental Health Support Teams in schools; and an extra 15,000 people with serious mental health problems will recover at home rather than in hospital, backed by our ongoing commitment to transform our community mental health services.
Finally, I think that we should capitalise on the positive developments we’ve seen in the past year. NHS services have demonstrated an ability to innovate at speed. The adoption of digital technologies can’t replace face-to-face contact altogether, but provides much greater choice for patients and can enhance a patient’s experience.
Public awareness of how much mental health really matters has grown and can help deliver change. Mental health is everyone’s business – and opportunities to improve it lie in every part of society, be it schools, charities, local authorities or big corporations.
What would you like to see policymakers talking about more? And what would you like to see happen?
Throughout the pandemic we have worked closely with government in ensuring mental health was prioritised. The additional £500m secured for our sector this financial year is welcomed.
There is increased awareness that mental health issues are not just for the NHS to deal with and that only a wider societal shift will secure long-term improvements. We need to work with charities, schools, local authorities and others to make sure we address the socio-economic impact the pandemic has had on people’s mental health.
Businesses also have a role to play. For instance, I have recently called for a compulsory levy on the gambling industry to fund treatment for those whose mental health has deteriorated due to gambling addiction – a trend that has steadily picked up during lockdown.
Advertising of products that place such pressure on our young around idealised lifestyles or body image need to be curtailed.
Recently, we worked with government and others on their cross-government mental health recovery plan. All departments have a major contribution to make towards better mental health and the prevention agenda. Better housing, education, employers, and so many others, are key. While we modernise and expand the NHS treatment offer, we need all parts of society to play their part alongside us.