During a shift in an NHS mental health crisis team, I’m visiting a woman who’s been feeling suicidal. She tentatively welcomes me into her flat and asks if I’d like a cup of tea. I’ve got multiple visits to make and I want to get started, so I politely decline.
She looks a little disappointed and asks if I’m sure. I sense it’s important to her, and I do quite fancy a cup of tea), so I relent and accept her offer. In that moment, the dynamic of our interaction shifts in a subtle but vital way.
A power imbalance remains. I’m still a mental health professional coming into her home, but I’m now also a guest. She is guarded at first, saying she’s had poor experiences of the crisis team before. Soon, she opens up as the conversation progresses. We explore what’s been going on together, and she agrees to a follow-up appointment the next day.
I work these NHS shifts every couple of weeks, alongside my role at Mind where we try to influence mental health policy and practice. We’ve seen huge rises in rates of mental health problems and a service model that is unsustainable in the face of increased demand. The human impact of this alone should make this a major priority for the next prime minister. The huge social and economic fallout will make it impossible to ignore.
The new cross-government mental health strategy will need to address the systemic drivers of poor mental health, but it must also rethink how support is accessed and delivered. As my crisis team encounter demonstrates, the quality of people’s initial interaction with services is critical to outcomes: a kind word and openness to conversation can make or break whether someone engages with support.
Reaching out for mental health support can be daunting, even more so for people with previous negative experiences of services. If responded to quickly and effectively, it is a key opportunity to prevent someone’s mental health deteriorating further and to understand what support they need to get back on track.
In the crisis team, I’ll normally see someone within 24 hours of referral and often spend around an hour with them for an initial assessment. But for those not in crisis, the pathway to meaningful support is much less clear and timely. This is despite us knowing earlier engagement often prevents more costly acute interventions.
Most people struggling with their mental health, if they feel ready and able to seek support, will book a GP appointment. Many GPs do a great job of talking to people about their mental health, but a ten-minute appointment can only really scratch the surface. The support options available are often limited to medication and talking therapy, for which people are likely to face a long wait.
Mental health problems are usually inextricably intertwined with people’s social and economic circumstances: their work, their finances, their relationships. Any trauma, past adversity they may have faced, or their upbringing, may also influence. A great first support conversation would allow the time to explore these factors and build a richer shared understanding of why someone is struggling.
These conversations would serve a therapeutic benefit – making someone feel heard and validated – which could be enough in some cases. It would also do a much better job of identifying the range of support someone requires, some of which may be clinical, some about addressing social and economic needs.
This is why Mind is calling for a ‘Same-Day Open Access’ model of mental health support in England, as has been proposed in Wales. This would mean people having more control over accessing the support they need, rather than bouncing between highly gatekept services. The first step would be to shift more resources towards people accessing a great support conversation with a skilled professional on the day that they need it.
These conversations should be available via a diversity of access points, so as many people as possible feel comfortable seeking support. Currently, people from racialised and marginalised communities struggling with their mental health tend to have worse outcomes. Due in part to a lack of culturally responsive support, they are more likely to only come into contact with services during a crisis.
Mental health services seem to have been politically deprioritised in recent years, despite the focus on long-term unemployment and benefit claims linked to mental health, particularly among young people. But the quality and accessibility of initial engagement – to build a trusting relationship and understand the complexity of the challenges people are facing – is also critical to better outcomes in this space.
Within local government and community services, there is growing recognition of the importance of ‘relational services’. But Whitehall and Westminster thinking is still largely stuck in a New Public Management mindset: a public service reform doctrine focused on market-style incentives and importing private sector practices into government.
This leaves it ill-equipped to recognise or design for something as simple as whether a professional has the time, and the relationship, to sit down with someone over a cup of tea.
If, as seems likely, Andy Burnham becomes the next prime minister, he will bring a deep understanding of these opportunities and challenges from developing the Live Well approach in Greater Manchester. This could provide the foundation for a transition to the Same-Day Open Access model of mental health support Mind is calling for, and an opportunity for many more people to get the help they need much sooner.
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