Dr Andrew Mayers
PhD, MBPsS, FRSA
My work frequently attracts the attention of local and national media. Please click here to see an overview of radio, TV, and other media appearances.
August 1st 2017
Jeremy Hunt announces ‘major’ recruitment in mental health: A new dawn or just the same old day?
Yesterday, Jeremy Hunt (Health Secretary) announced plans to recruit almost 10,000 staff to mental health posts over the next 4 years. The money would be drawn from the £1.3bn 'committed' to improve mental services (with the aim to bring services in parity with physical health). As a mental health campaigner, I was initially encouraged by the headlines that greeted me when I awoke on Monday morning. But does it all add up?
I have been campaigning for better mental health support for several years, especially for young people and for mothers (and fathers) experiencing mental health problems in the perinatal period. I am an academic psychologist at Bournemouth University, specialising in mental health. Through my external commitments and professional practice, I belong to a number of campaign groups (such as the Maternal Mental Health Alliance and I contribute to the All Party Parliamentary Group for perinatal and infant mental health group, 1001 Critical Days. I was driven to join these groups because of the chronic underfunding in mental health for decades (or probably ‘forever’, as Paul Farmer, CEO Mind Charity, put it yesterday). Through my work with local and national mental charities (such as Dorset Mind), I have seen the impact of cuts to services, reduction in public health and local authority funding, and the effect of austerity on communities. I was also compelled to tackle public stigma towards mental health, which ostracises sections of our society and discourages seeking help.
Let’s not forget that 1 in 4 of us will experience some mental health difficulty at some stage of our life. If you have not encountered problems, you no doubt know someone who has. Some conditions, such as depression, are a major burden to health services, and yet mental health only receives a fraction of the overall health budget. So, surely, I should welcome the promised investment and the commitment to recruiting the workforce to sustain that? Well, it’s a little more complex than that. Partly as a result of our campaigning, we have seen some encouraging funding pledges, especially in perinatal mental health. But there needs to be more. The promised £1.3bn investment in mental health needs to be put into context. Some might say that this funding only partially replaces what has been lost over the last decades. Where pledges have been made (even recently), the actual funds have failed to reach front line services. But let's say we give Mr Hunt the benefit of the doubt this time. He claims, to properly invest in mental health, we need a strong workforce to implement that. Hence the call to recruit thousands of new workers. That's OK, in theory, but what is the reality?
Part of the recruitment drive is to employ a further 2000 nurses by 2021. Surely that has to be a good thing? Well, it depends. To ensure that these nurses are in post, fully-trained, by that time, they would need to start their undergraduate courses by September this year. And yet, we are seeing a reduction in the numbers of applicants for nursing posts following the introduction of fees. There is little incentive for people to enter nursing, with the prospect of high debts to pay for the fees, and then years of chronically low pay. Why not waive the fees? Why should future nurses be paying to get the training needed to benefit society? Then there's nurses pay itself. While the pay rise cap remains, where is the reward for hard work (especially in the highly demanding and stressful role of mental health nursing). When questioned on this yesterday, Mr Hunt sidestepped the issue, focusing instead on praising how hard nurses work without addressing the problem with low pay. Hunt says that he is confident that they will recruit the nurses. But how convenient it would be, should the recruitment fail, to use that as an excuse not to spend the £1.3bn pledged. We might hear "well, we made the commitment, but no one took us up on it, so we will spend the money elsewhere".
It's not just about the pay either, or just nurses. All mental health staff have incredibly stressful jobs. Many of those staff enter the profession because they have their own lived experience and want to give something back. That experience is very powerful; I have seen that in the contact that I have with staff and service users. However, very little (until recently) has been done to protect those staff from the impact of working in those challenging conditions. Investment is needed in ensuring that all staff have access to proper clinical supervision. It's also not just about staff working directly in mental health services. All health professionals (GPs, acute hospital staff, practice nurses, community teams, etc.) need mental health training, so that (at the very least) they can properly signpost and/or refer to specialist services.
Of course, most of what I have said to this point applies to 'patients' with chronic or acute mental illness. There are considerably more people with sub-threshold mental health problems who do not qualify for treatment. But many still need support. That's where the third sector comes, especially through local mental charities. In many cases, someone with (say) relatively minor mood or anxiety problems might simply need structured, effective, peer support. Local charities can provide that expert support, especially through peers with lived experience. However, as Patron and Trustee for Dorset Mind, I can attest that our biggest challenge is finding the funds to runs the services. Very little comes from local authority, public health budgets, or local commissioning. A great deal comes from grant funding. Simply by providing these local services, we can prevent so many people escalating into more acute mental illness, and becoming a great burden on NHS budgets. Surely, one answer is to use LA and/or local clinical commissioning to ensure that all areas have access to expert services, away from the NHS.
So, was I happy with Mr Hunt's announcement yesterday? I welcome any funding, and certain applaud a drive to increasing staffing. However, this was not properly thought through. There is a much bigger picture that is being missed, quite probably because those making the decisions simply do not have the understanding about mental health that is needed to truly make the changes that are needed.
June 19th 2017
A blog for International Fathers’ Mental Health Day: Why paternal mental health is so important
When my good friend Mark Williams asked me to write this blog for International Fathers’ Mental Health Day (IFMHD), I had no hesitation in agreeing. This is something very close to my heart, professionally and personally. Here’s why. Professionally, I am an academic psychologist (based at Bournemouth University), specialising in mental health (and particularly perinatal mental health). I campaign for better mental health provision for mothers, fathers, and the entire family. Personally, I am Dad to four (now adults), Granddad to four, and there’s another grandchild on the way.
Of course maternal mental health is important. I work with many groups across the UK to help make that a little better for mums. I help train midwives and health visitors on mental health. I am advising the NCT on their new perinatal mental health peer support service. I worked on the Best Beginnings maternal mental health project. I am part the 1001 Critical Days initiative. I am a member of the grassroots Perinatal Mental Health Partnership (which is part of the Maternal Mental Health Alliance). I work some of the most inspiring maternal mental champions across the UK. But, fathers’ mental health is important too.
I have worked with Mark Williams to try and establish a charity and support network for fathers. That work is ongoing. For me, fathers need support in two ways: to understand more about how they can help their wife or partner, should she develop mental health problems; and to protect their own mental health. To mark IFMHD 2017, Mark Williams and I recorded this podcast. In that I mention some of the work that I have been doing.
For some men, when their wife or partner develops a mental health problem (whether that be during pregnancy or after the baby is born), they lack the knowledge, resources, and confidence to know what they can do to help. Often, they feel the need to ‘fix’ it. Because the person they love is ‘sad’ they try to make it better by (perhaps) organising a holiday, or treating her to new clothes. That’s all very well, but it’s not understanding what’s really going on. Emotional support is vital. In some cases, when the mother develops a serious psychosis, or exhibits extreme obsessions and compulsions, fathers might become very scared of what is happening. Dads need to learn what to do and where to get support, but there are still too few resources to guide them. We need to change that. There are good resources, such as those provided by Action on Postpartum Psychosis, Bluebell, and the NCT. There is a need for more resources that are safe and reliable.
Also, health professionals and other support services (including charities and peer support groups) need to cater more for fathers (and dads-to-be). Some antenatal classes include dads, and some of those are now including emotional wellbeing and mental health (for both partners). However, that needs to be standardised (and benchmarked) and extended to all locations. Following campaigns (such as Maternal Mental Health Alliance, 1001 Critical Days, and others), the UK Government have been allocating funds to improve maternal mental health. We now need to exert more pressure to have more funding for fathers too.
Then there’s the work we need to do to support fathers’ own mental health. It’s hard enough to get men talking about emotions, let alone fathers. There is so much stigma about ‘manning up’ and being the ‘rock’. At the end of the day, it is perceived, it’s the man’s job to provide the security. But, chaps are vulnerable too. All sorts of factors can cause the father (and dad-to-be) distress. There’s the uncertainty of fatherhood, the sudden change in responsibility, financial concerns, and relationship changes to name just a few, and that’s quite apart from the sheer emotional turmoil. We need to make it OK not to be OK, and to be able to talk about it. We need to provide outlets to allow men to talk freely and without judgement. We need professional and support services to be better trained in how to support fathers (and recognise the signs that dad might need support).
A key area that I have been working on recently focuses on birth trauma. That trauma might relate to significant threats to life (for the mother and baby), major blood loss, birth complications, and unexpected outcomes (including unplanned caesareans). We already know that mothers need more support following birth trauma, and some great work is being done on that by the likes of Unfold Your Wings, the Birth Trauma Association, and the Birth Trauma Trust. However, not nearly enough is being done for fathers who witness that trauma. When there is a birth complication, understandably, the mother and child are the main priority in what might be a medical emergency. All the same, much more could be done for fathers. They are left to cope alone, with no information and (perhaps more crucially) no follow-up. We know that the way in which trauma is processed, and the level of support given, are major factors in whether a person develops post-traumatic stress disorder (PTSD). And yet, little is done to recognise that for fathers who have witnessed (often) very distressing scenes.
I know of one case, where a mother (in the final stages of labour) experienced significant blood loss following a placental tear. The father (who was present) only knew there was an emergency when the delivery team hit the alarm (to get more help). He was given no information. Not even a brief explanation of what was happening. He was simply given his new son and told to ‘get on with it’. When his mother-in-law (alerted to the emergency) entered the room, he was seen to be visibly shocked and deeply distressed. The emergency was dealt with, and the mother and baby were fine. However, the father was never followed up to check the impact of witnessing that trauma.
We need to ensure that information and support is more readily available. However, before we can demand that, we need to know what fathers need. There is too little research to date. To address that, I have started some work in this area. Under my supervision, one of my undergraduate (final year) psychology students (Emily Daniels) undertook a research project. We recruited fathers who had witnessed birth trauma. We asked them about that experience, what information they were given, and what support they received. The formal results will be published soon, but we do know that fathers were saying about how little information and support they got. We will use that evidence to inform agencies to help change this lack of support. The work has already received some media attention, through newspapers (e.g. The Times) and BBC Radio and TV. Bournemouth University made this short video about the work. We will be extending the work in the near future.
In the next academic term (Autumn 2017), I will be starting two new projects on fathers’ mental health: one that explores what resources dads need to support the wife/partner’s mental health; and one that examines what help fathers need to support their own mental health.