The NHS is in a state of flux, facing wholesale reforms drawn up by the coalition. What is your take on the White Paper?
There is no doubt that the NHS is about to undergo the greatest change it has ever seen over the next few years. It is difficult to predict the intended and the unintended consequences of this change. It is our responsibility to ensure that patient care is not adversely impacted upon by the changes.
Within Perinatal Mental Health Services (PMHS) it is likely that the inpatient service will be commissioned regionally. It is less clear how the community services will be commissioned – but it is likely to be by local clusters. There are benefits to regional commissioning, as it should reduce the postcode lottery by ensuring that all women have access to a regional inpatient mother and baby unit without having to negotiate with individual PCTs for funding.
However, dichotomous funding for inpatient and community services is a potential risk. The regional funding for inpatient PMHS acts as a disincentive for keeping families in the community under the care of community PMHS, if they are funded by cash-strapped local services.
Are you confident that an improved NHS will be the result of the Government’s reforms, if approved by Parliament?
It will clearly be a different NHS. There are likely to be aspects which people will feel are an improvement and other aspects which people will feel are a detriment. I doubt there will be much net gain, and when this is balanced against the cost of the changes, both in finance and morale, I am yet to be convinced of the benefits.
How can GPs gain a better understanding of mental health issues?
In my experience, GPs have an excellent understanding of mental health issues: the majority of mental illness is treated within primary care. GPs are well placed to understand the complexities of mental illness as it plays out within family and social dynamics. In order to gain a better understanding, all one needs to do is to listen more to our patients, to understand the significance and the impact of mental illness on individuals and families.
Do you think GPs have a role to play in helping to tackle the stigma attached to mental illness, if so how can they work to address this issue?
The confidential enquiry into maternal deaths shows us that women with mental health problems are more likely to die in the post natal period than women without mental health problems. While suicide and overdose of illicit substances accounts for some of these women, the majority die from physical causes which were misattributed to their mental illness, denying them access to the necessary, timely treatment.
Assumptions are made about people with mental illness which can ultimately have life threatening consequences. Therefore we all have a role and a duty as health care professionals to reduce the stigma and stereotyped ideas of mental illness which will affect one in four of us at some point in our lives. Stigma can be tackled on a daily basis by ensuring that we don’t let casual discriminatory comments about mental illness pass us by, but tackle them head on.
I am hopeful that most people in the modern workplace would not make racist, homophobic or sexist comments and if they did there would be a procedure in place to censure them. However, comments and assumptions about people with mental illness (and even those who treat them) are seen to be more acceptable. This is something which we should all work on, to bring about change for the better.
