As a mental health service user and an NHS staff member i was recently asked by NHS IQ to give my views on what the effect of not having 7 Day Services has on patients. You can see me and other members of the public and patients giving our views here.
To coincide with World Mental Health Day, guest blogger, young person and professional Kat Cormack looks at the state of young people’s mental health in 2013 and examines access to treatment, perception of people with mental health issues and stigma.
So here we are on the week of World Mental Health Day 2013 and I can’t believe a year has passed already since the last one.
It’s also ten years since I started receiving mental health treatment and so now seems to me like a good time to take stock and see what is currently happening in children and young people’s mental health. I guess that makes this my “State of the mental health nation” speech.
Mental health, illness and everything in between is a massive area and I could talk to you about everything from ADHD to Z-drugs but then this would be less blog and more book: or five! So I’m going to focus on a few areas that I feel make for good indicators to assess the health of our mental health and services.
The last 10 years have been huge for me, seeing me going from a severely ill 14-year-old to a moderately ill but high functioning adult. In this time I have gone from being a student at school using CAMHS to someone who now works for the NHS and with YoungMinds (and occasionally uses Adult Mental Health Services).
I have also spent five years working with YoungMinds, the Royal College of Psychiatrists as well as completing an undergraduate degree in Psychology where my dissertation was based on young people’s experiences of transitions from CAMHS to adult services. This puts me in a somewhat unique situation (not unlike a tightrope at times) of being a professional, a “young person” and a service user all at once.
So where do we begin? I think two of the most salient indicators are access to treatment and perception of people with mental health issues. These are the two areas I will be covering in this blog.
Access to treatment
Asking for help with a mental health problem is daunting. I’m not going to lie. It takes courage to admit that things aren’t right and that you’re struggling and I commend everyone who takes this first step.
For most young people the first port of call is their GP, it was for me too. Ten years ago when I first asked for help my GP (newly qualified) had no idea about mental health having received no real training in the area. At the time I didn’t think much of it but looking back that’s pretty shocking given that such a high percentage of GP visits are related to mental health.
Fast forward 10 years and some progress has been made and I have met a lot of GPs who are very much up to speed with mental health and act accordingly. However many still have limited training and understanding and I have had my fair share of run-ins with GPs who are ignorant to the point of negligence. This needs to change. We cannot keep telling young people just to “talk to a teacher or your doctor” if they’re worried if we don’t then train these professionals to respond appropriately.
After seeing the GP for many young people they are referred to CAMHS. However we know that waiting lists are still unacceptably long with many young people waiting months (or even up to 18 months) for the support they so desperately need. This is not acceptable.
There is much talk of bringing about “parity of esteem”, to put it simply this means we need to start treating mental health as seriously as we treat physical health and that includes holding services to account to the same waiting times. You wouldn’t have to wait 18 months to get a broken leg fixed!
Another big problem we face in 2013 is the increasingly savage cuts to health and social care. Through an FOI request YoungMinds found that two thirds of local authorities have cut their budgets for children and young people’s mental health services since the coalition government came to power in 2010. One service suffered cuts of 41%. (Source: http://www.bbc.co.uk/newsbeat/21737173)
At a time when even more children and young people are experiencing mental health problems the last thing we can afford to do is cut services. Children and young people are not immune to the effects of the recession which have lead to a surge in family breakdown, youth unemployment and stress for young people. And as Tier 3 services like children’s centers are closed the burden increasingly falls even more heavily on CAMHS which was struggling as it was 10 years ago when I first came into contact with them.
With three in every classroom affected by a mental health problem we are letting down too many children and young people.
This is why I am happy to hear that many schools are beginning to ask more organisations like the wonderful BodyGossip to come in and talk to their students. I’m also glad that there is a lot more talk of teaching children resilience and even screening for mental health issues from the age of 7.
Perception of mental illness
Another area that I have watched with interest over the last decade is the way mental illness is viewed and the stigma associated with it.
Thankfully I can say that we’re making some progress with this. When I was at school we never ever heard about mental illness. Now we have amazing campaigns like Time to Change’s Stand Up Kid, YoungMinds in Schools, Student Minds, The Acseed initiative and Mental Wealth.
But we still have a long way to go. I may now be very open about my mental health, something I definitely didn’t feel able to do 10 years ago, but I am part of a minority. I am lucky enough to have the support of my family, friends and importantly my employer. This has not always been the case and I have suffered discrimination in the workplace because of my health as have many thousands of others. We need to create an environment in our country where it is okay to talk about how we feel.
I think that the recent ASDA/Tesco “mental patient” costume scandal is a very good example of some of the stigma we still face in society. Although having said that, the fact that this story hit the news as hard as it did is actually quite heartening. It wouldn’t have made mainstream news 10 years ago.
I also recently ran into the anti-psychiatry movement founded by Scientology, the ironically named Citizens Commission on Human Rights. As I stated in my blog here this was really shocking for me. I know people struggle with the idea that children can experience distress and mental illness but to run head first into people that don’t believe that mental illness exists at all?
There is definitely a lot of work still to be done to help educate people but I also know that there are lots of fantastic organisations, too many to name, fighting daily to reduce stigma and increase awareness.
So overall how is the state of children and young people’s mental health in 2013? I don’t think we can say clearly that it is “better” or “worse” than it was 10 years ago. There have been improvements, there have been set backs but perhaps, if I am dangerously optimistic, I would say things are gradually improving in some ways.
What we need now is for proper investment in children and young people’s mental health, and in mental health in general. For too long it has been a Cinderella service and we cannot continue this way. Research shows both that over half of adults with a mental health issue developed it by the age of 14 and that prevention and early intervention work and save both money, and more importantly lives, in the long run.
This is a speech i am giving at an NHS England meeting:
Everyone’s business: Patient engagement, experience and involvement
My name is Kat and i am the project manager for myhealtlondon’s WellHappy app for young people in the capital.
I’m also a service user and i’ve been using mental health services for about a decade now. When i was 19 i was lucky enough to become involved with the charity YoungMinds as part of their participation project for young service users; the VIK Project. That project has sadly ended now but was a huge part of my life for 4 years.
I came to this event knowing that i would be the only service user (at least openly) and the youngest person here so i’m here to talk to you about a couple of things from my own experiences, especially in relation to youth services & mental health although a lot of what i have to say has much wider applications.
And as much as i am very thankful for the invitation to speak today it doesn’t sit right for me. I’m not special and i am not representative of the areas i campaign around, especially the somewhat catch all group of “young people”. After all how can one person be?
I consider myself to be incredibly privileged to stand here in front of you today and share my experiences with you. But i kind of wish it always me on the stage!
And believe me i’m not the only one out there with an opinion, with things to say. But unfortunately there are still a huge number of barriers in the way of young people actively participating in not only the services they use but their own health.
Some of these barriers are tangible, things like running participation groups at times where young people are not able to attend, but a lot of them are more insidious, they are part of a culture which i believe needs to change.
It’s a problem that is widespread and not just applicable to health services. Young people are all too often dismissed as being apathetic and disengaged with nothing worth saying. We’re told our exams are getting easier and we’re getting stupider and fatter.
And the media is full of awful depictions of the worst side of a very small number of young people. I work with a lot of young people from Tottenham and the surrounding area who live in the areas worst affected by the riots a few years ago. They speak of their despair at the way young people were targeted by the media. Never mind that some of the looters and vandals were grown adults, there was even a teacher in there! All the focus was on them.
In fact a whopping 76% of all press coverage on young people is negative and a shocking 39% of adults cannot not think of a single positive thing that young people do.
Not surprising then that surveys have shown that 1 in 4 adults would cross the street to avoid young people
And if you were a young person why would you want to engage with people who had so clearly written you off before they had even met you?
This is a dangerous state of affairs when we know how incredibly important prevention and early intervention are. But would you trust official figures like politicians and police or even feel comfortable talking to your GP expecting to meet this level of prejudice?
And how as a clinician or a service are you supposed to engage with people who are actively trying to avoid you because of this? It creates a very damaging “us” and “them” culture and shuts down potential dialogues.
It becomes very easy to only engage with the loudest, most active young people who come to you. Easy to ignore the hard to reach groups, for example young men and the BME community are hugely underrepresented in mental health participation circles. And the problem with this is, yes it’s great that you’re engaging service users, but you’re still only consulting a tiny and not representative group. The more people you consult the more points of view you have and the more likely that changes will be made for the common good and not just the perceived good.
And is such a shame because participation can change lives, i’m a perfect example.
Being a young person and a service user can often leave you feeling a number of less than optimistic things about yourself. You can feel like you don’t have a voice and that your opinion doesn’t matter and will never be heard.
It’s easy to become just another statistic and to begin to feel the way that you are treated by professionals who often label you as “manipulative”, “attention seeking” or a hopeless case.
You can feel like you have no right or ability to make even the most basic decisions about your care and your life in general just because you are young and have mental health problems and this is nonsense.
And it can also be dangerous self-prophesising. If there is no point why bother trying?
I know that before i joined VIK i definitely felt like this. I wanted to make a difference and to help change the mental health system so others wouldn’t have to go through some of the things i have and would have a better standard of care but i didn’t have the faintest idea as to how to go about this and didn’t think it was possible, especially not as an individual.
After all where do you start? How do you get people to listen to you and who should be listening when the government and the NHS are so vast and feel so faceless?
But then due to pure chance i became involved in YoungMinds VIK panel and things started to change for me. It took time, it took at least 6 months before i really understood what participation was and it came as a real surprise to me! I’m allowed to get a second opinion? I’m allowed to ask, i don’t just have to sit there and have things like therapy or medication done to me and i can be an active participant in my care! Let alone actively participation in the design and delivery of services. Or being able to give feedback on government policy that directly affects me.
Unfortunately this all happened long after i had left CAMHS. Funnily enough the reason i left CAMHS was not because i was in any way “better” or “recovered” but because i was jaded, disengaged and no longer saw the point. All dialogue between myself and the team had completely broken down.
Oh and just to point out during my time in CAMHS the closest i got to experiencing participation was once being asked to fill in a small form about how i would like the waiting room to look. This in fact is quite an ongoing annoyance..if i had a pound for everytime i had been asked about a waiting room i would probably not have to work!
So just so you know for the future waiting room decor is not participation, it is tokenism at best!
Thankfully though when i went into adult services i had all this new knowledge at my fingertips and it has, overall been a much better experience. I have the confidence and the knowledge to know when something isn’t right and can now stand up for myself-for me this is HUGE. Not only that i can engage with professionals, we can have honest discussions and make shared decisions. It feels so much better to work in partnership and not just be prescribed to!
You would not recognise me if you met me 5 or 6 years ago. I could barely leave the house, i couldn’t put my hand up in class, i was petrified of public speaking. I had no self worth whatsoever.
YoungMinds have provided me and the other VIKs with some absolutely incredibly opportunities. While i was in CAMHS i never thought that i would, for example, meet politicians, go to government meetings or be able to get my voice heard through national publications and radio programs.
But through VIK all of these things and many others have been possible and it is hugely encouraging and empowering. When we speak at conferences we are often approached afterwards by professionals who are completely taken aback by our ability to present ourselves and our experiences in an eloquent, coherent manner and talk with great passion about what we feel should be done to change the system.
I think this shows that even professionals who deal with young people on a daily basis are often unaware that we are unable to express ourselves or know what is best for us. That is why being a part of VIK was amazing. It gave us a chance to prove people wrong and hopefully change some people’s minds about what it means to be a young service user and what we are capable of.
When i ask young people i come into contact with what they think their rights are in relation to their healthcare, especially mental health care, i get laughed at. In fact most of them don’t even know what their human rights are.
“We have rights?”.
Imagine if we got things right this time. If the experiences i have been lucky enough to have were common practice. Too often participation is seen by services as a nice add on, a favour to their clientele, it’s an after thought if anything is left in the budget.
Imagine if participation was just part of the process, if we spoke about it at schools and explained why it is important. If we actually taught kids their rights. If we taught them about the services that they could use if they needed it instead of the current system when you only find these things out too late..when you are stuck in the middle of services. It’s a scary place to be when you don’t know what’s happening.
My parents have always said that the worst thing was that they had no knowledge of the mental health system before i got ill. They too felt thrown in the deep end. Unsure of what was happening, what was meant to be happening and what they were allowed to do or say. I’m so glad that because of my experiences, if my kids ever have issues, i will not only know what to do but have the confidence to help them and fight for them if i have to.
If we get things right we could have a group of people, the next generation in fact, who are health-literate and havethe skills and the support to be empowered, confident enough to take control of their health and their role in services and the desire to change things to make them better instead of the current model i see which is enduring and then escaping services never to return or even think about them again.
It’s a big ask i know but i also know it would be worth it for everyone.
And that is why i make it a priority in all the work that i do to involve as many young people as i can. I want to give as many of them as much of the experience of participation as i did that i can so that they can grow, flourish even and help pave the way for a better, healthier future for everyone.
The last month or so has been pretty hectic, they were always going to be with the restructure of the NHS and the VIK project at YoungMinds coming to an end after four years.
But in the last few weeks i have managed to get a lot done!
After launching the app first at the Healthcare Innovation Expo and then at City Hall i had a few days to finally relax and then bounced right back into work mode.
Launching the WellHappy app
I attended an iBehave meetup at Google Campus around using tech to increase condom usage in young men. Devika, the winner of the SexFactor2012 awards, came with me and together we worked together with a team of other people from tech, third sector and health backgrounds to come up with solutions. As someone who is much more familiar with the mental health side of the app we developed (plug: download here!) it was good to have an expert and friend with me.
You can watch a short video made about the event here.
I also made a short film for YouthNet and TheSite about mental health and employment. I’ve seen a sneak peek but i’m afraid it has not been released just yet. When it is i will post it so watch this space.
And two last little things i thought i would mention..
Firstly my app was featured in the Guardian today after they interviewed me recently. You can read it here.
Secondly, more for those in London, the WellHappy app will also be featured in the Evening Standard on Thursday so make sure to look out for it!
On March 13th and 14th 2013 members of the myhealthlondon team attended the Healthcare Innovation Expo at the Excel Centre in London. We were there to highlight our website, our dementia community and to launch the WellHappy app for young Londoners.
It was also a great opportunity to find out what else is happening in healthcare at the moment and we met lots of interesting new people including service users, clinicians and commissioners. We also bumped into Lord Victor Abedowale, the Chief Executive of Turning Point and had a chat about WellHappy and how some of Turning Point’s services for young people are included.
One of the main attractions at the Expo was the Appzone which you can see in the pictures below. It was here that the Health Apps Library was launched by the NHS Commissioning Board.
Over the two days of the expo ten brand new, never-before-seen apps were launched including our own.
It was a great opportunity not just in terms of the amazing platform to launch our own app but also to meet other developers, designers and teams involved in app development. We shared a lot of learning on the day and have had lots of interesting conversations since, showing that what happens at Expo doesn’t have to stay there, especially not with the invention of Twitter! It’s great to see so many clinicians embracing social media and using it to help their patients and provide information and insight into the medical world.
You can find out more about the App Zone and Health Apps Library by visiting the site here or by following @healthappslib on Twitter
Kat Cormack, project manager, and Bruce Kynoch, Assistant Stakeholder and Marketing Manager launch the app.
Bruce and I gave a short presentation to the audience in the Appzone to officially launch the WellHappy app. This involved talking about the app, where it came from, whose ideas went into it, who helped us develop it and what it was like working on a project of this kind.
We also gave a quick demonstration to the audience on how to use the app and encouraged people to download it from Google Play or the Apple App Store.
Joining us were colleagues from LivingWell, BrightLemon and Digital White, our design and development companies who have been so integral to the making and launching of the WellHappy app. It was great to have their support on the day and to have them around to answer any technical questions people might have.
People also had a chance to try out the app on tablets at the event and give us feedback right there and then. It was great to see people trying out the app, searching for services near them and then going to download it on their own phones! All the feedback we got was incredibly positive and it was good to hear clinicians say how useful even they would find an app like ours!
It just shows that WellHappy can be used by anyone, you don’t need to be a young person to find the information in it useful and if you work with young people, whether you are a youth worker, doctor, nurse or a teacher in London it is worth a look.
Right, time for a super quick round up of the first fortnight of February because it’s racing ahead and things are at risk of becoming a blur!
The month started off well with an update with our app team at City Hall where we talked over our plans for launching the app and website and the event we are planning.
I then literally ran part of the way to the Right Here Showcase and immediately ran into someone i have known on Twitter for some time for whom i have a great deal of respect; Mark Brown, the editor of One in Four.
I had been desperate to attend the showcase at the incredible Welcome Collection in Euston, not least because Right Here Newham would be there, co- authors of the State of Mind manifesto.
I also got to meet Simon Lawton-Smith, head of policy at the Mental Health Foundation and got to mention my app..a lot!
I had expected to just be a participant but at the last minute ended up speaking with Lucie Russell, Director of Campaigns and Policy at YoungMinds about our exciting new MedFacts project which you can read about here.
We also heard about some great new projects that are also being funded through Innovation Labs including Youth Net’s Madly in Love microsite. I will be facilitating a workshop about this at the The Site’s Leaders workshop in March.
We also heard about my friend Yvonne Collin’s new project from 16-25 which Keep the trust: A sympathetic online support, advice and informal training service that can be used to support adult non-health professionals, who have been identified by young people as influential or important people in their lives.
You can read more about Innovation Labs which is a project from Comic Relief, Nominet Trust and Right Here (Paul Hamlyn Foundation and Mental Health Foundation) here if you are interested.
On Wednesday i actually got to hold a prototype version of the app i am developing in my hands for the first time!
It’s looking really good so far and i can’t wait to share more with you all!
At the end of week one Devika and I were invited to the GLA’s Peer Outreach Team meeting where we got to tell them about the app we are working on. We got an amazing reception and the team were really excited to get involved, especially in our launch event. It was great to be able to bring the project to the team as they were involved in writing the State of Mind manifesto that started all of this. We were able to go to them and give them an answer to one of the manifesto aims, “tell us where we can go when we need help”.
Hello dear readers,
I must firstly apologise from what feels like a very lengthy absence from the blogosphere for me, it was certainly not intentional but as it turned out quite unavoidable.
Those who have been paying attention will know that since August last year i have been working for YoungMinds and NHS London’s My Health London to produce an app and website for young people in the capital.
After a few false starts and issues at the beginning we are now working at full pace and racing towards a release date which has been set as mid-March..not leaving much time to get everything ready for launch.
We have developers, designers and young people working closely together to produce something that we hope will answer point five of the State of Mind manifesto and help young people find help when they need it most.
I will be releasing sneek peaks over the next few months as we get closer to launch so:
1. Watch this space
2. Follow me on Twitter at @KittyCormack
We will also be launching a website next month and i can’t wait for you all to see it.
A few weeks ago i attended two conferences on how young people use the internet and the risks and opportunities involved. Both were fantastic experiences and i not only enjoyed attending the conferences and hearing from young people and practitioners around the country but also presenting to such fantastic audiences.
The first conference, “Munch Poke Ping”, was hosted by Stephen Carrick-Davies and was something i had been looking forward to for a long time given that the subject matter was so intertwined with my own experiences and work. Originally i had asked Stephen, who i met through Katie Bacon of Online Youth Outreach, if i could attend. This led to me not only attending but also presenting at the conference about my own experiences of using the internet as a therapeutic tool, the positive power of peer support and the work i am doing currently with YoungMinds and MyHealthLondon.
The conference was attended by professionals working with children and young people from a variety of perspectives including teachers, support workers, youth workers, psychologists and others and the line up on the stage was just as varied as the audience itself.
Among the line up were speakers from PRUs including pupils, staff and a headteacher as well as Online Youth Outreach, Blackberry and Dr.Richard Graham who works with young people with technology addictions.
Although i am well versed in public speaking this event, for me, was a little daunting as it was my first foray into speaking as a professional and not just a “young person” or “service user” (the labels normally attributed to me). However as soon as i had a microphone in front of me i was fine! (Something that i imagine would shock those who went to school with me where i was known for being quiet and anything but happy about standing up in front of large groups of people).
After a somewhat dark session in the morning looking at grooming i spoke about the positive effect of the internet and how i believe it has helped me and helped me help others over the years. I did this through talking about my own experiences of mental illness and using and running support groups and forums online. I wanted to stress that not everything that happens on the internet is bad or untoward and that actually thousands of young people are helped every day by the peer support they receive online.
I have noticed that professionals, when considering young people and their internet use (especially “vulnerable” young people), find it very hard to see beyond one thing. Risk.
This means that projects are often slowed down or more likely not even considered, I hear a lot of fear and dismissal of service user involvement and participation let alone the concept of peer support within this.
My answer? Yes there are risks involved in going online, and yes some people are more “vulnerable” than others, however there is risk inherent in all areas of life. Risk is a fact of life and people will do “risky” things regardless, you may not be able to stop it but imagine the effect it would have if you could at least help manage and minimise it.
And while bigger organisations are pondering all the worst case scenarios of having even, say, a pre-moderated, closed forum for service users, service users like me have been doing this for a decade now.
And i understand the fear that exists, believe me. I understand the fear of lawsuits and Daily Mail fodder but please bear in mind it can be done, and done well.
It’s not about trying to making risk obsolete, it’s about building resilience, educating young people and providing support; just check out what the Cybermentors do.
There are safeguarding measures that you can put in place, so many i wouldn’t know where to start..and do you know what? A lot of them are common sense! Like not giving out personal details online, just like you shouldn’t give them to a stranger in the street.
I’m sure most young people would tell you too that we don’t want to be wrapped in cotton wool and actually we need to learn by experience.
Personally i doubt exactly where i would be today without the peer support i have and currently still get online, i don’t imagine it would be a good place.
It has been a part of my life for around ten years now including before, during and after more conventional psychological help. Yes the help that i was receiving wasn’t from someone qualified in any paper-based way but i was fully aware of that going in. Not only that but the support was free and, unlike most mental health services, available 24 hours a day, 365 days a year. A stark contrast to most service provision which operate on a strictly 9-5 basis (with a few exceptions of course). No two year waiting lists in sight either..
I don’t blame the services. I understand the pressure they are under, it was pretty bad ten years ago and with the brutal cuts to the NHS things aren’t looking too good here on the ground right now.
Peer support should be encouraged, as a grass roots movement of sorts it already wields immense power and touches and enhances the lives of thousands. Just look at the hit counts on websites that are already doing it. And look at how successful ChildLine and Beat Bullying for great examples of how to reach out online.
It was amazing to be given a platform to speak about something that is so important to me both personally and professionally. It is the reason that with YoungMinds and MyHealthLondon i am developing an app and website to help young people who need support.
I met some incredibly interesting people throughout the day and the conversation continued both at the conference and on twitter (#mpp #munchpokeping).
The day after was a conference run by YoungMinds and ACAMH titled “Young people in the internet wilderness: a ticking time bomb?”, my next post will be coming shortly!
YoungMinds and Myhealthlondon have teamed up to help young people in London. We are doing this by developing an app and website to help young people find help when they need it; whether that be with mental health, sexual health or drugs & alcohol use.
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Yes, i know, i still haven’t had a chance to blog about the two fantastic conferences i attended and presented at last week. It has been a seriously busy time here at MyHealthLondon and i have been (figuratively) snowed under. And of course got very soggy during the heavy rainfalls too.
However Tony Parkin (@tonyparkin) is a much better person than I and has already produced this blog for Agent4Change.
I thought i would mention it as he even wrote about my presentation!
None more so than the session by the impressive Kat Cormack, who told us that at 23 this was her first event not as a ‘young person’ but as a health professional. Kat works for Young Minds, and is currently seconded to the NHS working on an app for young people with a focus on mental and sexual health and well-being. Calmly and quietly, Kat told us of her own history of self-harming, and the failure of many near to her to understand and cope with the challenge that that presented.
Where Kat had found help, and crucially peers that were slow to judge and quick to offer support was online, and she brought home the real positive potential of online communities to help provide the empathy and resilience needed by many vulnerable young people. It is hard to describe the feeling in the room as Kat finished her session without risking either sensationalising or trivialising the experience.
For many this was the affirmatory and positive peak of a day that generally avoided the demonising and critical nature of many such debates. And the session also served to emphasise that 50 per cent of the students currently in PRUs are not there for behavioural reasons, but for medical and, increasingly, mental health issues.Kat’s own blog now offers a lifeline and crucial resource links to young people who may find themselves where she was.
You can read the whole blog here
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DIFFERENT NOT BROKEN
I'm a writer, a mamma, a recovered anorexic, a book-worm, a recovered bulimic, a runner, not in that order. Here id like to talk about that stuff
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