The basis for sustainable development in mental health care

Having come to the end of my two year RCPsych research fellowship in sustainability, it is time to do some reflecting…

I have found that sustainability is one of those words that people tend to slap onto the front of a new idea, service, or project to make it sound credible or perhaps ‘a la mode’. But sustainability is more than just a badge, it requires a broad understanding about the resources we use and impacts that we are having. But, does it have a place when thinking about mental health care?

Well, of course I am going to say, ‘of course it does’ given my role, but I do think the arguments for improving the sustainability of mental health care are compelling….

Financial

• The NHS has run out of money
• Expenditure on locums is vast
• Mental health need is outstripping resources

Environmental

• Climate change has been heralded as the largest threat to human health in the 21^st Century by the WHO and the Lancet Commission this year
• The mental health effects of climate change are significant
• The NHS is the largest contributor of greenhouse gases in the public sector in the UK, larger than a medium sized eastern European country such as Estonia
• Flooding in the UK is becoming a larger problem because of climate change and this has significant mental health effects

Social

• Population mental health needs are changing
• Patient expectations are increasing
• Staff are struggling to cope with service cuts
• Restrictions on and monitoring of health care professionals is growing
• The internet is a game changer and services need to stay in line with how society is changing in this digital age 

For evidence about these points, see the occasional paper; ‘Sustainable Psychiatry’ launched in March earlier this year.

Psychiatrists and all those working in mental health services need to think beyond the patient in front of them, beyond their standard practice and beyond next year to the bigger challenges that are going to affect mental health prevalence  and mental health services this century. Factors such as diminishing financial funds, ever increasing costs of care, unchecked population growth, food and water scarcity, climate change, ongoing wars and globalisation are already having a dramatic affect on mental health services in the UK and these issues will likely grow to dominate later this century.

 There is much we can do in mental health….

1. We need to think more broadly about the resources we have at our disposal. We shouldn’t just think of medications or psychology in our treatment plans but about local community groups, peer support, online education, activities with carers, employment support, volunteering, vocational skills training, adult education, natural settings and third sector organisations.
2. As mental health professionals, we understand denial as a potent defence mechanism and we need to help society engage with the mass denialism that exists with regards climate change.
3. We need to review our practice and reduce waste –as much as 10% of the carbon footprint of the mental health care is due to medications that are not taken.
4. We need to utilise the internet more systematically in service design and think more creatively about how to use it to improve care.
5. We need to be more aware about the importance of engaging with nature and being part of community. These are the natural setting for humans, are intrinsically beneficial to our mental health and need greater focus.

Despite my fellowship coming to an end, important sustainability work continues at RCPsych and across mental health in the UK. A JCP Commissioning guide on Sustainable Mental Health is being launched next month, aimed at getting CCGs and all other mental health commissioners to commission sustainable services. Three new RCPsych sustainability scholars, supervised by the Centre for Sustainable Healthcare, are lined up to start work with CCGs to develop new sustainable models of mental health care. Sustainable changes are happening across mental health, Psych SusNet continues to grow and evidence is emerging about the environmental impacts of mental health care. How could you get involved?