Sonia Sangha's picture

Dear all,

Efforts are being made to produce a list of practical suggestions on Psych Susnet to help encourage members to get involved and start being proactive to help our service be more sustainable. The current draft is shown below.

Please help us to make it useful and easy to read. Your feedback would be greatly appreciated.

Have you undertaken any of the actions? Tell us about it.

Please post your contribution in the Psych Susnet Forum (make sure that you are logged in, and then use the comment box at the bottom of this page) - by Monday 9th March.

Thank you!


Dr. Sonia Sangha (ST4 in General Adult Psychiatry) 





1) Practise evidence based medicine

The evidence-based dose for Flupentixol Decanoate is far less than the average dose being given. Giving this drug at high doses and too frequently incurs economic and environmental costs due to the use of single-use syringes and needles, opening and maintaining clinical facilities and patients and staff needing to travel. Simply by increasing the interval and reducing the dose of this drug being given to patients could save 168kg of carbon a year, equating to a saving of £250 per patient per year. Nationally, if all doctors committed to practising in this way, a saving of £300,000 each year could be made.


2) Consider the patient's preference

Patient preference should always be taken into account. This in itself can reduce resource use.


3) Think about medication alternatives

''Social prescriptions" such as prescribing community group, equine therapy or horticultural therapy group are not often considered. The recent 'EcoMinds' programme has managed to get patients returning to work and re-engaging with the community, following their ecotherapy programme. Moreover, 'using' nature has been proven to help reduce patients' anxiety, depression, aggression (in those with dementia) and even psychotic symptoms. Access to the outdoors has also been shown to reduce admissions and symptoms in young people with ADHD.


4) Encourage people to become healthier

Alcohol-related problems cost the NHS £2.8 billion a year. The bill for obesity-related illness is more than £4 billion a year. Inactivity is estimated to cost the NHS £1.8 billion. Working for the NHS means that we are often very busy and overwhelmed. However, despite us needing to help manage a patient's current problem (whether that be a relapse or a new episode), it is important not to neglect physical health issues, which also have the potential to improve a patient's mental health. For instance, motivating patients to be more physically active can be an effective supplement to treatment in mild and moderate depression and anxiety disorders. Advice and encouragement does not need to take long but can have positive long-lasting results and save the NHS money.


5) Support your colleagues

Making efforts to support our colleagues in what is a very hectic, intense and emotionally taxing environment could potentially help them cope better with work and prevent them becoming unwell, physically and/or mentally. Research has found that healthy employees are three times more productive than unhealthy ones. Overall sickness absence costs the economy £22 billion a year, with mental health and musculoskeletal problems being the major factors.


6) Use technological developments

These have the potential to help engage and empower patients which could lead to less reliance on services and therefore help to create a more sustainable health care system. 'True Colours,' for example, is a service innovation that allows people with mental health problems to regularly monitor their symptoms by means of texting in their symptoms or inputting them straight on to the True Colours website.


7) Consider alternative modes of delivery of psychotherapy

It is known that cognitive behavioural therapy (CBT) in itself is as effective as drugs in the short term for anxiety conditions and depression AND is also more effective in preventing relapse, making it cost-effective. However, the carbon footprint can be considerable (1062kg of carbon) due to factors such as travel and the energy to heat and light the room. Video linked face-to-face CBT or even phone-based CBT or e-CBT all have a much lower carbon footprint (236kg, 235kg and 105kg of carbon respectively).


8) Make efforts to reduce restraint episodes in inpatient care

Evidence suggests that this is associated with fewer injuries to patients and staff and lower staff turnover. An initiate implemented in Mersey Care NHS Trust called 'No Force First,' has improved the social sustainability of the inpatient service through reducing staff sickness and improving morale on the ward.


9) Use alternative ways of managing dementia

The costs of dementia are predicted to increase from around £20 billion to around £35 billion by 2026. Evidence suggests that reducing modifiable risk factors can significantly reduce the risk of vascular dementia, and Alzheimer's type dementia by up to one third! However, when someone already has dementia, supporting and emphasizing behavioural management would be a more sustainable approach. This could be done by bearing in mind the 'dementia friendly communities' which could reduce the burden on healthcare by enabling sufferers to cope with living independently for longer.


10) Use active travel methods to get to work

Cycling enables you to get fit, feel good, save money and carbon on fuel. Some NHS organizations have 'Cycle to Work' schemes. Walking to work is of course even cheaper, if this is a possibility, depending on how far you live from work! We all must highlight to the organizations we work for that sheltered bike racks, showers and changing rooms as well as cycle paths should be available on all sites, to enable this sustainable improvement to have effect.



Joining a sustainability network for mental health professionals is an excellent opportunity to stay informed and up to speed on how to help yourself, your team and your trust to practise in a way that will utilize your resources in the most efficient way possible and in turn help save money (


By Dr Sonia Sangha (CNWL ST4)



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