Today is World Mental Health Awareness day, and, together with several colleagues from the University of Birmingham’s Institute for Mental Health (IMH), I’m over in Boston at the International Early Psychosis Association (IEPA), where the theme of this, their 11th conference is Prevention and Early Intervention: Broadening the Scope. This is a conference that resonates with issues that are crucial to the IMH and youth mental health generally. My way to working in youth mental health was through medical school and psychiatric training. Being the first of the family to go to university, and not really having much of a notion of what doctors did (other than my GP), I didn’t have a clear idea of where I’d end up when starting a medical degree. However, what really excited me as a student were the lecturers on neuroscience and my own reading in philosophy and psychoanalysis, and together, these developed into the beginnings of an idea of being a psychiatrist. As a student at the medical school in Birmingham, we were fortunate to have a period of elective study and during this time I worked in Harare, in Zimbabwe, in both psychiatry and general medicine and then returned to complete my final year of medical school, and a 10-week block of psychiatry. These two experiences showed me something of what psychiatry was like and reassured me that, as a specialty, I enjoyed psychiatry both as theory and as practice. Contrary to what some of my lecturers and clinical tutors told me, psychiatry could help people, patients got better and recovered, the work was interesting, complex and varied, and, unlike some other areas of medicine, the discipline drew on a range of cutting-edge scientific advances, and clinical skills (history-taking, interviewing, and examination) remained paramount. Something from those early weeks also has remained an influence and motivation throughout my career: the experience of sitting with someone who has a complex, delusional system and trying to explore it with them in a sensitive and helpful manner, and to build some kind of alliance – a tricky task where, for them, there is no reason for them to be talking to a doctor, let alone a psychiatrist. After a period of acute medicine and neurology in the Selly Oak and Queen Elizabeth Hospitals, I trained in psychiatry at the Maudsley Hospital, in South London. Here for me was another formative experience – working in inpatient and community psychiatry in Brixton. In parallel to my clinical work, I developed research interests in psychopathology and psychosis, particularly delusions, and the research group of which I was part became interested in an area of practice and service development referred to as ‘early intervention’. What had been clear in the late 1990s and early 2000s was that people with psychosis were waiting many years to get treatment, the care they were getting was often not great (frequently involuntary admission, poor prescribing practices, and lack of use of psychosocial interventions), and services were waiting for people to get very unwell before offering help to them and their families. Early Intervention was an attempt to remedy this by delivering services in a flexible and non-stigmatising manner, with emphases on optimism, recovery, and tolerance of diagnostic ambiguity and comorbidity. Birmingham was central in recognising these problems in the clinical pathways for young people with psychosis, and innovating with services.
Early Intervention has subsequently been rolled out across the UK since the early 2000s and, as well as changing clinical practice and policy, has led to a great field of research, much of which is showcased in the biannual IEPA meeting. In England, psychosis is the first mental disorder to have an access and waiting time target, against which NHS Trusts are measured, and this target includes access to NICE-concordant treatments. However, psychosis is one of many mental health problems that can begin in adolescence and young adulthood. We know that 75% of mental health problems begin before the age of 24, and these include such problems as eating disorders, bipolar, substance misuse, and anxiety. The Institute for Mental Health (IMH) works to improve the outcomes and care for young people with mental health problems. The IMH will do this by working together to understand the causes of poor mental health, prevent mental health problems from developing, and respond to established illness by developing new treatments and services, with several key research themes and practices including: Justice and Inequalities in Youth Mental Health; Resilience and Recovery; Suicide and Self Harm; Early Intervention and Prevention; Co-Production; and Interdisciplinary Methods.
It’s a crucial time for youth mental health – young people are experiencing more mental health problems and are struggling to find the help they need. The University of Birmingham Mental Health Policy Commission has demonstated the current funding and workforce gap that would need to be addressed to meet the needs of young people and has stressed the importance of prevention and addressing adverse experience. Indeed, my own talk at the IEPA in Boston is on the causal relationship between bullying and psychosis, and work on preventing bullying in schools in Birmingham is a key area of research for us and the Birmingham Women’s and Children’s NHS Foundation Trust in the future.
Today is an opportunity to reflect on how far we have come and what still needs to be done. The creation and support for the IMH as a multi-disciplinary institution shows a growing recognition, and willingness for us all to work together, whether a young person with mental health problems, a clinician, an academic, or a policy maker, to tackle mental ill health. We know that there is much to be done, and the size of the problem can sometimes be overwhelming, but with the right approaches, funding, and support it’s something we can tackle.