Growing levels of stress and pressure are affecting our mental health in Doncaster – and doctors are not always the answer.

That was one of the points to emerge from the Doncaster Free Press’ latest round table, on the issue of mental health, which also saw calls for more support in our communities to help people deal with pressures of modern life.

Our panel at the NHS’s Woodfield House, Balby, was John Bottomley, associate medical director, Rotherham Doncaster and South Humber Healthcare Trust; Rupert Suckling, Doncaster director of public health; Annika Leyland, mental health social worker, Doncaster Council; Lee Golze, head of strategic commissioning and transformation, Doncaster Council; Stephen Emmerson, head of strategy and delivery, adult mental health, NHS Doncaster Clinical Commissioning Group; Andrew Goodall, chief operating officer, Healthwatch Doncaster; Melanie Hinchcliffe, GP, Lakeside Practice, Askern; Glyn Butcher, peer ambassador, Doncaster People Focus Group; Wendy Robinson, peer ambassador, Doncaster People Focus Group; Amanda Pratt, peer ambassador, Doncaster People Focus Group. Free Press community engagement editor David Kessen chaired.

What are the biggest problems that we’re seeing in mental health in Doncaster at the present time?

Rupert Suckling: “In many ways Doncaster is no different from the rest of the country, so we know mental health problems are one of the biggest problems. They are more common than cancer, heart disease. One in four people in their lifetime will have a mental health problem, and at any one time one in six people will have a mental health problem and its not going away.

“Studies have shown in the work place almost a third of people are saying they’re more stressed than they were two years ago and almost 50 per cent of people are saying they’re stressed every day. I think there are two main challenges. One is for people with mental illness, the treatment and the management of those people, and that includes access to not only services that identify the issues but support and recover, but more broadly, I'm interested in how we prevent some of the mental health problems arising, and that can include the impact on work and the criminal justice system. That is the broad picture. But clinicians will see different issues on a day-to-day basis.”

Glyn Butcher: “I think there are two main issues that we see every day. Number one is discharge. People are being discharged from wards without a proper care package that is followed up and implemented, where there is a timely response for them to be seen, and a benefits package put into place, rather than people being discharged without benefits or into a house without gas to electric and no food.

“The second thing is CPA, Care Programme Approach, where people are not having a review and because of that their care plan is out of date, because their needs have changed. Because the review has not taken place, things have been missed, causing undue distress for the individual, the carer and the community, causing problems with drugs or anti-social behaviour etcetera.”

Andrew Goodall: “There has been recent work that Doncaster Healthwatch did with other groups in South Yorkshire, where issues people told us were important to them around mental health were the need for more focus and investment in raising awareness and early intervention.

“More needs to be done abut the stigma of mental health and the way people are treated as a result of sharing their diagnosis. Waiting times are too long and need to improve so people can access services. This hasn’t come from just one or two people, these are common themes.”

Stephen Emmerson: I think from an adult perspective I would echo again what’s been said there. The focus splits into three areas, with the early identification and access to support from a range of sources, not just from a medicalised NHS perspective.

“Another would be that emergency care is there and we have strength and resilience to be confident that we can respond, and, echoing what Glyn was just saying, around the depth of support that is available to individuals as well for recovery and wellness, looking at where we actually get that support from, and recognising some of the value across a wide range of community assets and interventions that are not solely based on a medicalised model, and trying to connect all that care together.”

John Bottomley: “That’s definitely the experience in secondary care as a heath trust provider – needs of patients often are not a psychiatric illness that medical treatments can at to, it can be people with difficulty in coping, and the resolution of that isn’t resolved by medical interventions.”

SE: “I think sometimes there is a wider range of issues where the solutions might be much broader in terms of getting fundamentally to the bottom of a crisis. That might not be a medical issue – it might be connecting with support that’s required and understanding that those needs are.”

AG: “If we are saying many of the issues are not clinical and can’t be treated, is there more that can be done to enable more choice and control for people to take control of their own health and wellbeing so they can do things for themselves rather than relying on services, shifting that balance of power to the individual and the community rather than the institution?”

Melanie Hinchcliffe: “From a primary care perspective, I think things have changed over the last few months, with people being able to access services much more quickly, and certainly from care navigation where reception staff can signpost people. We’ve got access to things like Working Win and quicker access to IAPT – Improved Access to Psychological Therapy – that patients don’t necessarily have to wait for a GP appointment for. I think there has been a bit of a change particularly from primary care and access to services that we may be able to get into sooner where people are struggling, but not necessarily with a mental illness.”

GB: “For me, it is more the social stuff that we need to be focusing. In each community, if you had a heart attack, there may be a defibrillator. We need to have human defibrillators round mental health in each community, as a go-to place, as a hub, within each community, where people like Healthwatch, Mind, can congregate, places for people to come to instead of going to GPs where they’re not going to be medically treated.

“What they need is a listening ear, care and compassion, to make a phone call to benefits or housing, where people are trained so when we come to prevention, we are training people up around these sorts of skills, and pass those on through training and workshops, making people more resilient so they don’t turn up at A&E or have problems with debt.”

SE: “It’s that statutory part about keeping people well, and supporting them through a stabilisation process , but also understanding needs and connecting that person to where that support is going to come from. It’s joining that together.”

GB: “They may not be mentally unwell, but I may have no shoes on my feet and be hungry and thirsty. They may just come because they need someone to talk to.”

Annika Leyland: “I think it’s a fantastic concept that you’ve described, and I’d absolutely echo that. I think for me, it’s about really encouraging a social model of mental health and really championing that, looking at connecting people back into their local communities, seeing people as people and the social factors that lead to people being mentally unwell.

“We need to be strengthening that. Community hubs is a fantastic example where people can go and look at everything within their lives and treat people as people. Really in Doncaster what we have is integrated health and social care. The health workers and the mental health social workers are integrated which is fantastic because people give one story and don’t have to repeat that story.

“That’s a real positive that we’ve got in Doncaster – we’ve not seen the divorce from health and social care in terms of mental health social work that other areas have seen.”

GB: “Doncaster are pioneers and we don’t shout about that enough.That’s a massive breakthrough in Doncaster.”

JB: “In terms of people being able to self help and manage things before they escalate, the evidence is that actually that works less well than having someone doing it with them, like a care navigator. When we're looking at commissioning services were you don’t need formal psychological therapy, if you’re having maybe alcohol reduction, giving advice opportunistically or if people are on wards, and advising where people can go, the evidence is that you get very poor outcomes unless you have someone facilitating that with the person.”

SE: “I think that’s where we want to go, with peer support. It’s about being able to have that resource to guide and assist someone through and share some of their experiences as well. It’s what people can bring to the discussion with an individual about where they can find their support,and starting having that conversation.”

RS: “In my annual report last year I said we should strive to become a zero suicide borough and there are things like the zero suicide alliance who have got training and things like that that we can all do. Glyn talked about getting the equivalent of a defibrillator in the community, supporting people and peer mentors. We may need 10 times more than we’ve got. How do we do some of that?”

AG: “Some of that is based on changing culture and the stigma around mental health. There are still a lot of pejorative terms used to describe people who may identify with being mentally unwell or emotionally unstable and people shy away from offering emotional support for fear they may catch something or be associated with that. I agree community can do more and we can do more within our communities but it needs everyone to change their mindset.”

SE: “I think there is a positive move on that. We talk about mental health being more prevalent. But is it because we’re being more open about it and more prepared to talk about it?”

AG: “I know there is a lot of high profile information through social media and the media, and you have footballers sharing their own emotional health and wellbeing. But if you’re walking on the streets and talking to people in pubs is there any recognition of that or is it just on a macro level that looks great.”

RS: “A YouGov survey reported a third of people are worried about raising mental health as an issue at work. I was a meeting with Doncaster Chamber, where businesses were recognising that, but people were saying it still needs to be led from the top, that it is something you can talk about. In terms of symptoms, interestingly, sleep was coming up – if people are not sleeping is that an indicator?”

JB: “I think there have been significant changes and improvements over time in Doncaster. I’m mindful in the Doncaster Dementia Forum there is feedback from Eileen Harrington that having DMBC and RDaSH support for the dementia communities has made a big difference, with patients going into banks and not feeling stressed and flustered – the community is much more sensitive to that, so it is translating into direct changes.

“Secondly, people without dementia have found it helpful so that autistic people and patients with a learning disability have found that because areas are more dementia friendly, there is accessibility for people with other problems.

“Thirdly, this means that we're able to deliver better health care and social care for patients like that. When you look at commissioning for dementia services, we have over 100 per cent of the people you'd expect in Doncaster diagnosed with early onset dementia.

“Unlike anywhere else in Yorkshire and the Humber, we've got patients presenting and saying I think I've got dementia in their 40s and 50s, and I think we've found pretty much what we'd expect in demographics. We have the community engaging with GPs and secondary care providers. This has made a difference.”

Click here to read part two of our three part series. Click here to read part three.