Unequal Access to Treatment

This year, World Mental Health Day is about mental health in an unequal world. This article reviews some expressions of inequality - especially as they affect access to mental health treatment which can vary a lot.

 

International Equality

I can't write an article about unequal access to treatment within the UK without first reflecting on the inequalities seen across the globe. The Mental Health Atlas produced by the World Health Organisation highlights many disparities. There are many complex reasons for this inequality, including the general economic state of the country/region, whether mental health legislation is in place to bring rights, whether there are enough dedicated psychiatric hospital beds and, sadly, the 'brain drain' of trained staff to other countries where they can earn more. You then add into this recent/current wars that displace people and increase rates of all types of mental illness. Some harsh statistics are:

1. Only 57% of countries have specific mental health legislation, which can mean people are in hospital against their wishes for longer and with less rights. Although 80% of people everywhere stay less than one year.
2. The average number of mental health workers is 9 per 100,000 population, but there is extreme variation (from below 1 in low-income countries to 72 in high-income countries). The number of Psychiatrists ranges from around 12 per 100,000 in high-income countries to 0.1 in low-income countries - approx 120 times more.
3. Mental Health beds per 100,000 also ranges from 7 to 50. The UK average is about 15.

 

Inequality in the UK

Within the UK, a very affluent and well provided for service compared to many parts of the world, there is also significant variation. There are national benchmarking reports that will give you more detail such as those below.

1. NHS Englands Benchmarking data - https://www.nhsbenchmarking.nhs.uk/mental-health-sector
2. More detail for London - http://lmh.nhsbenchmarking.nhs.uk/login
3. NHS Scotland - https://beta.isdscotland.org/find-publications-and-data/conditions-and-diseases/mental-health/

We need to be careful in jumping to conclusions as there may be good explanations for variation. For example, in one area services may be outsourced to a third-sector provider and so not show up on NHS data. But sometimes there are real issues - such as relatively good access to therapists for short term conditions under Improving Access to Psychological Therapies (IAPT) in England, but the relative lack of people to work psychologically with chronicity in community mental health teams.

 

Inequality by Condition

Whilst well-known conditions such as schizophrenia and depression have remained relatively constant over recent years, there are some newer conditions that are being handled very differently. Access to diagnosis and treatment for ADHD and Eating Disorders are two examples. Long COVID is a very new third. It very much depends on where you live and this is because these newly prominent and different NHS trusts are working out how to fund this work in different ways. In other words, most areas see this as important work, but are having to address this creatively from within finite budgets. It's important that people are asking about help for these conditions, but that does not magic a solution - which requires both money and trained staff. Money, interestingly, is the easy bit - there is a national lack of trained and skilled mental health staff. And remember my first point about the UK being pretty well off...

 

Inequality by Medium

Covid threw video and phone into the mix as 'valid' ways to deliver mental health care - for understandable reasons. Though services are now more able to offer face-to-face appointments again, there is an ongoing place for both phone and video. Phone works well for quick catch-ups and reviews. It is easy and people have their phones with them wherever they are. Video is also almost as good as face-to-face and can save loads of commuting time - which can be especially important for people who have weekly sessions for example.

However, we must not let inequality creep in. Not everyone has devices fit for video calls and so must be offered alternatives. Phones are a good way to do a quick and prompt screening or triage appointment but can't become the norm for all delivery. Increasingly, the ability to be 'online' is important for many things, not just health, and so councils are looking at this almost as a human right and working to improve access for all.

 

What the church can do

With all these challenges there is a unique role the Church and faith communities can play. They may not deliver treatments but do offer a range of counselling and pastoral approaches that can give some degree of support while waiting. They can also love, help, and generally walk alongside people in their waiting. The Holy Spirit is the 'alongside presence' and 'counsellor' - here is a very literal application of these names. And of course, we can pray - both for those struggling but also for those finding it hard to access the treatment they need.

Most of all perhaps, as people of God, with a vision for loving and valuing all people, we can hold high standards, and be a voice for those who might otherwise struggle to be heard. Recognising this as more than an opportunity but a responsibility is a vital part of our role in the communities and places we're planted.

It's worth a pause to ponder what that might look like in your community. Are there people you are not reaching as well as you'd like to? May some people find it harder than others to access support or approach the church? Are there some who might not even know you are there? Let's be intentional and proactive in bridging the gaps, and bringing something of the kingdom of God and all the love, peace and equality that brings, to people of all ages and backgrounds.