Mar 4 2015

Careless media ‘in recovery’ – reflecting on portrayals of mental health

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by Geoff Ellis

You don’t need to be a regular Sun reader to know that “mad” is tabloid shorthand for “bad”. It is not news to point out that television and films, newspapers and magazines all have a tendency to link mental health issues to violence. All too often, the media blame game implies that someone living with a mental health issue is at fault where someone else, with a broken leg or appendicitis, is not judged in any way responsible for their condition.

The bad news is that sensationalist media portrayals of mental health issues have a big impact, promoting fear and mistrust. But the good news is that reliance on negative stereotypes is in decline. Thanks to energetic campaigning and education, the stigma surrounding mental health is gradually dispersing.

That is the message from a discussion, Perceptions of Madness, on Wednesday 25 February 2015 organised by PSSRU as part of the LSE Literary Festival. Four presentations centred on understanding mental illness through art, literature and drama were followed by a discussion led by a questioning audience.

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Feb 26 2015

Strengthening mental health systems in low and middle income countries

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by Valentina Iemmi

LSE Health and Social Care welcomed Professor Graham Thornicroft for one of its Formal Seminars recently. He gave a splendid overview of the main challenges in global mental health and the mental health system response in low and middle income countries.

© Video by LSE Health and Social Care

What are the challenges?

First, the treatment gap is wide. About 20% of the world population suffers from a mental illness each year. Over two thirds of people with mental illness receive no treatment and the proportion widely differs between high and low income countries. For example, while in the USA and in Europe up to three quarter of people with mental illness receive no treatment, in low income countries the figure raises to over 90%. This difference is not only due to the lack of resources but to their concentration on physical illnesses.

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Dec 17 2014

Eurohealth Volume 20, Issue 4: Migrants and Health

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by Sherry Merkur, Anna Maresso and David McDaid

Our final Eurohealth issue for 2014 throws the spotlight on migrant health and the importance of ensuring that everyone in Europe, irrespective of country of origin and legal status, has proper access to health services and treatment.

In the Eurohealth Observer section, Williams and Noori explore the often higher infectious disease burden in migrant populations in Europe, including for HIV, TB and chronic hepatitis B. Just as importantly, the authors highlight the real difficulties in monitoring and treatment, given the lack of reliable data on migrant-specific variables within current disease surveillance systems. Delving into more detail, Falla et al. identify the public health threat of viral hepatitis in Europe and emphasise the need for effective screening, particularly for vulnerable population groups such as migrants. The authors showcase the new HEPScreen Toolkit that has been developed specifically for the practical implementation of screening protocols.

Focusing on a particular sub-group of migrants, van Ginneken explores the disparate approaches taken by European Union countries on undocumented migrants’ entitlement to health services and the practical barriers that may also impede access to services. The article highlights the many areas that still need to be addressed, including the lack of legal clarity to entitlements, ensuring confidentiality, removing financial and administrative barriers to access and addressing cultural and language barriers in service provision. Taking a health systems perspective, Keith et al detail two different approaches taken by Sweden and Spain in granting access to health services to undocumented migrants and the impacts this can have on health systems, including challenges for data collection, health monitoring and resource allocation.

De Raeve and colleagues address issues of planning and forecasting the future nursing workforce at EU level in the Eurohealth International section. They propose four categories for re-classifying nurses in accordance with the European Federation of Nurses Associations’ nursing care continuum. In a second article, Connolly details the incremental growth of the European Commission’s competence in health security. He discusses how the 2009 influenza pandemic in the United Kingdom led to the establishment of the EU Health Security Committee and further legislative changes.

In the Eurohealth Systems and Policies section, Sobczak and Sagan present changes in the legal structure of Polish public hospitals and how this relates to financial losses and other challenges, such as access to necessary care. Affordability of care in the Dutch health care system is examined by Brabers and de Jong; they find that almost half of all service users believe that the rising costs of health care may prevent them from using care in the future. They also discuss the implications for access of shifting costs to individuals, through, for example, the introduction of out-of-pocket payments. Moving to the Mediterranean, Petrou first considers the weaknesses in Cyprus’s health care sector prior to the financial crisis, then evaluates the bailout agreement measures implemented in terms of efficiency and expenditure. Finally, for England, where reducing avoidable mortality is a health policy priority, Karanikolos and colleagues identify areas where progress is needed and offer recommendations for improvements in prevention, care and outcomes.

Eurohealth Monitor features two new books: one on trends in health systems in twelve former Soviet countries and one on geographic variations in health care in thirteen countries. News covers national, European and international developments in the health sector. We hope you enjoy this issue and we wish you a happy holiday season and a prosperous new year!

Eurohealth 20.4 has just been published by the European Observatory on Health Systems and Policies (in which LSE Health is a partner).

Read the full issue

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Dec 10 2014

Choosing who provides your care is empowering but only if you know how

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by Stephanie Kumpunen, Lisa Trigg and Ricardo Rodrigues

Many governments are going to great lengths to provide better information about the quality of health and social care services. In the US, the Centers for Medicare and Medicaid recently announced a raft of improvements to Nursing Home Compare, probably the most well-established comparison site for long-term care in the world.

In England, the NHS recently announced a number of improvements to its websites and continues to launch new information services to improve transparency and drive up standards. Recent initiatives include the launch of a site to compare diabetes care by Public Health England. And Bruce Keogh, medical director of the NHS, said that surgeons have a “professional and moral responsibility” to collect and report data on death rates for the public and for other clinicians.

Yet, as we show in a new paper, a number of studies demonstrate that public awareness and use of these sites is alarmingly low. Market research from the US suggests that people spend more time researching their choice of refrigerator than they do choosing a doctor or hospital.

Nor are these findings confined to the US or UK experience. Elsewhere in Europe, similar sites are also not regularly used. So what can be learned from past research? Our paper is an attempt to bring the research together to help with the provision of information in the future.

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Nov 28 2014

Encouraging new evidence on supporting dementia carers

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by Martin Knapp

Carers strategyIn October, the Department of Health published the new Carers Strategy, setting out a ‘National Action Plan’ for England to 2016. Four priorities were announced, each of them representing a continuation of previous objectives:

  • better identification and recognition of the caring responsibilities that many individuals carry;
  • realising and releasing the potential of those carers to pursue their education and employment aspirations;
  • personalise support to allow carers to have a family and community life; and
  • support carers to remain mentally and physically well.

New results just published from the START (STrAtegies for RelaTives) study link directly to the fourth of these priorities, and add helpfully to the evidence base. As a member of the research team, it has been a pleasure to find something that ‘works’!

These new findings provide longer-term evidence on a low-cost intervention that helps carers to develop their coping abilities. Carers experience the intervention positively, and it is cost-neutral in that it doesn’t add to the overall cost of dementia care.

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Nov 7 2014

Maternal mental health should be everyone’s business

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by Annette Bauer, Valentina Iemmi, Bayo Adelaja and Martin Knapp

Up to one in five mothers may develop a mental health problem during pregnancy or within a year of giving birth. Perinatal depression, anxiety and psychosis carry a total long-term cost to society of approximately £8.1 billion. This figure is equivalent to about £10,000 for every single birth in the UK. But the estimated cost of better recognition and treatment is only about £400 per average birth. Clinical Commissioning Groups in England should implement a clear strategy for commissioning perinatal mental health services.

Those are the key messages of a report, The Costs of Perinatal Mental Health Problems, of research carried out by PSSRU at the LSE and the Centre for Mental Health. The report was commissioned by the Maternal Mental Health Alliance as part of their Everyone’s Business campaign, with funding from Comic Relief. This is the first time that the longer-term economic consequences of a range of perinatal maternal mental health problems have been studied comprehensively, including the effects on children – viewed through an economic lens.

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Nov 3 2014

The 3rd International Conference on Evidence-based Policy in Long-term Care

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We are living in a time when Long-term Care (LTC) has two major challenges: an ageing world population alongside increasing demands for LTC against decreasing budgets. The 3-day 2014 ILPN conference provided a timely opportunity to host academic and policy debates on these very challenges.

PSSRU colleague and ILPN conference coordinator, Joanna Marczak, provides a brief summary of ILPN’s latest international knowledge exchange conference concerning LTC.

The 3rd International Conference on Evidence-based Policy in Long-term Care (LTC) took place on 31st August to 3rd September 2014 at the London School of Economics and Political Science (LSE), London, bringing together 130 delegates from 20 countries to discuss ongoing research and policy initiatives on issues related to organisation, delivery, funding and regulation of LTC services globally and nationally. The conference is part of the wider International Long Term Care Policy Network (ILPN) initiative launched by Jose-Luis Fernandez in 2010 that provides an interface between researchers, policy makers and other stakeholders to facilitate discussions and exchange of evidence between different stakeholders globally and broaden the pool of evidence on long term care (LTC) policies and practice. Continue reading

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Oct 28 2014

Taking qualitative research to its logical conclusion

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by Ann Richardson, Visiting Fellow, PSSRU

I have been doing qualitative research most of my working life and I enjoy it immensely. There is something very satisfying about capturing people’s views about a topic – often an issue of some importance to them – in their own words. Most of my paid work has focused on experiences of the health service, such as patients’ views about their treatment and care for coronary heart disease, cancer, diabetes and so forth. Some has concerned experiences of social care, such as parents’ views about the appropriate future care of their adult sons or daughters with learning disabilities. Such research may not answer statistical questions, but it gets to the heart of how people feel.

The writing-up of qualitative research traditionally involves some explication of the issues by the researcher and some quotations from those interviewed, to show how they expressed themselves in their own words. Over the years, I became interested in exploring whether one could omit the researcher almost entirely and allow those interviewed to tell their stories – and explain the issues – themselves. Much too often, it was their words which were most alive or moving and the researcher simply paraphrased them for explanation, but without a great gain in understanding. My reports became increasingly quotation-based, with some tentative analysis offered by myself. Whether this was a style that was seen to be better or worse than a more traditional one I never knew.

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Oct 23 2014

The NHS England Five Years Forward View and the missing £30 billion

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by Mireia Jofre-Bonet and Alistair McGuire

The NHS England Five Years Forward View was released on 23/10/2014 and highlights that the current NHS is facing a crisis. There has been a fall in real terms expenditure, as, regardless of what the current government states, the productivity gains that were necessary to maintain NHS expenditure in real terms have not been achieved. The King’s Fund productivity report (2014) indicates that spending on health care went from 5.5% of GDP in the mid 1990s to 8% in 2009 and then stayed around that level. The King’s Fund report adds that it could fall to 6% of GDP by 2021 under a flat cash scenario for the NHS and moderate GDP growth, meaning that the resources for the NHS could be reduced by about 25%.

Recently, any productivity gains that may have been achieved in the NHS have tended to come through wage restraints and volume changes on the input side of the productivity equation. Since productivity is the rate of change in outputs as inputs change; if output grows faster than inputs, productivity increases; if inputs grow slower than outputs, productivity also increases. Currently input growth is behind output increase and that explains any productivity gains. To maintain real health-care expenditure at 2010 levels, the King’s Fund report estimates that productivity gains would have to be around 4% per annum. This has not been achieved. More recently productivity has been running at 2% per annum, but this has probably been driven by people working harder as inputs get cut. Continue reading

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