Tag Archives: crisis

What is being done to tackle the NHS workforce crisis?

Concerns about the health and social care workforce are at an all-time high due, in part, to the impact of austerity, Brexit and the lessons learned from the Mid Staffordshire hospital scandal.

There has been a 96% drop in the number of EU nurses registering to work in the UK. Nursing and Midwifery Council (NMC) figures published in June showed a marked decline from a high of 1,304 in July 2016, to 344 in September, and then just 46 EU nurse registrants in April 2017.

Any indication that the UK is becoming a less attractive place to work is naturally a cause for alarm, especially as social care and health services will continue to depend on workers from outside the UK in the short to medium term. Actions by the government to reassure European Economic Area citizens and by the regulator to improve its processes are welcome, although much still needs to be done.

One example is the Cavendish Coalition, a group of 35 health and social care organisations that came together in the wake of the referendum result to address the workforce implications of Brexit.

A number of organisations are also working together to respond to the concerns of the workforce and to keep more of them working within the NHS and social care. While much attention has focused on the impact of seven years of pay restraint, other areas need to be addressed, including funding of postgraduate education, access to affordable accommodation, the poorer experience of BME colleagues, greater flexibility, and better use of technology.

Retaining talented staff is therefore crucial in the immediate term, but we must look at what we need to do to attract people to the healthcare sector in the longer term. NHS Employers’ own work in this area is stepping up, with a briefing document launched at its annual workforce summit, held in Liverpool in June, covering ways to bring in, and then consequently keep, local talent over the longer term.

There are plenty of instances of good practice from employers taking steps in this area, which we highlight.

South Tees hospitals NHS foundation trust works with Jobcentre Plus to offer a 12-week pre-employment scheme, which provides certain mental health service users with opportunities to get back into work through structured learning and vocational experience.

Meanwhile, Chelsea and Westminster hospital NHS foundation trust and Imperial College London medical school offer a scheme called MedEx summer school, which provides four-day work experience to year 12 students. It’s aimed specifically at students from underprivileged backgrounds who show talent for and interest in medicine.

Public Health England (PHE) uses the Project Search initiative, with a programme supporting young people with learning disabilities or who are on the autistic spectrum through a 10-month rotating work experience scheme, alongside specially tailored coaching and on-the-job training.

NHS Employers itself also has a number of programmes designed to help employers look differently at attracting and retaining a talented and diverse workforce, including practical support and information on apprenticeships, support to engage with young people via its ThinkFuture campaign, and briefings to encourage and support practices such as improving access to employment for people with mental illness.

The greater part of our workforce is sourced from the UK, and there is more we can and will do in that area. We need, however, to combine our focus on increasing domestic efforts with ensuring that the country develops a post-Brexit immigration system that won’t be detrimental to health and care.

There are many challenges facing the NHS, and more broadly, health and social care, regarding the availability of our workforce. We will continue to challenge the government to support better supply and retention, but we must also challenge ourselves to improve access to employment and to retain the people we already have through better quality workplaces and work.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

What is being done to tackle the NHS workforce crisis?

Concerns about the health and social care workforce are at an all-time high due, in part, to the impact of austerity, Brexit and the lessons learned from the Mid Staffordshire hospital scandal.

There has been a 96% drop in the number of EU nurses registering to work in the UK. Nursing and Midwifery Council (NMC) figures published in June showed a marked decline from a high of 1,304 in July 2016, to 344 in September, and then just 46 EU nurse registrants in April 2017.

Any indication that the UK is becoming a less attractive place to work is naturally a cause for alarm, especially as social care and health services will continue to depend on workers from outside the UK in the short to medium term. Actions by the government to reassure European Economic Area citizens and by the regulator to improve its processes are welcome, although much still needs to be done.

One example is the Cavendish Coalition, a group of 35 health and social care organisations that came together in the wake of the referendum result to address the workforce implications of Brexit.

A number of organisations are also working together to respond to the concerns of the workforce and to keep more of them working within the NHS and social care. While much attention has focused on the impact of seven years of pay restraint, other areas need to be addressed, including funding of postgraduate education, access to affordable accommodation, the poorer experience of BME colleagues, greater flexibility, and better use of technology.

Retaining talented staff is therefore crucial in the immediate term, but we must look at what we need to do to attract people to the healthcare sector in the longer term. NHS Employers’ own work in this area is stepping up, with a briefing document launched at its annual workforce summit, held in Liverpool in June, covering ways to bring in, and then consequently keep, local talent over the longer term.

There are plenty of instances of good practice from employers taking steps in this area, which we highlight.

South Tees hospitals NHS foundation trust works with Jobcentre Plus to offer a 12-week pre-employment scheme, which provides certain mental health service users with opportunities to get back into work through structured learning and vocational experience.

Meanwhile, Chelsea and Westminster hospital NHS foundation trust and Imperial College London medical school offer a scheme called MedEx summer school, which provides four-day work experience to year 12 students. It’s aimed specifically at students from underprivileged backgrounds who show talent for and interest in medicine.

Public Health England (PHE) uses the Project Search initiative, with a programme supporting young people with learning disabilities or who are on the autistic spectrum through a 10-month rotating work experience scheme, alongside specially tailored coaching and on-the-job training.

NHS Employers itself also has a number of programmes designed to help employers look differently at attracting and retaining a talented and diverse workforce, including practical support and information on apprenticeships, support to engage with young people via its ThinkFuture campaign, and briefings to encourage and support practices such as improving access to employment for people with mental illness.

The greater part of our workforce is sourced from the UK, and there is more we can and will do in that area. We need, however, to combine our focus on increasing domestic efforts with ensuring that the country develops a post-Brexit immigration system that won’t be detrimental to health and care.

There are many challenges facing the NHS, and more broadly, health and social care, regarding the availability of our workforce. We will continue to challenge the government to support better supply and retention, but we must also challenge ourselves to improve access to employment and to retain the people we already have through better quality workplaces and work.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

What is being done to tackle the NHS workforce crisis?

Concerns about the health and social care workforce are at an all-time high due, in part, to the impact of austerity, Brexit and the lessons learned from the Mid Staffordshire hospital scandal.

There has been a 96% drop in the number of EU nurses registering to work in the UK. Nursing and Midwifery Council (NMC) figures published in June showed a marked decline from a high of 1,304 in July 2016, to 344 in September, and then just 46 EU nurse registrants in April 2017.

Any indication that the UK is becoming a less attractive place to work is naturally a cause for alarm, especially as social care and health services will continue to depend on workers from outside the UK in the short to medium term. Actions by the government to reassure European Economic Area citizens and by the regulator to improve its processes are welcome, although much still needs to be done.

One example is the Cavendish Coalition, a group of 35 health and social care organisations that came together in the wake of the referendum result to address the workforce implications of Brexit.

A number of organisations are also working together to respond to the concerns of the workforce and to keep more of them working within the NHS and social care. While much attention has focused on the impact of seven years of pay restraint, other areas need to be addressed, including funding of postgraduate education, access to affordable accommodation, the poorer experience of BME colleagues, greater flexibility, and better use of technology.

Retaining talented staff is therefore crucial in the immediate term, but we must look at what we need to do to attract people to the healthcare sector in the longer term. NHS Employers’ own work in this area is stepping up, with a briefing document launched at its annual workforce summit, held in Liverpool in June, covering ways to bring in, and then consequently keep, local talent over the longer term.

There are plenty of instances of good practice from employers taking steps in this area, which we highlight.

South Tees hospitals NHS foundation trust works with Jobcentre Plus to offer a 12-week pre-employment scheme, which provides certain mental health service users with opportunities to get back into work through structured learning and vocational experience.

Meanwhile, Chelsea and Westminster hospital NHS foundation trust and Imperial College London medical school offer a scheme called MedEx summer school, which provides four-day work experience to year 12 students. It’s aimed specifically at students from underprivileged backgrounds who show talent for and interest in medicine.

Public Health England (PHE) uses the Project Search initiative, with a programme supporting young people with learning disabilities or who are on the autistic spectrum through a 10-month rotating work experience scheme, alongside specially tailored coaching and on-the-job training.

NHS Employers itself also has a number of programmes designed to help employers look differently at attracting and retaining a talented and diverse workforce, including practical support and information on apprenticeships, support to engage with young people via its ThinkFuture campaign, and briefings to encourage and support practices such as improving access to employment for people with mental illness.

The greater part of our workforce is sourced from the UK, and there is more we can and will do in that area. We need, however, to combine our focus on increasing domestic efforts with ensuring that the country develops a post-Brexit immigration system that won’t be detrimental to health and care.

There are many challenges facing the NHS, and more broadly, health and social care, regarding the availability of our workforce. We will continue to challenge the government to support better supply and retention, but we must also challenge ourselves to improve access to employment and to retain the people we already have through better quality workplaces and work.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

End of Ebola sparks crisis for Sierra Leone’s teen mums

Mamie Gibila travelled across choppy waters for almost four hours last week to reach a hospital. She was midway through labour with twins. The first baby was born at home, but she was unable to deliver the second and urgently needed medical attention.

Gibila lives in the town of Mina in the district of Bonthe, which comprises several islands off Sierra Leone, and the closest hospital is 105 nautical miles away. The journey, she says, was foul. When she arrived, it was too late to save her second baby.

This was her third pregnancy and her new baby boy, not yet named, is her second living child. She says she is 26 years old, but the doctor is sceptical. “From the looks of her she is less than 19 years,” says Dr Samuel Massaquoi, the district medical officer in Bonthe.

The district – where nine doctors serve 200,000 people spread across several islands that are not easily reached – illustrates the extreme challenges facing maternal health in Sierra Leone. The country has one of the world’s highest teenage pregnancy and maternal mortality rates. A third of girls aged 15-19 have children, and less than half (44%) of all births are attended by a nurse or midwife. Poor access to medical facilities and a lack of trained midwives mean that for every 100,000 births, 1,165 mothers die. Half of them are teenagers.

Just over a year since the country was declared free of Ebola, the government has pledged to prioritise fixing the dire state of maternal and sexual health services. One of its aims is to increase the proportion of women using contraceptives, from 23% to 33.7% by 2022.

“The targets are ambitious but they’re only ambitious because of where we are [as a country],” says Dr Kim Eva Dickson, the UN population fund (UNFPA) country representative. “Are they ambitious compared with where the country should be globally? Not really,” she says.

Sierra Leone map

Still, the country faces an uphill battle. When the Ebola epidemic began in 2014, social services collapsed and schools were closed for almost an entire academic year. As health teams focused their efforts on disease control, family planning services ground to a halt. In a year, 18,000 teenage girls became pregnant – a “huge spike”, says Dickson. To make matters worse, global commodity prices plummeted, further battering the country’s fragile economy.

As aid money was redirected towards Ebola, and humanitarian crises elsewhere, funding for family planning fell sharply. Over the past three years, the amount allocated to the UNFPA for family planning in Sierra Leone has fallen by more than half from $ 3,503,000 in 2014 to $ 1,358,260 this year. Last week, at a global family planning summit in London, Melinda Gates, the American philanthropist, said she was “deeply troubled” by Donald Trump’s decision to stop US funding for international family planning.

The US has also cut support for the UNFPA, which faces a $ 700m shortfall until 2020. “For this year we’re OK, but we don’t know where we’ll be in November,” says Dickson, adding that the agency pays for 95% of contraceptives in the country. “We’re looking to the Nordics, Sweden, Norway. We were hoping for the UK but we don’t know – with a change of government, Brexit, it is a big problem.”

Already, important services are being scrapped. Clinics that are unsafe and in need of renovation have been left untouched, while activities aimed at raising awareness and creating a demand for family planning have been slashed. In Bonthe, a boat service that offered family planning stopped running in December 2016. Before, a team used the boat to provide contraceptives to communities on the remote islands, and take people to hospital. Now, family planning services are sparse and it’s even harder for patients to get help.

“In these island communities people don’t come to the hospital until they are deeply sick,” says Amara Lebbie, who is in charge of outreach at Marie Stopes Sierra Leone. The boat, which cost $ 35,000, didn’t just save lives, it built trust. “You cannot provide family planning to people who feel frustrated, people who feel they have lost their mother or daughter because somebody didn’t respond to take them to the hospital,” he says.


In these island communities people don’t come to the hospital until they are deeply sick

Amara Lebbie of Marie Stopes

Building relationships is essential in places where myths about contraception are still common. Mary Magdalene Koroma, 18, who lives on Sherbro island, and who has had a contraceptive implant since she was 16, says few of her peers use family planning. “My friends said that if you start taking the pills you won’t be able to have children even in the future. And they don’t want to be faced with that,” she says.

Koroma’s mother, Alice, encouraged her daughter to use contraception because she wants to ensure that nothing jeopardises her education. Many of Koroma’s friends are now pregnant, which means they are excluded from school until after they have given birth. Even then, many will not have the money to continue studying. Not all parents think like Koroma’s mother. Standing outside a packed community hall in the capital Freetown, where a family planning outreach session is being held, Gladys Goba, programme coordinator at the Planned Parenthood Association, says some young people will use contraception without their parents’ knowledge, especially if they are from very religious families. “Some say I want the captain band [an implant in the arm] because they will not see me taking the pill every day, they will not see me having an injection every three months. It’s easy and the parents don’t see the arms of their child,” she says.

“That’s why the young people are coming [now],” adds Humama Kagbo, mommy queen, a woman leader, in the Dwarzak community. She points to the trickle of young people coming through the door: “They don’t want to get caught.” Earlier in the day it was mostly older people waiting in queues; now teenagers are arriving for contraception and reggae music has started pumping from the hall.

Young volunteers at the PPA are using WhatsApp and Facebook, as well as visits to communities, to spread the word. Health workers are also asking local priests and imams to raise awareness, with mixed results. There are still some taboos, says Goba. “There’s a perception that when a female gives a male a condom she’s a prostitute.” But attitudes are changing. When the outreach visits first started three years ago, some women would hide visits from their husbands – now men are more involved.

Medical and family planning staff used to visit the islands by boat but the service has been withdrawn.


Medical and family planning staff used to visit the islands by boat but the service has been withdrawn. Photograph: Michael Duff/Marie Stopes

The Rev Songaye George-Buanne, director of Fambul Initiative Network for Equality, which campaigns for women’s rights by educating boys and husbands, says more projects should reach out to men. He started running husband schools and boys’ clubs in 2011 after witnessing men’s frustration that, during the advocacy work after the civil war, men were often left out.

“The whole human rights thing just focused on women and that sprang up some antagonism in men. [There was a feeling that] all the advocacy here is for women, what about us? Have men not been violated as well?”

Trying to tackle domestic violence without targeting men, or trying to improve women’s access to healthcare, without educating the man who is head of the household, did not make sense. “Traditionally the men make a decision as to whether the woman gets health services, where she gets health services, the quality of health services she gets access to,” says George-Buanne.

Men’s sexual health needs must also be addressed, he says. Since 2010, pregnant women, new mothers and children under five have been entitled to free healthcare, but there is not much point giving a woman free treatment for sexually transmitted infections if her husband is not getting the same attention.

Campaigners say free healthcare for new mothers has been a step forward, but services are often hampered by stock shortages or an acute lack of trained health workers, especially in rural areas. In Bonthe, which lacks basic facilities such as a bank, some outreach staff leave after a few months, says Lebbie.

The UNFPA is constantly weighing up whether to spend more on funding free treatments or whether to invest in raising awareness. “If you really want to reach people [in remote communities] then you have to go out to them,” says Dickson. “It’s only when people begin to see the benefits for themselves that they will make the effort.”

So far, it is the latter that’s been hardest hit, especially in areas such as Bonthe. In the hospital there, Gibila and her son are the only patients lying in the ward. “After [Gibila] is stabilised we’d be very much pleased to offer her family planning services,” says Massaquoi. He hopes that, if she receives pills or an implant, he won’t see her in his maternity ward again in the near future. But there are many others in her home town of Mina that his team cannot reach.

‘Every crisis has a silver lining’: why Big Sur’s isolation is making people fitter

A community on the stretch of coastal California known as Big Sur has been largely cut off from the outside world since winter storms collapsed a bridge to the north and triggered landslides to the south, blocking the sole road.

For residents who remain, the only way in and out – bar helicopter – is on foot, via a steep, rugged hiking trail carved out of forested slopes. From dawn till dusk they use it get to and from school, work, grocery stores and other amenities.

Six months of huffing and puffing later the Big Sur health center has noticed something: all the exercise is making people healthier.

“Every crisis has a silver lining,” said Sharen Carey, the executive director. “People have lost weight. They’re improving their cardiovascular system. They’re sleeping better.”

One patient who had diabetes, and declined medication, is all but cured, she said. “He was required to walk the trail five days a week. Since February he has lost 24lb. His numbers went from diabetic to pre-diabetic. His blood pressure is normal. On paper he’s just about normal.”

Another patient with diabetes, and one with pre-diabetes, also showed marked improvement, said Carey. Many other patients reported simply feeling better and more energised.

“They’re getting outdoors and working. The ones who have lost weight have reported that they’re more energetic. Sleep, blood pressure, heart rate, they all benefit.”

The trail was a mile and a half – a three-mile round trip. That comprised about 4,000 steps which burned approximately 200 to 300 calories, said Carey, citing her Fitbit. “It doesn’t sound like much but it’s not just about burning calories, it’s getting your heart rate working.”

A new trail giving foot access to a cut-off part of Big Sur.


A new trail giving foot access to a cut-off part of Big Sur. Photograph: Rory Carroll for the Guardian

Residents interviewed on the trail agreed. John and Frances Hoeffel, retired lab technicians in their 70s, said they enjoyed the hike. They were returning from the library.

John and Frances Hoeffel returning home from a library visit.


John and Frances Hoeffel returning home from a library visit. Photograph: Rory Carroll

Others reported an additional benefit: commuting on foot via a narrow, winding trail rather than driving on the Pacific Coastal Highway has bolstered their sense of community.

“It’s been a leveller,” said Erin Gafill, whose family owns the Nepenthe restaurant. “We all have to walk that trail together. You get a sense of each other’s routines. We’re not as separated.” Long-term residents had newfound respect for how hard Latinos – who juggle multiple jobs – work, she said.

Erin Gafill at the Nepenthe restaurant.


Erin Gafill at the Nepenthe restaurant. Photograph: Rory Carroll

Her mother, Holly Gafill, agreed. “That trail is so intimate. You’re almost touching people if not hugging them because you haven’t seen them in ages. I look at the trail with so much gratitude.”

Few saw a bright side when torrential storms buried the highway in massive mudslides and washed away the Pfeiffer Canyon bridge, cutting off segments totalling 35 miles along Big Sur, a scenic coastal ribbon between San Francisco and Los Angeles which draws 3 million tourists a year.

The isolation has devastated hotels, restaurants and resorts, inflicting job losses and hardship.

Not all residents enjoy hiking the trail which emergency crews carved out of the hillsides in February.

“I find it pretty arduous, but then I’m overweight and I smoke cigarettes,” said Bill Crain, 56. “I paid a guy $ 50 to bring my cats back from the vet.”

Bill Crain hikes the trail about once a week.


Bill Crain hikes the trail about once a week. Photograph: Rory Carroll

Other neighbours grumbled too, he said, despite the benefit: “They may not like it but it’s good for them.”

Cubans experienced a similar phenomenon but on much more dramatic, painful scale in the 1990s when the economy collapsed, slashing food and gasoline consumption.

A new bridge is expected to open in September, restoring the tourist flow and letting residents once again drive to schools and amenities.

Yet the unexpected positive side effects of isolation have made some almost wistful about the experience. “I’ll be sort of sorry to see the bridge go back up,” said Carey. “We’re all hiking that trail all the time, but next year how many will still do it?”

Gafill, the restaurant owner, said the stillness and quiet harked back to the area’s bohemian 1950s era. “There will be a sense of loss when we go back (to normal) because we’ve gained so much – a return to a time when you had time.”

‘Every crisis has a silver lining’: why Big Sur’s isolation is making people fitter

A community on the stretch of coastal California known as Big Sur has been largely cut off from the outside world since winter storms collapsed a bridge to the north and triggered landslides to the south, blocking the sole road.

For residents who remain, the only way in and out – bar helicopter – is on foot, via a steep, rugged hiking trail carved out of forested slopes. From dawn till dusk they use it get to and from school, work, grocery stores and other amenities.

Six months of huffing and puffing later the Big Sur health center has noticed something: all the exercise is making people healthier.

“Every crisis has a silver lining,” said Sharen Carey, the executive director. “People have lost weight. They’re improving their cardiovascular system. They’re sleeping better.”

One patient who had diabetes, and declined medication, is all but cured, she said. “He was required to walk the trail five days a week. Since February he has lost 24lbs. His numbers went from diabetic to pre-diabetic. His blood pressure is normal. On paper he’s just about normal.”

Another patient with diabetes, and one with pre-diabetes, also showed marked improvement, said Carey. Many other patients reported simply feeling better and more energised.

“They’re getting outdoors and working. The ones who have lost weight have reported that they’re more energetic. Sleep, blood pressure, heart rate, they all benefit.”

The trail was a mile and a half – a three-mile round trip. That comprised about 4,000 steps which burned approximately 200 to 300 calories, said Carey, citing her Fitbit. “It doesn’t sound like much but it’s not just about burning calories, it’s getting your heart rate working.”

A new trail giving foot access to a cut-off part of Big Sur.


A new trail giving foot access to a cut-off part of Big Sur. Photograph: Rory Carroll for the Guardian

Residents interviewed on the trail agreed. John and Frances Hoeffel, retired lab technicians in their 70s, said they enjoyed the hike. They were returning from the library.

John and Frances Hoeffel returning home from a library visit.


John and Frances Hoeffel returning home from a library visit. Photograph: Rory Carroll

Others reported an additional benefit: commuting on foot via a narrow, winding trail rather than driving on the Pacific Coastal Highway has bolstered their sense of community.

“It’s been a leveller,” said Erin Gafill, whose family owns the Nepenthe restaurant. “We all have to walk that trail together. You get a sense of each other’s routines. We’re not as separated.” Long-term residents had newfound respect for how hard Latinos – who juggle multiple jobs – work, she said.

Erin Gafill at the Nepenthe restaurant.


Erin Gafill at the Nepenthe restaurant. Photograph: Rory Carroll

Her mother, Holly Gafill, agreed. “That trail is so intimate. You’re almost touching people if not hugging them because you haven’t seen them in ages. I look at the trail with so much gratitude.”

Few saw a bright side when torrential storms buried the highway in massive mudslides and washed away the Pfeiffer Canyon bridge, cutting off segments totalling 35 miles along Big Sur, a scenic coastal ribbon between San Francisco and Los Angeles which draws 3 million tourists a year.

The isolation has devastated hotels, restaurants and resorts, inflicting job losses and hardship.

Not all residents enjoy hiking the trail which emergency crews carved out of the hillsides in February.

“I find it pretty arduous, but then I’m overweight and I smoke cigarettes,” said Bill Crain, 56. “I paid a guy $ 50 to bring my cats back from the vet.”

Bill Crain hikes the trail about once a week.


Bill Crain hikes the trail about once a week. Photograph: Rory Carroll

Other neighbours grumbled too, he said, despite the benefit. “They may not like it but it’s good for them.”

Cubans experienced a similar phenomenon but on much more dramatic, painful scale in the 1990s when the economy collapsed, slashing food and gasoline consumption.

A new bridge is expected to open in September, restoring the tourist flow and letting residents once again drive to schools and amenities.

Yet the unexpected positive side-effects of isolation has made some almost wistful about the experience. “I’ll be sort of sorry to see the bridge go back up,” said Carey. “We’re all hiking that trail all the time but next year how many will still do it?”

Gafill, the restaurant owner, said the stillness and quiet harked back to the area’s bohemian 1950s era. “There will be a sense of loss when we go back (to normal) because we’ve gained so much – a return to a time when you had time.”

The Observer view on a crisis in mental health | Observer editorial

Anxiety can be good for you. It is part of the “fight or flight” reflex triggered in the presence of danger. The amygdala, the brain’s alarm system, is responsible for generating negative emotions. To prevent them flooding the brain, this part of the iambic system must be quiet. Working hard on non-emotional mental tasks inhibits the amygdala which is why keeping busy is often said to be one source of happiness. Keeping busy is not what the anxious and depressed can do – and so a cycle of misery is locked into place.

In England, new figures released last week revealed that misery appears to be escalating at an alarming scale. Prescriptions for 64.7 million items of antidepressants – an all-time high – were dispensed in 2016, the most recent annual data from NHS Digital showed. This is a staggering 108.5% increase on the 31 million antidepressants dispensed 10 years earlier.

Is the scale of the rise a welcome sign of progress, more people coming forward for help? Or does it also flag up a rising tide of insecurity and distress, beginning in the very young, that requires a more profound change in society as a whole than individual GPs repeatedly reaching for the prescription pad?


While the young have never been better behaved, drinking and smoking less, their levels of anxiety and depression are rising

Helen Stokes-Lampard, chair of the Royal College of GPs, said: “The rise could be indicative of better identification and diagnosis of mental health conditions across healthcare and reducing stigma … Nevertheless, no doctor wants their patient to be reliant on medication and where possible we will always explore alternative treatments, such as talking therapies.”

She also pointed out that talking therapies are in desperately short supply. She urged NHS England to meet its commitment to have 3,000 new mental health therapists based in GP surgeries. Kate Lovett, dean of the Royal College of Psychiatrists, said talking therapies have their place but “for people who have recurrent episodes of depression, longer use of antidepressants reduces incidence of relapse”. The theory that more people may be coming forward for help is positive news – but, for many, that is still not early enough. One study followed a large cohort of children through to adulthood and found that half of the adults who had a psychiatric disorder at 26 first had problems before the age of 15. While the young have never been better behaved, drinking and smoking less, their levels of anxiety and depression are rising and the chances of even the most chronic cases receiving adequate help are still shamefully slim.

In My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind, published three years ago, Scott Stossel explains how as a child he had separation anxiety then he developed phobias about flying, fainting, speaking in public, closed places, germs, vomiting and cheese. Antidepressants and therapy have not provided relief. “To grapple with understanding anxiety,” he writes, “is in some sense to grapple with and understand the human condition.”

The human condition today is ever more complex in an era of the internet, social media and the focus on status, appearance and material success. However, more is required as an antidote than early intervention, self-help and medication alone. As Richard Layard rightly argues in Happiness: Lessons from a New Science, a boost to serotonin and dopamine, both associated with mental wellbeing, is also provided by public policy that is judged on how it increases human happiness and reduces misery.

What might that mean in practice? A real living wage, a living rent related to local income levels, an end to the gig economy, affordable housing, investment in training and skills, an end to the freeze in benefits, proper pay for public sector workers and an increase in spending on the NHS. According to the Nuffield Trust last week, the NHS in England is currently receiving an annual increase of less than 1% compared with 4% over its history. Children born today, according to the Office for National Statistics, are likely to spend at least 20% of their lives in poorer health, a disgrace in a rich country such as this.

The World Health Organisation defines mental health as “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her own community”. It is also a definition of the common good that is the kind of medicine we all need.

The Observer view on a crisis in mental health | Observer editorial

Anxiety can be good for you. It is part of the “fight or flight” reflex triggered in the presence of danger. The amygdala, the brain’s alarm system, is responsible for generating negative emotions. To prevent them flooding the brain, this part of the iambic system must be quiet. Working hard on non-emotional mental tasks inhibits the amygdala which is why keeping busy is often said to be one source of happiness. Keeping busy is not what the anxious and depressed can do – and so a cycle of misery is locked into place.

In England, new figures released last week revealed that misery appears to be escalating at an alarming scale. Prescriptions for 64.7 million items of antidepressants – an all-time high – were dispensed in 2016, the most recent annual data from NHS Digital showed. This is a staggering 108.5% increase on the 31 million antidepressants dispensed 10 years earlier.

Is the scale of the rise a welcome sign of progress, more people coming forward for help? Or does it also flag up a rising tide of insecurity and distress, beginning in the very young, that requires a more profound change in society as a whole than individual GPs repeatedly reaching for the prescription pad?


While the young have never been better behaved, drinking and smoking less, their levels of anxiety and depression are rising

Helen Stokes-Lampard, chair of the Royal College of GPs, said: “The rise could be indicative of better identification and diagnosis of mental health conditions across healthcare and reducing stigma … Nevertheless, no doctor wants their patient to be reliant on medication and where possible we will always explore alternative treatments, such as talking therapies.”

She also pointed out that talking therapies are in desperately short supply. She urged NHS England to meet its commitment to have 3,000 new mental health therapists based in GP surgeries. Kate Lovett, dean of the Royal College of Psychiatrists, said talking therapies have their place but “for people who have recurrent episodes of depression, longer use of antidepressants reduces incidence of relapse”. The theory that more people may be coming forward for help is positive news – but, for many, that is still not early enough. One study followed a large cohort of children through to adulthood and found that half of the adults who had a psychiatric disorder at 26 first had problems before the age of 15. While the young have never been better behaved, drinking and smoking less, their levels of anxiety and depression are rising and the chances of even the most chronic cases receiving adequate help are still shamefully slim.

In My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind, published three years ago, Scott Stossel explains how as a child he had separation anxiety then he developed phobias about flying, fainting, speaking in public, closed places, germs, vomiting and cheese. Antidepressants and therapy have not provided relief. “To grapple with understanding anxiety,” he writes, “is in some sense to grapple with and understand the human condition.”

The human condition today is ever more complex in an era of the internet, social media and the focus on status, appearance and material success. However, more is required as an antidote than early intervention, self-help and medication alone. As Richard Layard rightly argues in Happiness: Lessons from a New Science, a boost to serotonin and dopamine, both associated with mental wellbeing, is also provided by public policy that is judged on how it increases human happiness and reduces misery.

What might that mean in practice? A real living wage, a living rent related to local income levels, an end to the gig economy, affordable housing, investment in training and skills, an end to the freeze in benefits, proper pay for public sector workers and an increase in spending on the NHS. According to the Nuffield Trust last week, the NHS in England is currently receiving an annual increase of less than 1% compared with 4% over its history. Children born today, according to the Office for National Statistics, are likely to spend at least 20% of their lives in poorer health, a disgrace in a rich country such as this.

The World Health Organisation defines mental health as “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her own community”. It is also a definition of the common good that is the kind of medicine we all need.

The Observer view on a crisis in mental health | Observer editorial

Anxiety can be good for you. It is part of the “fight or flight” reflex triggered in the presence of danger. The amygdala, the brain’s alarm system, is responsible for generating negative emotions. To prevent them flooding the brain, this part of the iambic system must be quiet. Working hard on non-emotional mental tasks inhibits the amygdala which is why keeping busy is often said to be one source of happiness. Keeping busy is not what the anxious and depressed can do – and so a cycle of misery is locked into place.

In England, new figures released last week revealed that misery appears to be escalating at an alarming scale. Prescriptions for 64.7 million items of antidepressants – an all-time high – were dispensed in 2016, the most recent annual data from NHS Digital showed. This is a staggering 108.5% increase on the 31 million antidepressants dispensed 10 years earlier.

Is the scale of the rise a welcome sign of progress, more people coming forward for help? Or does it also flag up a rising tide of insecurity and distress, beginning in the very young, that requires a more profound change in society as a whole than individual GPs repeatedly reaching for the prescription pad?


While the young have never been better behaved, drinking and smoking less, their levels of anxiety and depression are rising

Helen Stokes-Lampard, chair of the Royal College of GPs, said: “The rise could be indicative of better identification and diagnosis of mental health conditions across healthcare and reducing stigma … Nevertheless, no doctor wants their patient to be reliant on medication and where possible we will always explore alternative treatments, such as talking therapies.”

She also pointed out that talking therapies are in desperately short supply. She urged NHS England to meet its commitment to have 3,000 new mental health therapists based in GP surgeries. Kate Lovett, dean of the Royal College of Psychiatrists, said talking therapies have their place but “for people who have recurrent episodes of depression, longer use of antidepressants reduces incidence of relapse”. The theory that more people may be coming forward for help is positive news – but, for many, that is still not early enough. One study followed a large cohort of children through to adulthood and found that half of the adults who had a psychiatric disorder at 26 first had problems before the age of 15. While the young have never been better behaved, drinking and smoking less, their levels of anxiety and depression are rising and the chances of even the most chronic cases receiving adequate help are still shamefully slim.

In My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind, published three years ago, Scott Stossel explains how as a child he had separation anxiety then he developed phobias about flying, fainting, speaking in public, closed places, germs, vomiting and cheese. Antidepressants and therapy have not provided relief. “To grapple with understanding anxiety,” he writes, “is in some sense to grapple with and understand the human condition.”

The human condition today is ever more complex in an era of the internet, social media and the focus on status, appearance and material success. However, more is required as an antidote than early intervention, self-help and medication alone. As Richard Layard rightly argues in Happiness: Lessons from a New Science, a boost to serotonin and dopamine, both associated with mental wellbeing, is also provided by public policy that is judged on how it increases human happiness and reduces misery.

What might that mean in practice? A real living wage, a living rent related to local income levels, an end to the gig economy, affordable housing, investment in training and skills, an end to the freeze in benefits, proper pay for public sector workers and an increase in spending on the NHS. According to the Nuffield Trust last week, the NHS in England is currently receiving an annual increase of less than 1% compared with 4% over its history. Children born today, according to the Office for National Statistics, are likely to spend at least 20% of their lives in poorer health, a disgrace in a rich country such as this.

The World Health Organisation defines mental health as “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her own community”. It is also a definition of the common good that is the kind of medicine we all need.

Blame the nasty party for our nursing crisis | Letters

We know the NHS is under exceptional pressure. Applications to study nursing have slumped by 23% for 2017/18 (Would-be nurses abandon their dream as promise of degree training is broken, 27 June). The number of EU nurses registering to practise in the UK has fallen by 96% in less than a year. Can any reasonable person doubt that this government and its Tory predecessors are deliberately starving the service of essential funds in order to open up opportunities for profit for its wealthy cronies?
Linda Rhead
London

Why not sail HMS Queen Elizabeth (UK’s new aircraft carrier, 27 June) to the Port of London, where it could accommodate and feed people decanted from tower blocks? This might be a better use of taxpayers’ money than planning to bomb foreigners in five years’ time.
Aidan Turner-Bishop
Preston

As a young Catholic choirboy, I never thought in my old age I would thank a group of Orange Order persons for saving my triple-lock pension, and winter fuel allowance (May hands £1bn bonanza to DUP to cling on at No 10, 27 June). You could not make it up.
Jim McLoughlin
Liverpool

My daughter’s horse Oliver has a swift’s nest in his stable (Packed to the rafters, 28 June). He is not interested.
Joyce Blackledge
Formby, Merseyside

Re Rhiannon Lucy Cosslett’s article (How sad it is that English-speaking parents fear their children being taught in Welsh, 27 June): Diolch.
Robin Llywelyn
Minffordd, Gwynedd

Could we have Rhiannon Lucy Cosslett’s views on Rafael Behr’s use of the word “welch” (Opinion, 28 June)?
Viv Davies
Pen-y-cae, Powys

We live in Wales and our cat is bilingual: she ignores us in both languages.
Siobhan Tobin
Cardiff

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