Tag Archives: need

We need to open up about mental health in the workplace | Sue Baker

Looking after the wellbeing of employees benefits everyone – no matter your role, seniority, and whether you have a mental health problem, or not.

Working with employers over the past six years means we have a good indication of what works to ensure a mentally healthy workplace. Those elements are incorporated into the Time to Change employer pledge, which gives organisations the opportunity to demonstrate their commitment to opening up the conversation about mental health. More than 500 organisations have made that commitment.

There are multiple things employers can do to create a more open working environment. Senior leaders have a pivotal role to play in leading by example – being open about their own mental health experiences sends the strong message that this isn’t a sign of weakness and doesn’t limit your ambition or aspiration. Employees at all levels talking honestly and openly about their experiences has contributed hugely to a cultural shift in how we think about the topic.

When employees feel their work is meaningful and they are valued and supported, they tend to have higher wellbeing levels. We often talk about a three-pronged approach that employers can adopt: promoting wellbeing for all staff; tackling the causes of work-related mental health problems; and supporting staff who are experiencing mental health problems.

We’ve made a conscious effort in recent years to target male-dominated workplaces, such as construction. Our research shows that men still don’t consider mental health relevant to them. Men try to be self-sufficient, keeping problems to themselves. But mental health problems don’t discriminate – they can affect anyone.

Many of the biggest UK construction firms have signed our pledge, and they tell us that for them it has been crucial to have people “on the ground” in the form of employee champions who challenge workplace stigma, normalise conversations about mental health and encourage those who need help to feel comfortable asking for it.

With the right support from those around them, people with mental health problems can recover and have equal opportunities in all areas of life – including work.

Sue Baker is director of Time to Change, the anti-stigma Movement run by charities Mind and Rethink Mental Illness.

Children need to be in the right mental state to learn effectively | Tony Draper

There is a crisis in mental health for young people. Services are operating in silos and they are not working for over-tested, overstressed young people. Much emphasis has been placed on teenagers with low self-esteem, with behavioural and emotional issues and how we can support them.

At Water Hall primary school in Milton Keynes, we believe in the need to identify and address these issues early to be able to implement intervention strategies as soon as possible.

Taking action early enables vulnerable children to rebuild their self-esteem and take responsibility for their emotions, behaviour and learning. The outcome will be that they re-engage with education, perform well and are confident and happy young people.

Water Hall primary serves the Lakes Estate in Bletchley, a disadvantaged area where external issues regularly affect children’s mental and emotional wellbeing. The school has used the Kaleidoscope programme for eight years. The support system enables children to forget the things worrying them at home or elsewhere when they are in school.

Seven different stages make up a Kaleidoscope session: relax, visualise, express, move, build, explore and affirm. A designated room is used for sessions for either small groups or one-to-one sessions. Interventions last six to eight weeks.

The programme is used in all classes every day. Each morning starts with a session enabling children to be in the right frame of mind to learn. Lights are low, relaxing music is played and children are taught various calming techniques that they can use anywhere.

Kaleidoscope has had an amazing impact on the children’s emotional and mental wellbeing and their learning. Exclusions have fallen, attendance and behaviour has improved, children have taken responsibility for their learning and results have shot up. Kaleidoscope works, it gives children the tools to enable them to raise their self-esteem, with the accompanying improved outcomes for the school.

Our work proves that unless the child is in the right place emotionally and mentally, learning will not take place, however good the teaching and leadership in the school.

Tony Draper is headteacher of Water Hall primary, chief executive officer of Lakes Academies Trust, and the immediate past president of the school leaders’ union, the National Association of Head Teachers.

Patients need motivation to recover. The NHS must offer hope | Kate Allatt

Our NHS is under attack from all angles. People are living longer, we don’t eat well or exercise enough. Yet we expect more from the NHS; more people are visiting A&E departments and minor injury units year on year, and costs are rising.

How do we tackle this? What if we focus on marginal gains, the performance strategy that helped British Cycling to success in multiple Olympics?

This is an approach that focuses on “small incremental improvements in any process adding up to a significant improvement when they are all added together”. Could this improve patient outcomes and reduce waste in the health service?

One incremental enhancement we could seek in the NHS might be to improve our understanding of and response to the barriers to patient motivation. For example, could we find a way of encouraging stroke survivors to practise their rehabilitation exercises as frequently and intensively as they are prescribed? Patient adherence to rehabilitation regimes after discharge from hospital is described as “less than ideal”. By addressing these barriers, we will be more able to efficiently allocate therapy time, and thereby reduce GP appointments and hospital readmissions.

You might wonder what makes me an expert on this.


L​owering ​​patients’ expectations of ​recovery​ can be extremely damaging

In February 2010, at the age of 39, I had a huge brainstem stroke and was diagnosed with locked in syndrome. I was on life support and in intensive care for nine weeks, and was then written-off in rehabilitation after a further six weeks. My husband received a phone call telling him that I would never walk or talk again.

Over eight painstaking months in rehabilitation, I obsessively willed my body back to life, practising actions or movements 450 times per week. Slowly I learned how to do basic things like eat again, and at the end of it all I walked out of hospital. I went for a run on the first anniversary of my stroke. I’m now a motivational speaker and go to the gym every day.

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I never gave up pushing my body to improve: to speak, to eat, to run and to hug my kids. I managed to use my bad prognosis to galvanise my recovery, but the risk is that lowering patients’ expectations of recovery can be extremely damaging. Recovery should be measured in terms of improvements, not “getting better” – and that is always possible. My only focus, with three young children at home, was on when I would achieve my goals, not if.

Since embarking on my career in advocacy and stroke activism, I’ve found many reasons why patients lack the motivation to try to help themselves. They may be suffering from post traumatic stress disorder, which is common after a stroke and, just like depression, it affects mood and motivation levels. The side effects of the drug treatments for strokes – sleeping pills and muscle relaxants – can also affect motivation. After a brain injury many patients suffer varying levels of executive dysfunction affecting the set of mental skills that help to get things done, which can be mistaken for apathy or laziness. The overwhelming tiredness felt by those suffering from neurological fatigue can leave patients unable to complete normal daily tasks and therefore non-compliant with their treatment plans. It may be that some patients simply hate exercising or have no family support.

It is futile prescribing a stroke rehabilitation plan if – for any of these reasons – the patient is unmotivated before the therapy session starts or they are left at home trying to manage their own condition. The NHS should be offering hope and encouragement to motivate patients. And to do that, they need to listen to expert patients.

My advice to the King’s Fund Leadership Summit is that we need a better understanding of patient motivation to help rebuild the lives of stroke survivors. If patients adhere to clinical advice about practising their exercises as frequently and intensively as I did, just imagine how much we could improve their outcomes and reduce the waste in the NHS. But to do this we must understand the complex reasons why patients don’t do this already and listen to those who have struggled through similar experiences.

I don’t promise anything when I speak to people now – I just offer possibilities. I talk about how to optimise improvement, but never use the word recovery. After a life-changing event none of us will ever be the same as we were, even if we physically improve really well. We need to embrace that new self and strive to be the best version of ourselves that we can be, both in hospital and back home.

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.

Fashion models in France need doctor’s note before taking to catwalk

Fashion models in France will need to provide medical certificates proving they are healthy in order to work, after a new law was introduced banning those considered to be excessively thin.

A further measure, to come into force on 1 October, will require magazines, adverts and websites to mark images in which a model’s appearance has been manipulated with the words photographie retouchée (retouched photograph).

Doctors are urged to pay special attention to the model’s body mass index (BMI), a calculation taking into account age, height and weight. However, unlike similar legislation passed in Italy and Spain, models will not have to reach a minimum BMI.

Under World Health Organisation guidelines an adult with a BMI below 18.5 is considered underweight, 18 malnourished, and 17 severely malnourished. The average model measuring 1.75m (5ft 9in) and weighing 50kg (7st 12lb) has a BMI of 16.

Announcing the introduction of the new rules on Friday, France’s health minister said they were aimed at preventing anorexia by stopping the promotion of inaccessible ideals of beauty.

“Exposing young people to normative and unrealistic images of bodies leads to a sense of self-depreciation and poor self-esteem that can impact health-related behaviour,” the health and social affairs minister, Marisol Touraine, said.

Given Paris’s iconic role in the fashion industry, the measures – passed in 2015 but only just coming into effect – are likely to have a symbolic impact around the world.

The proposals had originally suggested a minimum BMI for models but, following an outcry from fashion executives and modelling agencies, this was ditched in favour of allowing doctors to decide whether a model is too thin.

Agencies who use models without valid medical certificates will face a fine of €75,000 (£54,000) and staff face up to six months in prison. Failing to flag-up retouched images will incur a fine of €37,500, or up to 30% of the amount spent on the advert.

Fashion models in France need doctor’s note before taking to catwalk

Fashion models in France will need to provide medical certificates proving they are healthy in order to work, after a new law was introduced banning those considered to be excessively thin.

A further measure, to come into force on 1 October, will require magazines, adverts and websites to mark images in which a model’s appearance has been manipulated with the words photographie retouchée (retouched photograph).

Doctors are urged to pay special attention to the model’s body mass index (BMI), a calculation taking into account age, height and weight. However, unlike similar legislation passed in Italy and Spain, models will not have to reach a minimum BMI.

Under World Health Organisation guidelines an adult with a BMI below 18.5 is considered underweight, 18 malnourished, and 17 severely malnourished. The average model measuring 1.75m (5ft 9in) and weighing 50kg (7st 12lb) has a BMI of 16.

Announcing the introduction of the new rules on Friday, France’s health minister said they were aimed at preventing anorexia by stopping the promotion of inaccessible ideals of beauty.

“Exposing young people to normative and unrealistic images of bodies leads to a sense of self-depreciation and poor self-esteem that can impact health-related behaviour,” the health and social affairs minister, Marisol Touraine, said.

Given Paris’s iconic role in the fashion industry, the measures – passed in 2015 but only just coming into effect – are likely to have a symbolic impact around the world.

The proposals had originally suggested a minimum BMI for models but, following an outcry from fashion executives and modelling agencies, this was ditched in favour of allowing doctors to decide whether a model is too thin.

Agencies who use models without valid medical certificates will face a fine of €75,000 (£54,000) and staff face up to six months in prison. Failing to flag-up retouched images will incur a fine of €37,500, or up to 30% of the amount spent on the advert.

If we want to improve mental health, first we need to tackle poverty | Dawn Foster

Mental health discourse welcomed an unexpected participant this month. Prince Harry, the fifth in line to the throne, spoke publicly about seeking counselling following his mother’s sudden death in his pre-teen years. Rightly, mental health charities praised his intervention, highlighting as it did that even extreme privilege cannot shelter us from depression, anxiety or any other psychiatric illness. Our bodies are fragile, and our minds equally so: this message is increasingly accepted as people with mental health problems, campaigners and medics alike have fought to end stigma by building a national conversation on mental health.

Removing the stigma around mental health is important but does little alone. Without services, treatment is still inadequate, and feeling less judged for your health issues means little if you’re faced with a lack of access to talking therapies and nonexistent community support. But the conversation on mental health also needs to examine how the structures of society cause and perpetuate poor mental health.

Poverty, poor housing and debt all have a detrimental impact on the mental health of children and adults. Money can’t buy happiness, but poverty can practically secure stress and misery. For children in particular, the impact of poverty early on increases the lifetime risk of long-term mental health problems. The National Child Development Study found children from the lowest-income families are four times more likely to display psychological problems than children from the richest families. Homeless children are four times as likely to experience mental health problems as settled families.

Across the UK, both women and men in the poorest fifth of the population are twice as likely to be at risk of mental health problems as those on average incomes, according to the Mental Health Foundation. Poverty increases the likelihood of developing mental illness, and mental illness increases the risk of poverty: combating only one factor does nothing to end the poverty cycle – the two are inextricably linked. Being as wealthy as the royals doesn’t preclude you from experiencing mental health problems, but it does lower the likelihood, cushion you in certain aspects and allow you access to a better standard of care more quickly.


Failing to address childhood mental health linked to poverty is like scrimping on a car repair only to crash into a wall

Refusing to recognise the link between socioeconomic deprivation and mental health creates a preventable drain on the public purse. Advocates for austerity argue that every penny counts, that “we are all in this together”, to borrow a famous phrase from George Osborne, heir to a baronetcy.

This is the ideological reasoning behind cutting the benefit cap to £20,000 outside London, implementing the bedroom tax, removing council tax benefit and forcing women to fill in forms confirming they were raped if they wish to claim child benefit for more than two of their offspring. But it makes no economic sense: these policies make rents unaffordable and increase homelessness, which contributes heavily to the deterioration of millions of people’s mental health. The Institute of Education found that poor mental health in children alone costs the UK £550bn in lost earnings. Children who experience poor mental health in childhood, disproportionately linked to poverty, earn less in their lifetime, requiring more financial support from the state, as well as seeking more medical assistance. It is akin to scrimping on a minor car repair only to crash the vehicle into a wall.

But even if economic arguments do not sway the government, the humanitarian, emotional argument should be recognised. Social policy can actively lower people’s risk of experiencing depression, anxiety and other disorders.

Austerity is an economic choice: it’s a foolish one that saves nothing and harms millions. Any campaign on mental health should champion combating poverty to stop more people experiencing entirely preventable problems.

Prince Harry, mental health and the need for a more caring society | Letters

In my view, those who try to come up with totalising explanations of mental health are misguided (Letters, 20 April). It’s neither purely social nor purely individualistic, though effective help should start from actually listening to and honouring the individual case. Often in practice it does not, and I would agree with Professor Read that a biogenetic medical model is generally inappropriate and can actually be damaging. It also goes radically unacknowledged that there are various different types of bereavement, some of which are far more traumatic than others, and are not directly comparable. The effects of traumatic sudden bereavement experienced in childhood or adolescence can last for years and ultimately for a lifetime, as the princes have now highlighted. It is known that this type of bereavement can sometimes result in lasting shock followed by delayed grief years later, yet there is often little or no acknowledgment readily available, never mind any effective support.

On top of this, and especially in a culture of competition, the bereaved are often subjected to cutting comments, judgments and dismissals. Sometimes these are from those who claim to know what it’s like because their grandparent or cat has died, while sometimes they are from people in medical or authority positions whose callous judgmental ignorance can be devastating. Why does it require the intervention of princes to highlight the issue? At least they get taken seriously.
LE Collier
Cheltenham, Gloucestershire

It seems to me that a potential key to improving psychological provision for common human grief and misery (Freud’s term) is not only more better-trained, organised professionals, but also a more compassionate and empathic caring society attuned to the emotional needs of others. Where many families are so economically impoverished, they barely have the inner resources, strength and resilience left to attend to each other’s mental pain and suffering. What chance this election gives us all an opportunity to change our minds about the material hardship and distress we are causing those most in need of help, so they can move on?
Ya’ir Z Klein
London

Keith Farman asks whether bereavement is a mental illness. Before answering, note that Harry says he suffered from denying grief when his mother died, not from the grief itself. While grief is a normal reaction to loss that cannot be blamed on others or self, its first stage is usually denial, which may help deal with events following the loss and which I believe is an illness. However, as confidence recovers, fear should subside and a second stage of grief usually occurs when the rage or fear roused by the loss is normally expressed. This is not evidence of mental illness. Alison Sesi says children cannot yet express their feelings effectively. This should not be so. But they may not experience grief but the simpler hate, sadness, anxiety or rage. I suggest that when our species acquired verbal language, most societies came to believe in gods and devils. Though later religions used these to help sustain laws and customs, they do not exist. So mental illness has long been endemic.
George Talbot
Watford, Hertfordshire

Professor Samuels never misses an opportunity to take a swipe at the evidence-based psychological therapy now available on the NHS. Prince Harry is at liberty to choose whatever sort of therapy he wishes and his comments, which seek to normalise and reduce the stigma attached to mental health problems, are very welcome. We don’t know what sort of therapy Prince Harry had, but scientific evidence suggests that had he attended eight to 12 sessions of cognitive behavioural therapy (CBT) at his local GP surgery for the traumatic bereavement he experienced, the outcome would have been a good one.
Hal Westergaard
(Cognitive behavioural therapist), Bath  

It was with interest that I read Andrew Molodynski’s comments regarding ECT as a useful option for treatment resistant major depressive disorder (Shock treatment on increase again in NHS, 18 April). I have experienced this horrible illness along with anorexia for a number of years. I underwent a significant number of ECT treatments. Apart from some short-term memory loss, it is painless, and one is unconscious for a very short period. For me it was life-saving. I don’t  think I would be alive today without it. If the need arose I would willingly have it again. Although medical treatments may help the many symptoms of severe depression, it frequently returns time and time again.

The causes of this life-altering illness need to be untangled if treatments are to succeed. This is where psychologists/psychotherapy may have the answers. In an underfunded and understaffed mental health service, therapy can be difficult to access. I have been one of the fortunate ones. Let no one underestimate the distress of severe depression on the individual and their loved ones, and the challenges it presents to mental health staff. ECT is an important life-saving treatment for people like myself.
Sheila Cook
London

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When therapists also need therapists: ‘Suffering is not unique to one group’

Britain’s Prince Harry has earned praise in recent days for speaking up about his personal issues with mental health, the need to not stay silent about emotions, and the benefits of seeking therapy.

Describing how he arrived at a breaking point in an interview with the Telegraph, he explained it was listening to other people’s problems and realizing he was unable to be as helpful as he wanted to be that pushed him to seek help.

“You park your own issues because of what you’re confronted with, and all you want to do is help and listen, but then you walk away and go, hang on a second, how the hell am I supposed to process this?”

He then added that for every three hours of listening to people, psychologists take half an hour to process it themselves with someone else. He’s right: one of the most important traditions within the mental health world. Therapists also need therapy.

We asked four psychotherapists with extensive experience in the field to open up about how they, too, use therapists.

David Lopez, practitioner for 15 years, Connecticut

David Lopez, a former president of the American Academy of Psychoanalysis and Dynamic Psychiatry, says there are a few different reasons why therapists will seek therapy.

The first is during the training process, when therapists in training will have a supervisor and often a therapist of their own.

“Typically, people who want to become therapists have an interest in connecting with people. When they are doing therapy that need needs to be redirected, to be tamed so that it does not get in the way of not being objective,” Lopez elucidates.

What needs to be addressed in training is something called “countertransference”, Lopez explains. While a client transferring emotions they would have for someone in their outside lives onto their therapist (called “transference”) is generally considered a good thing, a therapist transferring emotions onto their client is to be avoided.

If a therapist in training was orphaned young, they may emotionally react to stories their clients bring into sessions about parents and loss, for instance. The challenge for the therapist is then not necessarily to get rid of the feelings related to loss and parenting, but to become very aware of them and become intimately acquainted with these “blind spots”.

A common blind spot might simply be witnessing a patient struggle with some kind of grief and watch them cry: a therapist may want to go and hug them, and be their friend.

“You may wish to connect with a patient for your own need, instead of applying the tools that you have been taught. But they’re not paying you to be their friends, even if a hug in that moment may feel good to give.”

Elena Lister, private practitioner for 30 years, New York

“Shockingly enough, therapists are also people,” Elena Lister says, not without a considerable amount of irony.

Lister, a psychiatrist, analyst and professor who teaches at Cornell and Columbia universities, says that there is nothing particularly mysterious leading therapists to seek treatment of their own, beyond the initial training requirements during the early years. The answer is it’s life, and life’s trying and often painful events.

Lister herself sought therapy when she lost her six year-old child to leukemia. At the time, the help she found did not adequately meet her needs, she says. Identifying this lacuna in her own field convinced her to specialize in grief and loss, meaning she could seek to be there for others in a way she had not been able to professionally find herself.

Treating patients (including patients who are therapists) who are undergoing such extreme pain means developing an ability to leave what has happened during a therapy session in the room once it is over.

“You have to be able to keep it in boundaries. Some people have gone through such tremendous suffering. You have to be fully present in the room. But if I am going to do this, it’s my mandate to not carry it to the next room. I have a duty not to.”

To keep herself upbeat and in the right mental space for all her patients, as well as of for herself, Lister says she has to do “all sorts of things. I talk to friends, to myself, to my husband. I exercise, I meditate”.

Leslie Prusnofsky, private practitioner for 35 years, New York

Leslie Prusnofsky, a psychiatrist, psychoanalyst and faculty member at Columbia University, says that in some ways treating therapists is no different than treating non-therapists.

“You’re dealing with a lot of people’s pain. Whether it is therapists or lay patients, pain is human, and human suffering is not unique to one group.”

But Prusnofsky says that treating therapists does sometimes come with its own particular obstacles.

“It can result in more walls that have to be pulled down,” he explains. This will be the case even if the therapist-patients are very willing to engage in treatment.

Part of the therapy process is trying to break through to things that are naturally being protected, he explains. There is “an unconscious resistance” that can be found in everyone, Prusnofsky says, but therapists who know the jargon may be even better than others at hiding the real root of their problems.

“Using the jargon is one of the cover-ups to stay away from the depths of what they [the therapist-patient] actually need to explore.

“If someone comes in saying they have a lot of ‘repressed anger’, you may find with time, the deeper you go, that the anger turns into sadness. What is revealed is a sense of loss or of deprivation that is harder for the person to deal with.”

David Forrest, practitioner for 50 years, New York

For David Forrest, a clinical professor of psychiatry at Columbia University, and a trained psychotherapist and psychoanalyst who also holds a private practice in Midtown Manhattan, one of the most interesting – and tough – questions that therapists go to therapy for is when it’s time to call it quits.

Forrest, whose work includes research and teaching in the field of neurology, says that asking the question of when a psychotherapist should retire is a particularly fascinating one.

“To ask how does a psychotherapist know when it it time to hang up their spurs, asks us to define the mental capacities necessary to be a psychotherapist in the first place,” Forrest poses.

A surgeon may no longer physically be able to withstand the arduous hours, or may suffer from an injury that prevents them from operating, but so long as a psychotherapist’s brain is going, when do they know to stop? Doesn’t an older therapist mean a more experienced therapist, an attribute one would seek?

Memory loss or small mental failings can affect the mind as one gets older and negatively impact remembering a patient’s complex history.

But other things may start to go with age, too, Forrest says, elements that might be just as crucial to quality therapy-giving.

Deciphering what is funny and not, for example, sometimes morphs with age.

If someone contracts frontotemporal dementia, their sense of humor tends to degrade from the more elaborate sensitivities, Forrest says. A therapist with this kind of affliction may develop a new kind of sense of humor – that is less suitable in a therapy room.

“It [the sense of humor] would no longer be deadpan and dry. It would sink to slapstick and sadistic, and the brain would enjoy low-quality humor.”

“The pun is a low sense of humor,” the psychiatrist explains, helpfully.

As for Forrest himself, a veteran of the profession: have decades and decades of practice and inquiry into the human brain started to wear him out? Such a question is one more adapted to younger professionals, he responds.

“For someone like me, there is no question of burnout.”

The lesson of Prince Harry’s grief? We need mental health services for all | Suzanne Moore

One of my strongest memories of attending Princess Diana’s funeral is of sitting up high in Westminster Abbey and looking down on her young sons. During the long service no one touched them or hugged them, though everyone was moved by the handwritten “Mummy” card on top of her coffin. The much reviled Sarah, Duchess of York leaned over to see if they were OK. Otherwise, nothing. They were to be “brave”, I suppose. They had walked behind that coffin for a very long way, their heads bowed, impassive. Why had they been made to do that?

The dysfunction of the first family was challenged and disrupted at the funeral by Earl Spencer’s speech. The public grief was dismissed by much of the establishment – as Diana was herself – as hysterical, and it proved the polar opposite of the royal reaction. The family holed up in Balmoral. Charles could now work to get everyone to accept Camilla as his partner, which they largely did. And the boys? It seemed they must just get on with it.

Twenty years later, in a lovely interview with Bryony Gordon in the Telegraph, Prince Harry has now spoken about his grief and how it affected his mental health. The stiff upper lip and the repression required to keep it so is not the way forward. Acknowledging the problems and talking about them is.

The loss of his mother when he was 12 was at the root, Harry says, of his feeling of anxiety, which manifested itself in “fight or flight” responses when in public. He talks of his aggression – he found boxing helped with this – and the feelings of internal chaos and breakdown that come after a deliberate shut-down of emotion. He didn’t want to think about his mother as it would be too sad. Yet, of course, not thinking about loss does not mean its effects go away. Harry was supported by his brother, William; “shrinks” helped as well; and finally, being open helped too.

Seeing fellow soldiers with PTSD from serving time in Afghanistan made him realise that actually this was not the root of his mental health issues. Rather, he had pushed away emotions, shoved them right down, always saying life was fine when it wasn’t at all. “And then I started to have a few conversations and actually, all of a sudden, all this grief I had never processed started to come to the forefront and I was like, ‘There is actually a lot of stuff that I need to deal with.’”

Alongside this, he, William and Kate saw that in much of their charity work, mental health was intrinsically bound to many other issues, but not always addressed. They decided to work on this.

Harry has rightly been praised for talking personally and thus destigmatising mental health issues. This is no doubt excellent. The normalising of mental health problems, which it is estimated will affect a quarter of us at one time or another, is necessary, but so too is funding. Mental health services are in a very poor state and it is almost impossible to get help. Many people in Harry’s situation would not get access to counselling and would be offered antidepressants and possibly a short course of cognitive behavioural therapy, as this is considered most cost-effective. In acute cases, people in a state of severe breakdown are now forced to go to hospitals far from their homes because there are no beds to be found nearby. This is a real crisis, and it is more visible by the day on our streets.

Royals doing charitable work can help, but we need to think about how the whole of society copes with an epidemic of mental health problems in our young people.

Harry’s likeability and frankness, alongside William’s, have helped to rehabilitate the royals’ image: a facade of modernisation. Remember that at the time of their mother’s death the family was viewed as out of touch, anachronistic. Their lack of emotional engagement seemed to belong to another era. Charles’s treatment of Diana, and her refusal to accept the script that had been written for her, threatened their popularity. Lessons were learned and the princes have been part of this PR.

Indeed, Harry is not the first royal to go public with such issues, although I am very glad he has. His mother talked, after all, of her struggles with bulimia and her suicide attempts. She spoke of difficulties with self-esteem and how bulimia gave the illusion of comfort, followed by disgust. She talked of feelings of self-revulsion and the compulsion to “dissolve like a Disprin” back in 1993. Many dismissed her then as unstable, attention–seeking and manipulative as a result.

Twenty years after her death, the fact that her youngest child can open up in such a way and be widely praised for it shows, I hope, that the world has moved on. Now it’s time to make the help and support that was available to a prince available to all.

What we need is a national social care service | Anne Perkins

Neil Kinnock was on the radio at the weekend, talking about his hero Aneurin Bevan with the journalist Matthew Parris and one of Bevan’s biographers, John Campbell. Any conversation about Bevan’s life is mostly about the NHS and so it was this time, too. But it was a useful reminder of how, among all the battles fought over its creation, among the fiercest was the question of replacing a patchwork of local provision with a single centralised structure that tried to guarantee that everyone got the same level of care wherever they lived. At that the point the radical, big-government approach petered out. Social care was left where it always had been, with local councils.

Now the Institute for Fiscal Studies (IFS) has published a study looking at the difference in social care provision across England that raises the question of whether it too should be centrally funded. After all, whether it’s soaring demand for A&E or delayed discharge from hospital, the impact of inadequate or ill-designed social care services on the overall state of the health service has become the stuff of daily headlines.

Then there is the ageing population. Although we are all healthier in old age, the need for care doesn’t track changing demography exactly: men’s life expectancy is growing faster than women’s, so there are more old couples looking after each other rather than relying on formal care.

George Osborne’s response to the incipient social crisis was to set in motion plans to shift the entire cost of locally incurred spending to local taxes, with a system of equalisation that has yet to be explained. He introduced a social care precept allowing an increase of up to 2% in council tax to be spent on social care.

Since the amount councils can raise through council tax depends on their tax base, these changes are – as the IFS points out – hitting poorer councils much harder than well-off ones, even though in theory, the introduction of national criteria for eligibility for paid-for social care should mean a reasonably equitable approach. The IFS study found that cuts in social care were much steeper in metropolitan areas such as Greater Manchester, Tyneside and Greater Birmingham, which typically have significantly higher levels of need, than in the south of England (although that may be partly because there are more older people in the south).

But the distinction between what we pay for and what we expect wider society to support is more than just a matter of an arbitrary geographical divide. We are so familiar with it that we rarely ponder the palpable inequity between providing free care for, say, a cancer patient, regardless of their wealth, while charging someone with dementia who also has some modest assets.


Councils argue that keeping older people well is about much more than care homes and clearing hospital beds

Because social care is provided locally, the national focus is always on the NHS. So although last month’s budget made another £2bn available for social care, it is being delivered in a way that ties it in to supporting the kind of services that will ease pressure on the NHS. Councils rightly argue that keeping older people well is about much more than care homes and providing a bed clearance service for their local hospitals. It’s about wellbeing in the widest sense of the word, and the NHS’s provision of community services like stroke rehabilitation also have a significant role to play.

In some ways, NHS England chief executive Simon Stevens’ sustainability and transformation plans with their objective of integrating health and social care in ways that meet local priorities are an attempt to synthesise the national with the local. Yet there is such an inbuilt conflict between a free-at-the-point-of-use NHS and means-tested social care that it is hard to see how they can continue to coexist.

It comes at a high cost to patients. When hospitals are in effect incentivised to shovel the old lady who’s had a fall out of bed and off their books pronto (I exaggerate, a little), leaving her local authority to pick up the bill for getting her back on her feet, it seems the two arms of care that ought to be wrapped protectively around her are instead locked in a standoff. It is more arm-wrestling than hand-holding.

The government now promises (another) green paper on paying for social care in the autumn. But successive plans, each of which points to more central government funding, have crashed and burned on the runway. Oh, for a Bevan (and a Clement Attlee) with the courage and determination to sort it out.

Anne Perkins is a leader writer