Health Inequality - Why Bristol must improve services for Physical and Mental Health

Mental Health is a Protected Characteristic so Councils have a Duty of Care to this population.

JSNA (Joint Strategic Needs Assessment) and other guidance requires councils to fund or obtain funding for exercise for mental health, even the current Government policy is 'No Health Without Mental Health'. Equality of access to people with mental health issues and barriers to access to physical exercise is a right.

This applies also to people with other illnesses and disabilities, and for other services also where people have a specialist need.

Relevant policies -

"Joint Strategic Needs Assessment (JSNA)
    To improve and protect health and wellbeing outcomes across the city while reducing health inequalities

Health and Wellbeing Board
    A duty to consult service users and the public.

WAYS OF WORKING (Supplement to the Terms of Reference agreed at Full Council in May 2013)

2. Functions of the Board - in summary    

2.4. Communicate and engage with Bristol communities.  See Section 6 below.  A duty to involve users and the public in the JSNA and Joint Health and Wellbeing Strategy (JHWS).

3. Identifying needs and priorities

3.1 Ensure that the JSNA is refreshed, using a variety of tools, evidence and data, including user experience to support this process.

3.3 Reach a shared understanding of the health needs, inequalities and risk factors in local populations, based on the JSNA and other evidence, and demonstrate how this evidence has been applied to decisions and strategic priorities.
4. Strategy
4.1. The Board will develop, publish and refine a Joint Health and Wellbeing Strategy which sets out objectives, a rate of improvement for health and wellbeing outcomes, including reduction in health inequalities, and how stakeholders will be jointly held to account for delivery.

6. Patient and Public Involvement

6.1. The Board has a duty placed on it to involve patients and the public in both the JSNA and JHWS.

6.2. The Board will aim to deliver this duty in a meaningful way.  Realistic and practical mechanisms to deliver this duty will be developed in conjunction with the development of HealthWatch."

Joint Strategic Needs Assessment (JSNA) - The health and wellbeing of Bristol - http://www.bristol.gov.uk/page/adult-care-and-health/joint-strategic-needs-assessment-jsna

Health and Wellbeing Board - Joint Health and Wellbeing Strategy - 

http://www.bristol.gov.uk/page/council-and-democracy/health-and-wellbeing-board

Bristol City Council leaves £700,000 Public and Mental Health money unspent - FOI

Dear Mr Hale

We write in response to your requests for information received here on 31 March 2014. For your reference your requests for information are in bold below and our responses follow.

Please answer the questions below, as required under the Freedom of Information Act

Answer for first three questions is the same and the budget is set to be the same as the grant funding.

What is the Bristol City Council Public Health Budget for the last spending year, this spending year and next spending year?

2012-13 there was no ring fenced budget

2013 -14 Ring fenced public health grant for Bristol is £27,312,500

2014-15 Ring fenced public health grant for Bristol is £29,122,300

What is the Bristol City Council Public Health Ring fenced Budget for the last spending year, this spending year and next spending year?

See above

What is the Bristol City Council Mental Health Ring fenced Budget for the last spending year, this spending year and next spending year.

2012 13 no budget

2013/14 budget for Mental Health was £650,754

2014/15 the contractual/pay budget spend will be the same, but non-pay expenditure may change (up or down) according to new priorities

How much of the current spending years' public health budget remains unspent?

£658,930 remains unspent from 2013-14 budget

How much of the current spending years' mental health budget remains unspent?

£48,568 – underspend due to staff secondment and reduction in hours (staffs request not service decision)

How many Public Health posts have been frozen?

None

How many Ring fenced Public Health posts have been frozen?

None

How many Public Health posts have been reduced in terms of hours per week?

None

How many Ring fenced Public Health posts have been reduced in terms of hours per week?

One post was reduced by 0.5 wte this year, due to  personal request  not a service decision.

How many Mental Health posts have been frozen?

None

How many Ring fenced Mental Health posts have been frozen?

None

How many Mental Health posts have been reduced in terms of hours per week?

One  post was reduced by 0.5 wte this year, due to  personal request  not a service decision

How many Ring fenced Mental Health posts have been reduced in terms of hours per week?

None

Are there any plans to cut funding and/or freeze posts for Smoking Cessation Services?

The proposed structure has shown no plans to reduce posts.  We have reduced the Smokefree South West Contract, but that is a decision made across south west and with that organisation.

Are there any plans to cut funding and/or freeze posts for Mental Health Services?

No

Are there any plans to cut funding and/or freeze posts for Sport Exercise for Mental Health Services?                                                                                                                                                                         

This is not a public health funded area

How many staff hours per week were/are assign for direct work on Bristol Active Life Project for the last spending year, this spending year and next spending year?

This is not a public health funded area

Given the mayors' promise that if the reorganisation affected any services Bristol City Council would undertake a consultation into resolving these effects, what plans are there for that consultation?

We have no current  plans which would affect services at the moment, but will adhere to necessary consultation requirements if plans change

How much Contigency fund money has or is being spent on re-organisation (including redundancy (compulsory or voluntary) payments and any other related costs)?

No Public Health grant funding has been used to fund re-organisation

How much Contigency fund money has or is being spent on redundancy (compulsory or voluntary) payments and any other related costs)?

Not applicable as no public health staff have been made redundant

On behalf of

Freedom of Information Team

Freedom of Information Act - Bristol City Council - Public and Mental Health Spending

I wrote this Freedom of Information Request on Monday 31st March 2014 to check whether Bristol City Council are spending their Public Health and Mental Health Budget appropriately.

Dear Chief Executive

Please answer the questions below, as required under the Freedom of Information Act

What is the Bristol City Council Public Health Budget for the last spending year, this spending year and next spending year?

What is the Bristol City Council Public Health Ring fenced Budget for the last spending year, this spending year and next spending year?

What is the Bristol City Council Mental Health Ring fenced Budget for the last spending year, this spending year and next spending year.

How much of the current spending years' public health budget remains unspent?

How much of the current spending years' mental health budget remains unspent?

How many Public Health posts have been frozen?

How many Ring fenced Public Health posts have been frozen?

How many Public Health posts have been reduced in terms of hours per week?

How many Ring fenced Public Health posts have been reduced in terms of hours per week?

How many Mental Health posts have been frozen?

How many Ring fenced Mental Health posts have been frozen?

How many Mental Health posts have been reduced in terms of hours per week?

How many Ring fenced Mental Health posts have been reduced in terms of hours per week?

Are there any plans to cut funding and/or freeze posts for Smoking Cessation Services?

Are there any plans to cut funding and/or freeze posts for Mental Health Services?

Are there any plans to cut funding and/or freeze posts for Sport Exercise for Mental Health Services?

How many staff hours per week were/are assign for direct work on Bristol Active Life Project for the last spending year, this spending year and next spending year?

Given the mayors' promise that if the reorganisation affected any services Bristol City Council would undertake a consultation into resolving these effects, what plans are there for that consultation?

How much Contigency fund money has or is being spent on re-organisation (including redundancy (compulsory or voluntary) payments and any other related costs)?

How much Contigency fund money has or is being spent on redundancy (compulsory or voluntary) payments and any other related costs)?

I request a waiver of all fees for this request. Disclosure of the requested information to me is in the public interest because it is likely to contribute significantly to public understanding of the operations or activities of Bristol City Council and is not in my commercial interest.

Yours sincerely

Dr Peter Hale

My views on - West Midlands Police suspends officer's Twitter account

BBC News - West Midlands Police suspends officer's Twitter account - http://www.bbc.co.uk/news/uk-england-birmingham-26205961 - In My Opinion this is an injustice! He is Mental Health expert.

West Midlands police should concentrate on achieving the practical steps he advocates that would improve policing for people with mental health issues and everyone else.

Any public service needs continuous analysis and improvement, partly in public, and always with involvement of other experts such as with conferences.

It is the right of people with mental health issues and of the public in general to have services held accountable so that they improve.

Mental health staff to be based in police stations - My Comment

BBC News - Mental health staff to be based in police stations - http://www.bbc.co.uk/news/health-25588547 - 10 areas of England as part of a pilot scheme -

Mental health staff to be based in police stations - http://www.bbc.co.uk/news/uk-25602179 - Video and Article.

This project is inadequate. The criminal justice system still send people with mental health issues to prison, which of course makes mental health worse. People should get the mental health treatment they need, always and without exception, whether or not there is police contact. So One Cheer for this postcode lottery effort to get some people treatment some of the times they are in crisis in some places.

A further need is for Crime Victims with mental health issues to be listened to when they report a crime -

BBC News- Mind 'shocked' crime victims with mental illness ignored - http://www.bbc.co.uk/news/uk-24430556 - Video - Mentally ill crime victims 'disbelieved'.

Is anything going to be provided at police stations to ensure people with mental health issues who have been OFFENDED AGAINST are listened to?

Mental Health Treatment is a Right

This post challenges the view that Mental Health Treatment is only a means to an end such as making the person employable.

Which sound reasonable statements from 1 or 2 ? -

1 a) We should treat someone with a broken leg.
   b) We should treat someone with cancer.

2 a) We should treat someone with a broken leg so he/she can gain employment.
   b) We should treat someone with cancer so he/she can gain employment.

I suggest that only the most harsh and uncaring person would suggest the simple statements in 1 need further qualification to suggest that the treatment is just a means to get the person into employment.

So who would advocate statement 2 for an illness?

2 c) We should treat someone with mental health issues so he/she can gain employment.

At the Conservative Conference in Autumn 2013 George Osborne promised help for people with mental health issues so they can get work.

"Only about a third of the 200,000 Jobseekers Allowance claimants affected will be on the work placements.

The other two thirds will either have to attend a jobcentre every day or undergo programmes to address the reasons they cannot find work like illiteracy or mental health problems."

George Osborne extends 'work for benefit' for jobless - 30 September 2013 - http://www.bbc.co.uk/news/uk-politics-24327470

The treatment is a RIGHT and should be provided now anyway?

Statement 2 comes with a threat also that those who don't co-operate with their treatment will be forced to, or lose benefit. But who would argue that point for the broken leg or the cancer? - argue that people with a broken leg or cancer should be compelled to co-operate with their treatment, or lose benefit?

Of course there may be some people with mental health issues who don't co-operate with the treatment. However, given that mental health is an issue of the mind, and the mind is the source of decision making, that is hardly surprising! Even so, the vast majority (including the less co-operative) want to get better and/or manage their condition.

However, all healing depends on trust. Except as a last resort, any compulsion is a breach of trust, and so counterproductive. The last resort is for when the person is not coherent enough to make decisions, in that case it would clearly be wrong anyway to punish the person for bad decisions via benefit sanctions. Further, sanctions to Employment Support Allowance and/or disability benefits (which many with mental health issues can and should get) would clearly be illegal.

It is equally wrong to give treatment only to prevent offending -

Mental health staff to be based in police stations - My Comment - http://peterhaleserviceuser.blogspot.co.uk/2014/01/mental-health-staff-to-be-based-in.html

The brilliant cartoon below satirises the discriminatory approach to mental health of expecting people to heal themselves and/or undergo treatment solutions that are easy and miraculous. The cartoon highlights the 'pull yourself together' attitude of ill informed people. It's especially worrying that some such ill informed people are in power!

Helpful Advice - If People 'helped' with physical health like they do with mental health - https://pbs.twimg.com/media/BaqVFWiCAAAZtUX.png:large

A further point about the stupidity of making people (many of them ill) work for free is highlighted in my post -

Why forcing people to work for benefit won't work - http://peterhaleserviceuser.blogspot.co.uk/2013/10/why-forcing-people-to-work-for-benefit.html - Wombling for Welfare!

That post references -

Maslow's Hierarchy of needs - http://www.bbc.co.uk/news/magazine-23902918 - Abraham Maslow and the pyramid that beguiled business.

At least Step 1 and 2 needs must be met BEFORE someone is capable of work.

Added to all of the above failings is an attitude amongst public services that it is OK to neglect the physical health of those with mental health issues, and thus harm their physical AND mental health. These services to the most vulnerable should not be cut; this is a health budget not just a leisure budget. It is usually wrong to assume that people with mental health issues need the same non-specific exercise and health solutions as everyone else. It is wrong to treat exercise and health for those with mental health issues as a leisure activity, and so expect all mental health sufferers to join mainstream leisure centres, teams, and activities. Again, physical health treatment combined with a supported environment for health and exercise should be a right! This is covered in the post -

Mental Health and the Right to Life and Exercise -http://peterhaleserviceuser.blogspot.co.uk/2013/09/mental-health-and-right-to-life-and.html - at risk of dying up to 20 years before the general population

Frank Bruno - Fitness and Mental Health

Daily Mirror

Former World Heavyweight Champion Big Frank is taking on the illness that had him out for the count

Frank Bruno is back and is fighting fit but this time it's not boxers he's battling - via Daily Mirror Video & Article - 

http://www.mirror.co.uk/news/uk-news/frank-bruno-back-fighting-fit-2870346

Former World Heavyweight Champion Big Frank is taking on the illness that had him out for the count

'FRANK Bruno is back on form and up for the fight of his life – to knock out the stigma around the bipolar disorder that floored him last year.

The former world heavyweight champion , 51, says he finally feels in control again after a decade in the grip of mental illness.

With a welcome return of the warm smile and deep belly laugh that made him a national treasure, the boxing legend tells the Sunday Mirror how he fought his way back to health.

“This time last year I was in a very dark place,” he says. “I’m determined to never go back there again.

“Mental illness is a terrible thing to have to cope with but I’ve learnt it’s a fight you can win if you live your life the right way.

“So that’s what I do now. Today my life’s about working hard, staying healthy and being happy.”

He works out most days, and looks fit enough to step back into the ring tomorrow.

Now Frank is using his experience to help fellow sufferers fight back. He says: “I am determined to help as many people as I can to believe they too can get through mental illness.”'

....

Bristol Post

Boxing legend Frank Bruno leads new fight in Bristol - 

http://www.bristolpost.co.uk/big-hitter-Boxing-legend-leads-new-fight/story-20109719-detail/story.html -

Boxing Gym - mental health trust Bristol Active Life Project

"WITH the sound of his distinctive laugh there was no need for the visitor to a Bristol gym to announce his arrival.

Former world heavyweight champion Frank Bruno needed no introduction as he made his way into Bristol Boxing Gym.

His visit, to a project supporting people with mental health issues through non-contact boxing sessions, was a perfect fit considering the difficulties he has himself suffered with depression and bipolar disorder since his career ended. And it proved an inspiration to the people running and benefiting from the service to meet someone who has overcome battles inside and outside the ring.

Bristol Boxing Gym ran its first session with the local mental health trust's Bristol Active Life Project last month on World Mental Health Day.

Now 11 people are benefiting from the box fit programme.

Mr Bruno spent time chatting with the people who attended yesterday's session and was also reunited with Bristol North West MP, who trained alongside him at Spaniorum Farm Gym in Compton Greenfield when he was in pantomime at the Hippodrome and she was a regular there as a teenager."

....