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Posts Tagged ‘Mental Health’

Tackling health inequalities must involve addressing lesbian, gay, bisexual and trans inequalities

Posted in Healthcare, HIV, LGBT, Mental Health, SIG, tagged , , , , on July 7, 2017| Leave a Comment »

By Dr Justin Varney, National Lead for Adult Health and Wellbeing, Public Health England

Public Health England estimates that between 2-5% of the population identify as lesbian, gay, bisexual or other – comparable to many ethnic minority and faith populations. Despite legislative reform many LGBT people continue to experience discrimination, marginalisation and harassment.

  • 38 per cent of trans people have experienced physical intimidation and threats and 81 per cent have experienced silent harassment (e.g. being stared at/whispered about)
  • One in five (19 per cent) lesbian, gay and bi employees have experienced verbal bullying from colleagues, customers or service users because of their sexual orientation in the last five years
  • Almost 1 in 4 trans people are made to use an inappropriate toilet in the workplace, or none at all, in the early stages of transition. At work over 10% of trans people experienced being verbally abused and 6% were physically assaulted.

The impact of this discrimination on mental health is easy to understand, however the stark data on suicide and self-harm demonstrates the depth of the impact that this discrimination can have:

  • 52% of young LGBT people reported self-harm either recently or in the past compared to 25% of heterosexual non-trans young people and 44% of young LGBT people have considered suicide compared to 26% of heterosexual non-trans young people
  • Prescription for Change (2008) found that in the last year, 5% of lesbians and bisexual women say they have attempted to take their own life. This increases to 7% of bisexual women, 7% of black and minority ethnic women and 10% of lesbians and bisexual women with a disability
  • The Gay Men’s Health Survey (2013) found that in the last year, 3% of gay men have attempted to take their own life. This increases to 5% of black and minority ethnic men, 5% of bisexual men and 7% of gay and bisexual men with a disability. In the same period, 0.4% of all men attempted to take their own life
  • The Trans Mental Health Study (2012) found that 11% of trans people had thought about ending their lives at some point in the last year and 33% had attempted to take their life more than once in their lifetime, 3% attempting suicide more than 10 times.

The impacts aren’t limited to mental health, and the level of inequalities in lifestyle behaviours such as smoking and substance misuse will almost certainly play out in a great burden of chronic disease and premature mortality over the life course.

The evidence base of inequalities affecting LGBT populations continues to grow as we get better at incorporating sexual orientation and gender identity into the demographics of research and population surveys. Positively, as the NHS rolls out the sexual orientation monitoring information standard this year, this understanding will no doubt continue to grow.

As public health professionals we have a responsibility to advocate for the populations in our care, and this should include advocating for LGBT populations. Lesbian, gay, bisexual and trans communities are diverse, vibrant and varied and have many assets, although the LGBT community sector has faced fiscal challenges due to the economy there remain many small local LGBT organisations that are keen to work with public health teams to address these inequalities.  This is population who clearly need our professional expertise, advocacy and support to co-produce solutions for change and one where we could have a real impact.

So during this lesbian, gay, bisexual and trans Pride season please take up the opportunity to engage, empower and partner with your local LGBT community.

FPH is committed to improving the health and well-being of the LGBT population. If you would like to join us in our work please consider joining our Equality & Diversity Special Interest Group or our LGBT Health Special Interest Group. To express an interest in joining please email policy@fph.org.uk and we can help you get started!

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Psychological support in disasters is public health’s business

Posted in Uncategorized, tagged , , , , , , on February 14, 2014| 2 Comments »

  • by Dr Anne Eyre
  • Trauma Training

I recently met a Director of Public Health. We were both in the lunch queue at a conference which was focusing on civil contingencies, the needs of people in disasters and organisational structures for addressing local resilience.

As we queued I asked her about provision of psychological (trauma) support services in her area for addressing the needs of people in the event of a major emergency. She replied, somewhat curtly, that she did not know: it was not her responsibility she said; it was not her budget. I was told I obviously hadn’t read the Health and Social Care Act, 2012.

Somewhat bemused, I sought reassurance. Perhaps I had misunderstood; she was not suggesting that psychological support services are not to do with public health? Sadly, I did not get that reassurance.

Just to be clear I went away and re-read the Act, and also the Department of Health’s guidance on the roles and responsibilities of Directors of Public Health in Local Government. This says that, among other things, Directors of Public Health (DPH) should offer leadership, expertise and advice on a range of issues, from emergency preparedness through to improving local people’s health and concerns around access to health services.

With regard to health emergency, preparedness resilience and response (EPRR) the role of Local Authorities, via their DPH, is to:

  • Provide leadership for the public health system within their local authority area;
  • Take steps to ensure that plans are in place to protect the health of their populations, and
  • Fulfill the responsibilities of a Category 1 responder under the Civil Contingencies Act.

This is encapsulated in the Emergency Preparedness Framework 2013 (NHS Commissioning Board, 2013).

At a time of tight budgetary constraint, and pressures on all those working within our public services, keeping trauma support and other mental health services on the agenda remains a formidable challenge in ordinary time, let alone in the context of major emergencies and disasters.

Perhaps this helps to explain why psychological support services, and indeed broader aspects of humanitarian assistance, remain the poor relation when it comes to emergency planning, response and longer term recovery in so many areas of the country. But these are integral aspects of public health, and not just in the event of disasters.

It is a worrying thought that our sense of health responsibility could become limited only to those activities over which we have direct budgetary control. Directors of Public Health in particular have a key role to play in delivering real improvements in local health in today’s health system. They are corporately and professionally accountable; with such seniority comes responsibility.

The challenge and expectation on all those who lead on health-related initiatives before, during and after emergencies, is that they will think holistically about people, across phases of disaster, beyond rigid organisational structures and within a multiagency framework in responding to the needs of their communities. For a long time this idea has been encapsulated in the concept of integrated emergency management and it is integral to so many of our organisational philosophies today.

I think it is important that we never forget that public health is about people and that responding to disasters – before, during and after they strike – is about helping and supporting people, including through the provision of robust public mental health services. This is not to say it is easy, and not to acknowledge that addressing mental health and other needs in today’s world of limited budgets and organisational structures can be difficult. However the challenge to those in leadership positions, and indeed all of us, is to work with and through these, not be constrained by them.

The public and those we serve will help ground us in this. Try telling those affected by the recent floods, or any other disaster for that matter, that public health in emergencies is not to do with psychological support.

References

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Brixton Reel Film Festival: mental wellbeing through the movies

Posted in Uncategorized, tagged , , , , , on October 10, 2013| Leave a Comment »

  • by Lucy Smith

Public Health Manager – Mental Wellbeing
Lambeth & Southwark Public Health Directorate
London Borough of Southwark

Public health work in Lambeth and Southwark has always sought to include a programme improving mental wellbeing for all who live and work in the borough. This includes improving mental health literacy, increasing capacity in the community and workforce to do more to understand and work to promote and protect mental health and to influence policy and strategy across all areas.  Brixton Reel is an outreach project as part of the wider programme.

Lambeth and Southwark have high levels of mental ill health with around 30-53,000 people aged 16-74 years old who could be suffering from common mental health issues such as anxiety and depression. In addition there are groups who do not have a diagnosable mental disorder but who score low on life satisfaction and wellbeing scales, such as people who have a disability, are unemployed or carers or in receipt of benefits.

Lambeth & Southwark have an ethnically diverse population with a large black and minority ethnic community, mostly black Caribbean or black African. There is also a large white Portuguese speaking population in Lambeth. In Southwark there is a Latin American community of mainly Spanish speakers.

The Brixton Reel Film Festival was first commissioned in 2009 by Public Health to promote positive mental health and wellbeing in African/African Caribbean communities and to help empower those communities to take action to take care of their own wellbeing.

It also seeks to use film as a medium to de-stigmatise the concept of mental health, promote and improve recovery and accessibility of services, such as local psychological therapies and to understand more about the experience of living in the borough for different communities.

The project is delivered in partnership with a range of partners (often smaller organisations) such as Telefono de la Esperanza, Amardeep and Carenet who provided outreach, staff time and venue space. It is thanks to the support of partners and match funding from the Maudsley Charity that the festival has grown and successfully reached its target communities .

In 2012 the festival expanded to include an event in Peckham for the first time. Six film events were held at local cinemas and community hubs with free food and entertainment and open to all. Representatives from the health community and volunteers engaged in talking to people about mental wellbeing.

‘Sing your Song’, about the life of the African-American singer and human rights activist, Harry Belafonte, was one film screened. A lively and informative panel discussion took place afterwards with social activists, historians and actors about how Harry’s life story exemplified the ‘five ways to wellbeing’.

A final event was held in March at a Portuguese restaurant with Fado singers. A previous festival included the screening of a short film, ‘Connect’ made by young people from St Martin’s Estate, Tulse Hill, who then had an opportunity to engage in a Q & A session and meet actors from the film ‘Attack the Block’. Other events included laughter yoga and bollywood dancing as well as short film to promote the link between physical activity and wellbeing.

Evaluation of last year’s festival recorded almost 800 people attending. Of those who completed evaluation forms (284), 84% said the events had increased their understanding of mental health and wellbeing, 65% had found out information about services that could help them, friends or family. Over two thirds (63%) said it had changed their view of people with mental health issues.

A fifth of the audience were White or White British with the majority being from target groups of black British/Caribbean or African background and 6% Asian. There was a cross cultural aspect to the festival with events being attended by African-Caribbean and Asian communities who may not socialize together in other circumstances.  The festival also had radio coverage in the form of live debates on Colourful Radio and BBC Radio London’s Sunny and Shay Show.

Brixton Reel 2013 is funded by Lambeth CCG and London Borough of Southwark and  will take place this November. For more information on this project or full evaluation report please email: lucy.smith@southwark.gov.uk

Feedback about Brixton Reel:

“I’ve just moved to Brixton and it is really nice to know there are fun, free and interesting events on here. It’s good to know that mental health is taken seriously too”

“Such events are very important because being “alone” (at home) is a feature of poor mental health. Bringing people together often (in small ways) is needed”

“This event is important to allow friends to express how they are feeling after the event, touch on subjects that might have been not spoken about, which leads to better understanding.”

‘Participating in the activities and speaking with the public about mental health. Also I found quite satisfying was when I encouraged an individual to speak to another organisation relevant to their needs’ (Festival Volunteer)

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Expert argues prisoners have a right to better health

Posted in Health Inequalities, Health Protection, tagged , , , , , on December 2, 2009| Leave a Comment »

By Dr Alex Gatherer

Consider some of the facts relating to prison health.  The majority of prisoners, some 80% or so, have some form of mental ill health, and between 5-10% have serious mental illness, which requires specialist care in suitable facilities.

Furthermore, in any community, the local prison at any one time will hold a disproportionately high number of non-nationals and minority ethnic groups, of people positive to HIV and Hep C, of people with educational and social skills deficiencies, of those addicted to some form of substance addiction, of those with serious communicable diseases and of those previously hard-to-reach in our cities and towns.

In most countries, including our own, this high needs group will be detained in old premises with inadequate facilities for meaningful activity and recreation and often in overcrowded conditions.

And the majority of prisoners will be out of prison and back in their home environments on the streets in our communities often after only a short time.

‘Statistical compassion’ is one of the unmentioned skills required of top quality public health practitioners.  We must be able to look behind the statistics and see the suffering, the unmet needs and the social injustices amongst the individuals who make up the overall figures that are so central to the reports we write.  Without ‘statistical compassion’, how can we make sure that we take into account, in everything we do, those who are in greatest need?

Public health has a choice. We could ignore the above, as we did for many years and waste any opportunities to help a vulnerable high risk group. Or we could realise that it is in the interests of public health as a whole to prevent our prisons from being focal points of disease.

We could also realise that the right to health applies to all.

  • Dr Alex Gatherer is Fellow of the Faculty of Public Health. In November 2009 he was awarded the American Public Health Association’s Presidential Citation for his work in improving health in European prisons.

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