The fact that cities and urban centres can increase stress in individuals is well recognised. There is a correlation between living in a city and a range of mental health problems, although this doesn’t automatically mean urban life has to have a negative impact on our wellbeing. Cities concentrate on a range of factors, both positive and negative. So, a city may suffer from pockets of deprivation, high rates of crime and pollution, but also provide good educational opportunities, access to modern medical care and stimulating public spaces. However, as anyone who commutes through a big city will know there is a lot of stress about.
This was brought home to me this week as I attended a two-day training course. Other attendees came from across London and the south-east of England. The organisers had clearly worked hard to identify a location within the Greater London region that meant regardless as to where your journey began reaching the venue would provide a challenge of navigation and endurance. It is perhaps a good thing that the topic being covered was Mental Health First Aid.
Fortunately, the course was exceptional. It offered a great deal to managers or those whose work areas brought them into contact with mental health issues even if they had not had any formal training in the subject. There is also a lot about looking after your own mental health. If you get an opportunity to go on a course like this I recommend grabbing it.
Travelling to this non-exotic and highly inaccessible location did provide me with more time than usual to reflect and think. Naturally enough I was considering about the progress made in terms of mental health. Certainly, there is now greater recognition of the issue. A number of high profile individuals have been very open about their experience with mental ill health. Time to Change and Thrive LDN have done much to help reduce discrimination and stigma. The statistic that one in four people will have a mental illness in their lifetime is embedded in the public consciousness. It can sometimes feel like improvements in treatment services are lagging behind, but profile raising, encouraging people (and politicians) to talk about the issue does help secure resources. So overall it feels like progress is being made. I was feeling generally positive until I thought about dual diagnosis.
There are two subjects which always trigger a stress response with me. Sometimes this can even lead to a degree of aggression (albeit normally revealing itself as noisy exasperation). Dual diagnosis is one. Hepatitis C the other. Both were issues I became aware of early on in my drug and alcohol policy work. Twenty years later I struggle to understand why we have not made better progress. It can make me angry. This is especially true in regard to Hep C, where new drugs offer so much promise, but that is for another week.
So dual diagnosis. It is far from uncommon. Indeed, for many drug and alcohol services most of their clients will have a mental health issue. Likewise, mental health services have significant numbers of clients with existing or a history of substance use problems (although it varies massively depending on the diagnosed condition). Obviously, many people within this group have complex problems and require specialist and long-term support. But for many people seeking help they find themselves falling between services.
This partly reflects the discussion over which issue has primacy. Should the mental health issues be treated first? Or do we need to deal with the drug use or drinking first. This debate is reflected in a mountain of research which consider whether drug use caused a specific the mental health condition, or has it perhaps aggravated or triggered an underlying problem. Or is it the case that the drug use may be self-medication? These are all valid questions and the accompanying arguments are good in terms of attracting grant funding, stimulating debate and progressing professional careers. Of course, I recognise that these are not just abstract points and can have important benefits in guiding more effective treatment and approaches. But from my perspective the plight of the individual, the family and friends has too often been lost. We have not focused enough on closing the gaps between services (often unintentionally encouraged by commissioning practices), of bringing different disciplines and professions together. If professionals often struggle to navigate treatment pathways, then something has gone seriously awry. Drug and alcohol treatment and mental health services should not be in competition.
We live in demanding and rapidly changing times. Our populations will experience various stresses and threats to their physical and mental health and effective, resource, smart, responses to these stresses and threats requires new ways of thinking and new collaborations, but we must never lose sight of the individual.