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It may have been running for nearly thirty years but World Mental Health Day is as vital now as when it was first brought into being. Celebrated on 10^th October, the day was initially seen as a way of bringing forward debate on mental health issues. The first ‘theme for the day’ introduced in 1994 was “Improving the Quality of Mental Health Services throughout the World.”

This year’s theme of “Mental Health in an Unequal World” reflects the importance of ensuring equal access for all. This focus on equal access is particularly important in the light of the Covid crisis, with the World Health Organisation singling out groups such as health and frontline workers, students, people living alone and those with pre-existing mental health conditions as having been particularly affected.

In tandem with this year’s theme, in the UK research carried out by the Mental Health Foundation reveals that those with long term health conditions, facing discrimination, or parenting on their own are particularly vulnerable. Commenting that “we are all in the same storm, but we are not all in the same boat,” the Mental Health Foundation study reveals a divergence of support depending on social and/or economic factors. That, they say, leads to a need for a multi-faceted response plan which takes into account not only immediate mental health needs but also looks to alleviate the socio-economic causes of mental health problems.

The fact is that although the country is opening up, the effects of covid are ongoing. And whilst anxiety levels may be decreasing, (49% of the population having felt anxious or worried due to Covid in the third week of June, compared with 62% in mid-March), that doesn’t mean that all is now well. People have been affected by the ongoing Covid pandemic, and there is a fair chance that ongoing anxieties may continue for some time to come.

On a more positive note, the World Health Organisation (WHO) comments that at the world Health Assembly in May 2021, “governments from around the world recognized the need to scale up quality mental health services at all levels” with some countries finding “new ways of providing mental health care to their populations.” The WHO is using World Mental Health Day to highlight some of these successes on its website with testimony from around the world under the theme of “Mental health care for all: let’s make it a reality.”

As highlighted above, when we talk about mental health care for all we should remember that certain groups including those in the medical profession are particularly vulnerable. ‘Physician heal thyself’ may be an old cliché but it is one which is particularly apt here. It can be all too easy for those in the health profession to focus on patient care at the expense of their own mental well being.  That’s where finding ways to work smarter, to call on outside help when needed, and to use digital solutions to reduce administration can make such a difference. Making time to step back and to de-stress is an essential part of health practice. After all, in order to best serve your patients, you need to be fully focused and clear about what you can offer.

World Mental Health Day 2021 calls for equal access for all. Don’t let those in the health profession be the ones to miss out.

There probably won’t be many who would disagree with the statement that ‘exercise is good for you’. But it has to be the right sort of exercise. Whilst some may thrive on marching ten thousand steps a day or a rigorous gym session, other individuals may find that more gentle pursuits will suit them better.

In fact, just as we are all individuals, the type of exercise which we take should also be individual to us. What my body needs in order to optimise health and cardiac strength may well be completely different to what you need. So much so that what benefits you might actually harm me and vice versa.

That individuality also extends to the exercise strategies we adopt when recovering from an injury or when affected by a disease. There may be a standard suite of recommendations, but some will work better than others. But how will you know what suits you best if you aren’t aware of the alternatives? That was the challenge which researchers set out to meet when they looked at the walking strategies adopted by those with Parkinson’s disease.

There are seven recommended coping strategies to help those with Parkinson’s remain mobile. These include walking to the sound of a metronome, motor imagery in which individuals copy another individual’s walking pattern, and adopting relaxation techniques. The researchers found that whilst 35% of those surveyed admitted that walking difficulties affected their daily lives, just 4% were aware of all of the recommended coping strategies with 17% never having heard of any of the strategies.

This lack of awareness of the options can be particularly problematic as some strategies work better than others in different settings. For example, the movements’ visualisation strategy saw an 83% success rate when used outdoors but this fell to 55% when used in confined spaces. This led researchers to conclude that “The choice of compensation strategies for gait impairment in PD should be tailored to the individual patient, as well as to the context in which the strategy needs to be applied.”

However, the researchers also stressed that that choice should be based on an individual first being aware of all of the options. Now that’s a strategy which works well in so many areas of life. Yes there is a danger of becoming bogged down in the detail, but approached in the right way that danger can be avoided as people and businesses benefit from being able to make the right choice for them from a position of strength in knowing what options are available.

For example, with winter coming up and the continuing uncertainties of covid, health businesses may be concerned about enabling existing and potential clients to contact them. Knowing that options are available which could help to maintain a high level of professional patient contact could ease concerns. These options include the use of online booking services or the ability to switch phone calls as required to a virtual assistant service. Knowing and flexibly deploying options could help businesses not only to maintain a good service but also potentially to improve service levels, enabling them in turn to improve the lives of their clients. Time to walk? Maybe with the right mix of services it could even be time to run!

“I hope all of the cadets have been inspired by their experiences and if they decide to continue their path in healthcare – whether as a doctor, nurse or midwife, or in one of the many other roles available – they will be welcomed with open arm.”

Those comments were made by the Chief Nursing Officer for England, Ruth May, as she welcomed the first group of graduates from the NHS Cadet programme. Launched in 2020 the programme, which is run in tandem with the St John Ambulance Brigade, aims to provide teenagers with a basic understanding of a healthcare career.

Alongside first aid training the cadets learn leadership and other skills as they help out with NHS vaccination centres or support clinicians by assisting patients. Whilst the programme actively seeks out those from marginalised backgrounds as well as those currently not in employment, education or training, it also looks to attract those who might not have previously considered a career in the NHS.

The next tranche of cadet programmes starts in September 2021. Running across more than 55 sites, the programme will accept “more than 1,000 cadets on the foundation pathway for 14 to 16-year-olds, and around 500 on the new advanced pathway for 16 to18-year-olds.” In this, the volunteer cadets will join countless other volunteers who help out in a number of roles across health services.

Volunteering can help cadets to gain a glimpse of the more than 350 careers which are available across the wider healthcare profession. Commenting on the programme the Chief Executive of St John ambulance said: “St John has partnered with the NHS on this ground breaking programme because we know that access to a career in health represents a brilliant future, especially for young people who have faced challenges in earlier life.”

Of course, volunteers should not and will not replace trained healthcare practitioners. But by supporting patients, they can help to ensure that healthcare practitioners focus on providing timely and effective healthcare solutions. And with resources stretched, in particular following the Covid pandemic, any way in which time pressure can be reduced in the health service is to be welcomed.

Even simple approaches such as sending SMS text reminders to encourage people to attend appointments can help to smooth out patient flow and optimise treatment time. Not only can SMS texts remind those who may have forgotten about an appointment, they can also encourage those who are unable to attend to cancel in good time, thereby freeing up time slots for others to make use of.

Or how about the provision of an online booking service? With patients taking the lead in making the booking, not only are they more likely to choose an appointment time which best suits them, they are not taking up valuable clinician or support staff time in managing the booking. In a time pressured world even simple steps such as these can help to reduce time congestion; thereby enabling health practitioners to concentrate on providing good levels of ongoing patient care and perhaps in the process inspiring others to join a healthcare profession.

A focus on patients, not paperwork. That’s the aim of the Health and Care Bill which was introduced to Parliament on 6^th July. The Bill builds on NHS recommendations for reform, including the White Paper ‘Integration and Innovation: Working together to improve Health and Social Care for all’ which was published in February 2021.

Delivering the Bill’s objectives requires a greater focus on collaboration between the NHS, care providers and local councils. By bringing together areas such as social and mental health care in the community alongside NHS services it is hoped that the needs of individuals as well as the population as a whole will be better met. As Sir Simon Stevens, NHS chief executive, commented: “This Bill contains widely supported proposals for integrated care, which have been developed and consulted on over recent years by the NHS itself.

This joined-up care even extends to dental and ophthalmic services, giving integrated care boards responsibility for these areas. For example, section 99 of the new Bill requires integrated care boards to make the necessary arrangements to secure the provision of primary dental services to meet the reasonable requirements of the persons for whom it is responsible.

It is also hoped that the new flexible and collaborative model proposed by the Bill will enable the development of new solutions such as moving certain services out from hospitals and into communities. In turn this may help to deliver a more personal care structure for individuals as they look to move from hospital to community care settings.

Alongside that fresh emphasis on collaboration, the Bill also introduces a new procurement regime for the NHS. It is hoped that this will reduce bureaucracy and the need for competitive tendering. In particular it is envisaged that this will also speed up the procurement process, helping health services to react in a more timely fashion to changes in health requirements, such as that caused by Covid.

Preventative measures also come in for review with the emphasis on reducing future demand on health services. Here again the Covid pandemic has highlighted the impact of poor health regimes and inequality in health outcomes and the need for the Government to act in improving the general health of the population. One area here which has already come in for comment is the decision to ban the advertising of junk food on TV before 9pm.

Commenting on the Bill the Health and Social Care Secretary Sajid Javid said:

“The astonishing response of our health and care services to the COVID-19 pandemic has hit fast-forward on some of the bold changes the NHS set out to deliver in its Long Term Plan and shone the spotlight on other areas that require change to achieve better care for our communities. To help meet demand, build a better health service and bust the backlog, we need to back the NHS, as it celebrates its 73rd birthday this week, and embed lessons learned from the pandemic. This will support our health and care services to be more integrated and innovative so the NHS can deliver for people in the decades to come.”

What do you do when someone makes a reservation and then either fails to show up or cancels at the last minute? It’s a problem which is having a significant impact on the pub and restaurant trade as it comes out of lockdown.

At a time in which table numbers are limited due to social distancing requirements and yet venue and staffing costs are fixed, every empty space could potentially tip a venue into a loss making situation. And when not just one or two but a hundred people fail to turn up over a weekend, as one pub reported to the BBC recently, then it’s easy to see why the problem of no-shows is hitting the headlines.

In response, an increasing number of venues are starting to take credit card deposits at the time of booking.  Talking to the BBC, one pub owner commented that: “The taking of the card details has been exceptionally effective. Our no-shows have gone to virtually nil and our late cancellations have evaporated.”

Encouraging people to only book tables if they are reasonably certain they will attend the venue, or at the very least to cancel in good time, not only helps the hospitality industry it also helps fellow diners who otherwise would be turned away. So it is a win-win situation for venues and their customers.

It’s also a lesson which other sectors can learn from. In the health sector which has its own no-show problem, various approaches have been taken in recent years in order to encourage people to attend booked appointments. And with some fifteen million no-shows each year at GP practices, representing some 5% of all appointments, the problem of individuals failing to attend appointments is one which definitely has an impact on the health of the nation.

 Perhaps the method which people are most familiar with nowadays is the sending of an SMS text reminder. It’s a fairly simple approach, but can prompt people to cancel and rebook if they are no longer able to make the appointment.

Currently there is no option for NHS practices to charge patients who fail to turn up for appointments. Nevertheless, that doesn’t prevent other health practices which do charge for their services from charging for no-shows. By taking credit or debit card details at the time of booking, health practices can, in accordance which their advertised procedures, debit those cards with a fee in the event of an individual failing to turn up for an appointment or cancelling at the last minute.

Here again, the process of handing over card details and knowing that a charge will be made in the event of a missed appointment can help to concentrate people’s minds and encourage them to cancel in good time if they are unable to attend. And of course practices are still free to waive the charge in the event of extenuating circumstances. The charge should be viewed not as a way of penalising customers but as a way of encouraging attendance; thereby optimising appointment times and ensuring the maximum number of people can be seen in the time available.

Equality, diversity and inclusion: three practices which should be baked into the core or every organisation. But sometimes it pays to step up and do more than the usual day to day in order to celebrate these traits. To take the time to highlight ongoing efforts to promote the fair and equal treatment of all, as well as to share best practices.

Recognising this, the NHS Employers’ Equality, Diversity, and Human Rights Week looks to encourage and support health and social organisations to join in a national conversation about the promotion of equality and diversity. The week, which runs from 10^th to 14^th May, takes as its theme the NHS Peoples Promise. This has been broken down on successive days to cover:

• Being a team
• Being recognised and rewarded
• A voice that counts
• Safety and health
• Compassion and inclusivity

Events across the week include twitter chats, virtual round tables, and webinars; with individual organisations also being encouraged to undertake their own programme of events, even if those simply take the form of a chat over coffee.

Interestingly, the week coincides with another important event; Mental Health Awareness week. This runs from 10^th to 16^th May and takes as its theme the positive impact which nature and green spaces can have on people’s mental well being.  Research from the Mental Health Foundation revealed that over the past year, going for walks outside was the top coping strategy. Moreover, 45% of individuals surveyed reported that being in green spaces had been vital for their mental health.

Recognising that around 13% of households don’t have access to a garden, the team behind Mental Health Awareness week hope to use the event to promote the importance of access to green spaces; aiming to convince “decision makers at all levels that access to and quality of nature is a mental health and social justice issue as well as an environmental one.” Their second aim is to inspire people to connect with nature in new ways for the benefit of their mental health.

As Mental Health Foundation Chief Executive Mark Rowland said: “Nature is not a luxury. It is a resource that must be available for everyone to enjoy – as basic as having access to clean water or a safe roof over our heads.”

This is a conversation which could also be had as part of the Equality, Diversity and Inclusion week. Are there steps which could be taken to improve the natural surroundings at your organisation or to help those who may not have a garden to better access green spaces? Would there be a benefit in encouraging individuals who feel stressed or overwhelmed to step outside and take a quick walk in a nearby park or public green area? And how could work schedules be reorganised so that people have the time to step outside when needed?

It’s easy to say that working hours should be filled with working activities. But when we become stressed the quality of our work and our decision making can suffer. Being able to take even ten minutes outside in a green space could just help to break the stress cycle, thereby leading to a more productive and safe working pattern.  

The reopening of gyms marks a new chapter in the UK’s recovery from covid. Admittedly, at the time of writing, only those in England have reopened, with Scotland due to follow suit on 26 April. In Wales the gym re-opening time has been brought forward to 3 May, whilst those in Northern Ireland are currently awaiting an announcement.

Nevertheless there are signs that, with sports and other outdoor activities also opening up to training and even competition, fitness in the UK may no longer have to rely on walks, cycles and solitary home exercising. Not that exercising in the home doesn’t have its place. Particularly as we get older, regular stretching and mobility training could be beneficial in the long term. And, where better to carry out those exercises than in the home, albeit under regular supervision and check-ups from a physiotherapist or other health professional.

But does regular exercise really bring the expected benefits? That was the question asked by a two year randomised control trial which assessed the effectiveness of ‘Standing Tall;’ an e-health balance exercise programme delivered through an app, which aimed to reduce the incidence of falls in older people. The trial, the results of which were reported in the BMJ, [1] revealed no statistical difference after twelve months between the control and intervention groups. However, when viewed over twenty-four months, the intervention group had a 16% lower rate of falls and 20% fewer injurious falls.

The report’s authors concluded that the results showed that “a tailored e-health exercise programme is an effective intervention in preventing falls in older people.” This backs up other studies which have demonstrated the way in which balance exercise programmes can be an effective way of reducing falls amongst those who live in the community. The challenge for health professionals is to find a way of ensuring that individuals follow recommended programmes. The report’s authors say that without some kind of physiotherapist led intervention or home visit programme just 21% of individuals stick to exercise plans.

Of course the need for such interventions can place a strain on health resources; not something which would be recommended at a time when a return to general exercising will inevitably bring with it increased demand. Perhaps that’s where e-programmes can help, delivering prompts as required and helping people to maintain a regular exercise programme.

It’s another example of the way in which technology can benefit the health service. In recent years we’ve seen how SMS text and other electronic reminders can help to boost appointment take up. And we’ve also experienced the benefits which electronic diaries and digital patient records can bring; in particular in reducing administration time; or in the case of digital records in enabling a more holistic treatment regime thanks to the easy availability of records across disciplines.

The more that individuals can integrate simple exercises into their daily routine the better. Even the basic balance exercises shown on the NHS website [2] could make a difference in the long term. Every fall prevented not only helps individuals to live a more productive and healthy lifestyle, it also reduces demand on health services.  It’s time to step up, stand tall and get exercising.

[1] BMJ 2021;373:n740

[2] https://www.nhs.uk/live-well/exercise/balance-exercises/

“The growth of self-employment and home-working has resulted in many more individuals potentially spending much of their day in virtual isolation.”

That quote comes from our February 2020 article which examined the challenges of isolation, with particular reference to both homeworking and a House of Lords Science and Technology Committee enquiry into protecting cognitive ability and mental health processes in old age. One year on, and the challenges posed by lockdown and isolation have moved into mainstream consciousness.

Sadly some of the solutions suggested in our previous article such as promoting an active social life have been overtaken by events. And no matter how many online quizzes or get togethers we have, they are not the same as meeting freely with a group of friends or family. Nevertheless, the core of our article, making use of technology to free up personal time, still remains valid. Even something as simple as deploying SMS text messages to remind patients of their appointments could help to free up valuable time. And when health services are working at full stretch, personal time is at a premium.

Online socialising, managing the day-to-day or home schooling aside, what other options are available for those who are locked down or working from home? Well, we may not be able to take part in group sporting activities but the benefit of ongoing physical exercise cannot be underestimated. And that doesn’t just mean getting out for a run or bike ride after work or taking part in an online exercise class.

Sometimes little and often can be of great benefit, particularly if you can incorporate your routine into your working day. So when you have saved yourself five or ten minutes by retrieving a client’s electronically saved file rather than having to find a manual file why not take the opportunity to do a bit of stretching. And when generating an invoice proves to be unnecessary as your client has paid by card in advance of their appointment, take those couple of free minutes to check your desk posture or even just walk up and down your stairs. For those who are working from home or in a mainly desk-based occupation The Chartered Society of Physiotherapy (CSP) website demonstrates a few ideas for relieving aches and pains.

A study released in January 2021 by the University of Oxford revealed that when it comes to cardiovascular disease ‘every movement counts toward better cardiovascular health’ Admittedly the greatest benefit was seen by those who were the most active; highlighting the benefit of following World Health Organisation guidelines in undertaking at least 150 to 300 minutes of vigorous activity per week.

But when time is at a premium then every opportunity to move and stretch muscles could help. Better still, work some stretching exercises into your daily routine. A couple of minutes here and there won’t noticeably impact your working day but it could help you end that day feeling  a little more refreshed than you would do otherwise. And while you are building that new routine, take the time to ensure that you are also ‘working smarter’; making the most of technology in order to cut down on administrative tasks. Then you may have time for a little more exercise after work.

How do we interact with the world around us? It’s a fascinating subject and one which is throwing up new discoveries all the time. It might be easy to dismiss as a cliché the comment that how I see the world is different to your perception. However, the more that we learn about perception the more we understand that each of our individual responses may be influenced by a range of stimuli including past experiences and our personal and physical circumstances.

Recently two articles on the Science Daily website have added to the discussion about perception and response. The first reported the results of a study into the way in which our brains not only track how we move through the physical environment but also how we perceive the movements of others.  By deploying a backpack which wirelessly connected to electrodes, the study collected data in real time as participants moved through a room. Interestingly the study identified the fact that what we pay attention to influences the way in which our brains look to map out a location. For example brain patterns flowed more strongly when the participant was looking for a hidden spot than when they were merely exploring the room.

The second article looked at the results of a study into the way in which our auditory pathway is affected by preconceptions. It’s been known for a while that our cerebral cortex predicts what will happen next, with sensory processing neurons merely encoding the difference between those predictions and reality. Now a study has discovered that the same is true of the auditory pathway. Commenting on the study Dr Alejandro Tabas commented: “Our subjective beliefs on the physical world have a decisive role on how we perceive reality.” adding “We have now shown that this process also dominates the most primitive and evolutionary conserved parts of the brain. All that we perceive might be deeply contaminated by our subjective beliefs on the physical world.”

How does this impact on our day to day lives? In part studies such as these only act to confirm what we instinctively know. For example when we give injections we tell patients that there might be a small scratch, thereby managing and minimalising any expectation of pain. Or we encourage positivity in recuperation or in managing a long term condition; helping patients to take control and influence outcomes.

As health practitioners studies such as these also help to remind us that each patient will react and respond differently to treatments and to information provided. There is no ‘one size fits all’ response with each individual reacting in part as a result of their inbuilt programming and preconceptions.

But we too can learn from these studies about the way in which we respond and react to situations. Sometimes our instinctive reactions are the right ones, born out of past experiences. But other times it may be worth stopping to question whether our decisions are based on past ‘bad’ experiences and whether we are unfairly projecting these on to new situations.

For example, is a previous poor experience of technology putting us off from trying a new programme? Or is a reluctance to engage with new methods of working a response to an earlier trial which may have taken place at a time in which we were already overloaded? In other words, is our brain anticipating a negative response and do we therefore have to work even harder to overcome and set new more positive pathways in place? Anticipating responses can be a lifeline when under pressure. But failing to question and to learn new pathways can also lead to a repeat of past mistakes. That’s really why studies such as these are so important. Not only do they push the boundaries of understanding but they also force us to stop and reconsider.