Interviews

Integration vital to tackling mental health in the capital

Dr Onkar Sahota AM, chair of the London Assembly Health Committee, discusses the urgent need to integrate mental health services. David Stevenson reports.

At any one time more than a million adults in London are estimated to have mental health problems, but getting access to the right care pathway and service is far too “fragmented”, PSE has been told. 

A new report, ‘Healthy minds, healthy Londoners’, published by the London Assembly’s Health Committee, has estimated that some £26bn is being lost from the capital’s economy each year as a result of mental ill-health through reduced productivity. 

Dr Onkar Sahota AM, chair of the Health Committee, told PSE: “I am on the front line, but of course it is good to hear from experts.” 

London’s younger generation and black, Asian and minority ethnic (BME) people are of particular concern. There are “cultural, practical and structural” reasons that they do not always get the help they need. 

He said it was a “surprise” that there was no recent research into this. “The last data is about 10 years old, so commissioners are using data which is out of date, not accurate and does not give a true reflection of the size of the problem and what services are needed to address it.” 

Mental health must be as much of a priority as physical health and should not be dealt with just at the crisis stage. Therefore, there must be a focus on prevention and early intervention. 

Dr Sahota added that many people with mental health problems can also end up having social problems, housing problems, issues with employment, and great difficulty coping in the community. “Therefore, we need to make sure they are given an integrated care package. Mental health services – and I say this from the front line as a doctor – are very fragmented,” he explained. “You have to apply to social services for social help, mental health services for mental health services. The point of entry can be very difficult and some of the services available aren’t appropriate. 

“For example, I saw a patient recently who had a counselling need – but they may not be seen for three to four weeks before counselling – and they need this service immediately. 

“In the capital we have more than one million people suffering from mental health illness, which is the single largest cause of being unwell. It is higher than the incidence of cancer and heart disease. It is a big problem. 

“We need to treat mental health illness as we treat physical illnesses. Just because we can’t see broken minds as easily as we can see broken arms and legs, we need to give them equal priority.” 

He also noted that good mental health isn’t “just about being absent of disease” it is about being in a “state of wellbeing”. The report cited Office for National Statistics figures showing that London compares badly to the rest of the UK against all four measures of general wellbeing – anxiety, happiness, satisfaction and worthwhileness – that exist regardless of clinical diagnosis. 

“Although it is hard to find the ‘cause’ of wellbeing, things like good housing, employment and reaching your potential are all measures that contribute towards the feeling of wellbeing,” said Dr Sahota. “London’s problems are much more pronounced and we need to make sure we have a holistic approach to people and the wellbeing of cities.”

People of African/Caribbean descent, the largest minority ethnic group in London, are over-represented at each level in the psychiatric process. They are also more likely to be treated as inpatients and sectioned than any other ethnicity. 

Discussing the report’s recommendations, Dr Sahota said: “We need to get up-to-date data. We need to make sure we are commissioning services appropriately and that they are accessible through a single point and that there is integration of care.” 

The Health Committee has now called on the mayor to set out what additional steps he (or a future mayor) could take to promote good mental health in London, particularly with reference to young people and BME groups. 

It has also recommended that NHS England London works with London boroughs and clinical commissioning groups to shift focus to early intervention and prevention when commissioning mental health services and support. 

“I do hope the mayor gives this issue the attention it deserves,” said Dr Sahota. “We should be looking at the health impacts of all our policies, as it is the only way to address this topic.” 

The mayor’s office had not responded to a request for comment at the time of publication.

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