Welcome to the Oxford Psychiatry Podcast series, today's podcast will be a little bit different.
I'm here with Dr. Daniel Ball to talk about his work in sustainability.
He's taken two years out of his psychiatry training to think about sustainability.
So, Daniel, could you tell me a little bit more about what you're doing at the moment?
Thank you, Charlotte. Hopefully it will be different, but also interesting and different.
Sustainability is something which is difficult to get your head around.
But once you do, I think it's quite an interesting paradigm or interesting way of thinking about mental health services.
So what am I doing at the Royal College of funded a two year post to think about sustainability of mental health?
They've chosen a clinician because they realise the importance of thinking about sustainability from a clinical perspective.
So the next two years will be about thinking through what a mental health service looks
like when it is improving and sustainability when the practise is when the governance,
when the interventions are thought about from a sustainable perspective and improvements are made that reduce the impacts,
the broad impacts that services are having on society, the environment and economically as well.
It sounds a very broad remit that you might be involved in lots of different things.
But could you just give us a flavour of what exactly sustainability is?
Sustainability is a very broad subject and it can be quite confusing.
It rose out of the corporate out of corporate America when they were trying to understand what corporate responsibility should be,
trying to understand the broader impacts of an organisation.
And John Elkington came up with the triple bottom line as a framework for understanding sustainability.
So an organisation has impacts in three broad areas. People profit and planet.
So it has impacts on society, on communities,
and has impacts on profit and the money that they're making or the money that they are using and has impacts on the environment.
So when we think of our mental health services and sustainability,
what we need to realise is that every everything that you do, every drug you prescribe,
every intervention has a financial cost and environmental cost and the social cost or another way of thinking about this is about capitals.
So if you think about the fact that we have financial, environmental and social capital,
well, the first two, we need to make sure we reduce our impact on those capitals.
And I think actually mental health services should be restoring social capital because
mental health conditions can reduce social capital by reducing community contacts,
reducing employment rates, things like that.
So mental health services should be restoring social capital. So we think about it in those three areas.
Right. Another way of thinking about sustainability is that analogy of a factory.
We have a factory, say, in Europe somewhere that is producing the most wonderful teddybear, the cheapest price.
And you think, well, it's a fantastic factory,
but actually you take a broader look and you realise that that that factory is working its workers to the bone so that they their morale is low,
their relationships break down because they're spending all the time at the factory.
The factory don't give pay them enough so they can't send their children to school and you find that they're polluting the river a lot.
So what you find is that although it's a great product for small cost, the environmental and social impacts are really significant.
And in a sense, the NHS is doing that.
We are delivering really good interventions for small amounts of money, which is great, and I don't want to knock that.
But actually, if you look at the environmental impact, it's huge.
It's the equivalent of a few sub-Saharan Africa countries put together or a couple of Eastern European countries.
And actually, if you look at some of the social impacts,
the staff experienced patient experience or actually what the NHS is thinking about in terms of contributing to communities,
to local communities and the impact that it could have, it's just not thinking in these ways.
And just like that factory needs to wise up a bit.
The NHS needs to wise up to the fact that it has a lot of potential to improve its practise and a
lot of scope to really build build communities and be an inspiration really to other organisations.
And as health care professionals, we should be leading the way in this regard. But I can see for a service such as, say.
Renal dialysis, there might be a lot of savings that you can make that might have an impact on the individuals
and communities and also on the environment and the planet thinking about water usage.
For example, how would this exactly relate to mental health services where we might be using less resources to some degree?
How can we make that move? It's a very good question. I think that it is easier for the technical specialities, like kidney care, like anaesthetics,
where they're using a lot of materials to focus on what the environmental impact of that is.
But a way that I think about it is we use the bio psychosocial framework, biological,
psychological and social framework to keep a patient healthy when actually any health
organisation needs to use the triple bottom line to keep the service healthy.
So when we think about mental health services, actually medications. Right.
So if you if you look at studies, about 50 percent of patients that we prescribe medication to actually take kids,
if you look at the carbon footprint of medications, they are about 20 percent.
So they're about 10 percent of the income for the NHS is produced by pharmaceuticals that aren't being used.
OK, so what do you think about that? What about maximising adherence?
Another thing is looking at things like how can we reduce clinic attendance by empowering patients to manage their own care so
that there is a different relationship and a different less reliance on services so that empowering patients is about prevention.
It's about the lead service analysis and it's about using technology.
I'm quite excited about the potential for using technology, for educating patients,
for using online cognitive behavioural therapy techniques that have good,
good evidence that first actually peer to peer support networks for patients actually to have access to the electronic notes
and be able to write on them and monitor their symptoms using texting from their smartphones onto a Web based platform.
There's lots of different areas that we can really empower patients,
really educate patients to manage their own conditions more and therefore reduce reliance on services.
And we know that reduce reliance on services actually is less costly financially.
It's less costly for the environment actually, and hopefully will restore them back to an independent functional state in that community.
Therefore, restoring social capital. Wow.
I mean, it sounds like the sustainability agenda then could really improve things on so many different levels.
Actually, when you look at the constraints of the health services at the moment, they're really significant.
So the Climate Change Act says we need to reduce emissions by 80 percent by 2050.
And that's not necessarily legally binding. We're not going to be thrown in prison if we don't meet them, but the NHS is committed to meet them.
If you look at the funding, we're unlikely to get any real time funding increase for the next 10 years for
activity in mental health services increases about four or five percent per year.
How do you think that increase in activity, if you look at the population growth with the fastest population.
We've got the fastest rate of population growth in Europe. How are we going to deal with that?
Mental health services, actually, if you look at society as well.
It changes all the time using social networking sites. Urbanisation, sustainability is something which not only deals with the constraints,
but also moves with the times and gets you thinking about how to engage with society in a preventative way,
not in a not necessarily an individual illness focus, but establishing a community health focussed, preventative and empowering.
I say that as more of a sustainable way of looking at mental health services from a systems point of view.
It sounds like this all makes sense and it's all a really good idea.
But why should psychiatrists or other clinicians actually be interested in this?
What's in it for them? Yes, that's a big question.
It's very difficult to when you speak to clinicians who are overly stressed with their day to day work,
with their day to day clinical burden to get them to think big.
I think patients need to be interested because actually this is a Win-Win if they can begin to see new ways of practise.
To say, which I mean, I've got some ideas I don't have out of it by any means, you know, we we need to work together.
That's part of the network that I'm creating, a sustainability representative network.
We're trying to build up a body of all bank of case studies and experience of what sustainability looks like on the ground.
And we find what you find is, is that there are some things we can do which make life easier for ourselves by, as I've said before,
reducing burden on services, but also working together and having a greater responsibility for your service in general.
And I believe in is a sense of community amongst staff members.
So whilst you might be stressed out by himself, by working together on these things, you can really foster a positive spirit.
And also, I think there needs to be a broader responsibility for amongst clinicians, for the health of their service.
We're in a situation where the NHS isn't guaranteed for the next 50 years.
And we need to really be an advocates for showing politicians and commissioners that we can produce high quality services that are fit for the future.
And we need to think actively about that.
So I think our responsibility does lie in broad, broader terms than necessarily just the patient sitting in front of us.
And clinicians have a history of forward thinking. And I think sustainability is that.
Can you give me a snapshot of what a sustainable mental health service would look
like or perhaps any specific examples about what you're doing locally in Oxford?
Right. Okay, so I think one particular area, when you mentioned kidney care is being an easy way to think about sustainability.
If somebody needs dialysis, they just need dialysis. Well, or they need a new kidney.
But if somebody has a mental health condition, yes, they need all the management.
They need the medication and psychotherapy, the support the mental health services can bring.
But there is also a lot of work that they can do to help themselves.
So I would say there's something about a sustainable mental health services that has recovery as a priority at every step along the patient journey.
It also is one that's developed structures within the community that can maintain mental health.
So an interesting thought is that for people with chronic health conditions for
hours spent in front of a clinician compared to the 4800 hours spent at home,
clinicians tend to focus on the four hours they see the patient was actually we should
really be enabling the patient to deal with those 4800 hours away to improve that.
One way that we think about that in Oxford, as you've asked, is, is the true colours intervention, which is something run by Professor Geddes here,
which is a mood monitoring service and now is more than mood monitoring any kind of mental health symptoms where you texted it on your smartphone,
it goes to a Web based platform. You can see how your your symptoms are doing.
Say you've been drinking a lot. The symptoms aren't so good. You stop drinking, your symptoms improve.
You think, oh, I should maybe not drink as much as I do.
It teaches patients, enables patient, empowers patients to manage their own condition a bit more as one example that we've got.
OK, and are you taken two years out for the Sustainability Fellowship?
What kinds of things are you doing during this fellowship? Well, I'm trying to understand how to measure sustainability.
That's looking at the bottom line framework. People profit think not trying to think not just how much the service costs financially,
but what the environmental impacts, one of the social impacts of an intervention.
We're scoping out potential review of the complex needs service here in Oxford is a potentially sustainable service.
We are building a network which you can join if you go to the Centre for Sustainable Health Care's website and click on the Mental Health Network.
On the left hand side, you can join a mental health sustainability network.
We've got an increasing number of members, currently around 70, which is grown since since in the past month or so,
as I've been beginning to advertise that that's really a sharing of ideas and opportunities for improving sustainability.
And I'm also developing a college record for sustainability.
And really, it's about.
Creating a context for change, not only telling clinicians about how to think sustainably, but also giving them the tools to do that as well.
OK, what are the challenges that you're facing when you're trying to do this work?
Yeah, I think the challenges are a number of levels. Sustainability is very broad.
It's difficult to get get your teeth into. So I think for providing case studies and practical examples are the key to that.
Another key challenge is prevention, because as we squeeze as clinicians,
it's very easy to become squeezed in your clinical practise to just fight fires.
And sustainability is about forward thinking. It's about planning future opportunities or future relapse risk with your patients.
It's really about prevention. And that could be a struggle when there's so much of a squeeze.
There's also the challenge of working with teams, because you might find that as an individual, it really is tricky for sustainability.
But getting the team empowered to change practise can be quite difficult as well.
And I think sustainability is only going to become more important.
We only have a finite amount of resources that we realise at a very high level of David Nicholson and Malcolm Grant.
Malcolm, across the chair of NHS England since just resigned as the CEO of NHS England.
And they've got sustainability. We they realise the importance of the agenda.
And I think it's only going to get more important. But it's about realising the clinician.
It's a it's a clinicians agenda today.
It's not an agenda of tomorrow. That's not going to be a challenge. All right.
Well, thank you very much. That was a really good introduction to sustainability and the benefits it can have on people on the planet and on profits.
And it really does sound like it's going to be something that we all need to take on and think about in our day to day practise.
You mentioned it once briefly, but could you just reiterate, if other people are interested in getting involved in this,
how can they contact you and how can they get involved in this? Yes, if you're interested, please do get in touch with me.
If you the best way to find me is on the Centre for Sustainable Health Care website,
or you can go to my blog on RCF site, dot org, UK Forward Slash Sustainability or you can tweet me at sustainable site.
So thank you, Sean. We'll certainly look forward to hearing about how you get on and hearing about how your plans develop.
Thank you very much. Thanks.