It has been a great morning. I've had a whole fascinating talks, inspiring talks now for the next 15 minutes.
I want you to close your eyes. I'm going to take you to the Caribbean now.
These bad things.
But yes, I would like to share my experience and Public Health England's experience of addressing some of the things that you've already discussed.
I think you actually still might find that you're actually out of my my mind's eye.
But anyway, that'd be fine, did. So there are some lessons which we can learn from this system,
and obviously I've learnt a lot from all of this because what you said you were saying since morning.
So before I can jump into the Canadian.
Just wanted to kind of briefly describe about who we are. So we I work for an organism for Public Health England.
It's execute an arm of the Department of Health and Social Care with the premium body,
which is responsible for public health in this country and the vision going forward.
I think in the next four or five years, it's very ambitious. We would like to be one of the best in the world.
Along with that, I guess some smokes.
But yeah, hopefully you'll get that though, along with this headline, but we employ five thousand five hundred staff.
We work with national local governments, education sector NGOs and other governments as well.
In terms of our core of law, in terms of what we do, our bread and butter, so for example, historically before 2004, we have a young organisation.
We we only came into place in 2013. Before that, we were gone.
I mean, the service was still there, but under law would know better than anybody else in this room.
They were fragmented across the country.
Primarily, we were responsible for provision of at the moment, we are responsible for a region of metropolitan services,
which includes disease surveillance and epidemiology and production services,
which includes environmental hazards, emergency preparedness, knowledge and intelligence.
Very, very important at the moment. We have some data hubs which tries to actually provide local health profiles,
so not only on communicable diseases, but also non-communicable diseases across the country.
And then health and well-being, which includes screening, promoting and promoting health and promoting health.
Since 2016, especially after the Ebola crisis,
the Foreign and Commonwealth Office and even public of the joined hands to kind of improve our global health presence.
And as a part of it, we have also been investing in non-communicable diseases, especially mental health and obesity.
In terms of those particular two strands of work and the things that you offer
at the moment is we undertake a situation analysis for that particular disease.
We work, we bring together partners from non health policy.
We also evaluate, for example, at the moment, we are also supporting evaluation of national health insurance in British Virgin Islands.
We we undertake demand and forecasting. We look into the number of people who have been accessing services and we actually
come up with forecast for what happens on this in the quarter going forward.
We also do some work on health appointments. So this particular work, which I just mentioned.
Is at the moment it's based in the Caribbean, and this would be very good.
These islands, they are small island states. I'm very conscious that I got to go and sell these island states out in Virginia.
So when you talk about these islands development, now that I talk to people,
I'm going to these islands, they're all, you're going to have a lot of fun. It's fun.
You know, it's beach. It's everything.
And you would notice on the right hand side of this, you know, highlighted some of the demographic characteristics.
These island cities are not as small as five thousand and Montserrat two in Bermuda, which is 65000.
So Bermuda is somewhere in the middle of nowhere, actually.
And then you've got these islands very close to Cuba and even the U.S. One of the things which you would
notice is most of these islands are they belong to high income countries category of classification.
For example, Bermuda and Cayman Islands, they are one of the richest islands in the world.
So you would imagine that money is not a problem. We.
So as a part of our work, we were requested by these governments to go into their system and to actually explore to what extent
their mental health system was equipped to address the needs of people with poor mental health.
So what did we do? We use the tool, which has been used elsewhere as well, and we tried this out in my life and years ago as well.
But this is nested in other countries as it the brain damage names.
So basically, it tries to take, you know, a baseline assessment of what's out there in the country,
not just in health care, but also in non healthcare settings, whether people have access to care,
whether they have counsellors in school, whether they are getting psychotropic medicines,
whether there is a policy in place without legislations and so on and so forth.
And so there are two aspects to it. So we did the quantitative analysis using the brain, which has been, I would say,
validated yet very positive that it would have been used in five different countries.
And this analysis has been a stepping stone for devising policies in this country and coming up the district mental health plans as well.
And then the mutual aims, again, a very similar group, and it has been used in several countries across the world,
including high income, low income, I believe in countries. We followed it up by field visits to these countries.
We contacted stakeholders. Again, not limited to health care.
We went beyond that, so he went to say we went to schools, we visited, we actually talked to everybody because all of us had no.
So everybody, civil society, everybody and we try to focus broadly on these domains.
So we wanted to actually see to what extent the policies are in place.
Treatment coverage, health services, you know, assets in the community.
And importantly, you cannot improve services if you do not have data to kind of know whether the services are in place,
whether they are moving or not, you need data to kind of demonstrate any effectiveness.
I'm going to take you quickly through the findings, I guess you want them.
I'm not sure whether it will come as a surprise or not, but for me it was a surprise because as I said at the outset,
these places are actually amongst the richest places on Earth, literally.
So for example, the moment I was like third or fourth, just after Liechtenstein and you know, you one of bar and other places.
So. Although people when when you go there, everybody says it is a priority, he's a priority.
I don't know who will come to that, but we've just just a few slightly that it is a political priority.
What we gather the mental health policies of most of the plans and policies look [INAUDIBLE] and span.
They actually look that has what it should be, according to international standards.
Looks good. But is it all what it claims?
Is it actually, you know, in place moderate?
The focus because they got so much of money, the focus is on actually coming up with more specialists, specialists for everything.
An island of 5000 population coming up with a forensic psychiatrist and asking me is we need a camp
psychiatrist agility to learn adolescent mental health psychiatrist for the island population of.
I'm not saying saying that they don't require it, but we're focussing on this end of the spectrum rather than actually preventing these very cool.
So 10 minutes on so. So there was lack of strategic approach to children's public health.
Again, in spite of all the money into the system, there was no clarity on how much money has been invested in public health in mental health.
So there was a single body of fund actually going towards how to block single block of funding.
Nobody knows what's been happening and the treatment gap.
Now this is the surprising bit, so we're not actually present this. So this is based on the prevalence data,
which we actually denied of use model estimates from the global burden of disease studies and
also the secondary data which we accessed from these respective governments that Friedman got.
But this was surprising to me was 80 to 86 percent, which is similar to what you find in India.
So many of the, you know, speak of the word you mentioned, all of you mentioned 80 to 85 percent.
This officer, this should not be happening in this place, especially given that they are they have they have the resources.
And so based on our findings, we we contributed to revising their mental health policies and plans.
But again, ideally, we would like these systems to adopt all our recommendations.
But when you presented it, their stakeholders picked up those things which are highlighted in yellow.
So they were keen to kind of agree to our recommendation on revising the policy and then reviewing the funding arrangement.
A quick quiz. Can anyone tell me actually where this photo would have been taken?
It's what I read. I mean, it's one of these items. This.
Again, nothing against it. Nothing against it, but. This one from a distance, making this fireworks exciting potential.
It was like Cayman Cayman Islands.
So again, how does that given you microphone? You know, there is no party game and everybody's happy.
Everybody is rich. Not really.
There are two different economies that probably you would know this, you know, people well, they have two jobs, the local people, they have two jobs.
They are struggling to meet the ends. This was shocking, actually.
So I trained in India, at least, not until I see the goodness, I see the goodness, I see the things which need to be changed.
But this is not because the people are employed in this setting. People are required to pay, but this is a primary health care centre.
Forget about psychiatric guarantee. Even for me, if I haven't got a phone, I would need to pay from my pocket out of pocket before seeing a doctor.
I'm not consistent across the islands, but few islands have, so everything is out of pocket.
And yes, the vast bankers and nothing against the bankers, I, the people who control the finances, the financing industry, they have the money to pay.
But you know, the normal people, they don't. This one chicken, chicken, chicken.
So for example, in India, where you would see stray dogs, animals and any guess where this photo was taken, which I haven't?
And that's true that all over the place. Nothing against it as well. Again, nothing against it.
Nothing against it. I'm just saying, you know it is.
So this is this swanky looking hospital is in British Virgin Islands and just outside the, you know, come out of the hospital and, you know,
the public health is not being taken care of everything, you know,
all the focus is towards actually creating a system and providing a tertiary system.
So. So one of the ministers even asked me they should be ready.
Not really. Probably not. Really.
They should is doing a great job in government, and he's actually building up a multi billion hospital in Cayman Islands.
Would you be able to actually link up with him and actually bring something else here in British Virgin Islands?
So the focus is is away from prevention, but actually coming up with specialist services for everything, which is which all of you most want to see.
I'm not going to delve too much, but there's no primary health care, at least, you know,
even if there is a very basic minimum and especially for mental health, is non-existent.
It's not integrated at all. So this was really shocking for me.
I didn't expect that these islands would would have these many challenges.
Forget about the. So you you you know, some of the speakers spoken eloquently about recovery.
There's nothing about recovery here. They people, actually, there's a massive treatment gap.
People end up in these services when they are in crisis and they are under treatment.
They stay in these places for many years because their families just leave them.
And some of them, they have money to pay for them as well. And many of these items send their patients to England that they occupy occupied.
So they have very access these beds for many, many years and they're happy to pay them,
but they're not happy to invest in the primary health care since. Very busy slide again, based on our findings, we advise them, obviously,
the first one was to integrate mental health into primary health care and then
support people with severe mental illness to manage their physical health.
Again, I was talking to some of the police over here that people with poor mental health, they do not die first thing or they don't.
These problems in the media, they don't commit suicide. They die of physical ailments.
So that was again, you know, mind and body, you know, treated are they're not treated together.
And then in terms of promotion and prevention of poor mental health in the community,
there is just like in in India, there's massive stigma, lack of awareness and discrimination.
People, if you have a very difficult for them to actually know,
come out and say that they have depression because if they come and say that they will lose their jobs, their families will not treat them properly.
So there was lack of communication between professionals.
There was. They will hold some mental health promotion activities on October 10th or one of the making of this, but that's about it.
Housing was again actually highlighted as one of the key issues over there as well,
because it's homelessness is not just as you mentioned, not just in India, but everywhere as well.
These were the he thought, highlighted by patients.
So again, going back to some of the parts which are highlighted by speakers already.
What do patients want, you know, through share, health, wealth and happiness?
It's not about actually merely treating people or providing them care.
It's about to what extent they live that have their lives with their family.
They may hold jobs. We have access to education, we have friends.
That's what makes them happy.
So the first thing which came out during our discussion was rehabilitation and recovery and rehabilitation means different to different people.
But if you divide it by the person who is suffering from that or living with that illness, not like professionals.
And that was really one of the results of who I really like, but not health aspects of, you know, providing what provision of mental health support.
Information system was well, there was no information system.
There was something in the primary and secondary care for physical health, but for mental health.
A paper based records. Will people still use paper in these times, you know, and trust me?
I was talking like this of I've been in different places and talking to ministers, but I do have sympathy, you know, we don't have money.
You can you do something about it? You know, your spending, your spending on personal services when you should actually turn it upside down.
We should spend somewhere else. So the lack of transparent approach to monitor and evaluate there are no set of mental health indicators.
I'm going to skip this, but the key two points, which I want to mention is.
The only disease mankind has ever been able to eradicate. This one was.
We have not been able to actually eradicate everything the medical care. Nothing, nothing.
If there's one thing which all of you can actually take back to is only no in terms of modifiable factors,
including ultimately only 20 percent of that is influenced by medical care that things which actually make people happy.
Is outside the remit of medical care.
So is it it's it's important for us to actually not only just look at this paradigm, but go beyond it and, you know,
come up with structures that support these other other things which are important, such as education, employment, and I'm going to get this.
And again, I'm one of the things that my daughter actually, if you her and she keeps saying,
she likes designate, so she keeps saying money can't buy her thing.
No money can buy happiness. And I think it's pretty.
It's very valid for these spaces. They have plenty of money and they have it on.
All they are doing at the moment is spending here. Yeah.
People need to refocus not only in India, but in Western world as well.
You know, you need to invest. The majority of poor mental health starts before the age of 15.
Why are we not talking about, you know, enough people? We need to invest.
You need to invest early, start in schools. This is where you need more support.
And this is where we need to have this radical transformation that we invest upstream rather
than wait for somebody to actually require being imprisoned on these kind of admissions to.