1 00:00:08,640 --> 00:00:18,960 It has been a great morning. I've had a whole fascinating talks, inspiring talks now for the next 15 minutes. 2 00:00:18,960 --> 00:00:25,240 I want you to close your eyes. I'm going to take you to the Caribbean now. 3 00:00:25,240 --> 00:00:26,310 These bad things. 4 00:00:26,310 --> 00:00:36,570 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. 5 00:00:36,570 --> 00:00:42,180 I think you actually still might find that you're actually out of my my mind's eye. 6 00:00:42,180 --> 00:00:49,200 But anyway, that'd be fine, did. So there are some lessons which we can learn from this system, 7 00:00:49,200 --> 00:00:57,390 and obviously I've learnt a lot from all of this because what you said you were saying since morning. 8 00:00:57,390 --> 00:01:02,790 So before I can jump into the Canadian. 9 00:01:02,790 --> 00:01:11,730 Just wanted to kind of briefly describe about who we are. So we I work for an organism for Public Health England. 10 00:01:11,730 --> 00:01:17,180 It's execute an arm of the Department of Health and Social Care with the premium body, 11 00:01:17,180 --> 00:01:24,590 which is responsible for public health in this country and the vision going forward. 12 00:01:24,590 --> 00:01:30,980 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. 13 00:01:30,980 --> 00:01:34,010 Along with that, I guess some smokes. 14 00:01:34,010 --> 00:01:42,380 But yeah, hopefully you'll get that though, along with this headline, but we employ five thousand five hundred staff. 15 00:01:42,380 --> 00:01:53,910 We work with national local governments, education sector NGOs and other governments as well. 16 00:01:53,910 --> 00:02:04,320 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. 17 00:02:04,320 --> 00:02:09,900 We we only came into place in 2013. Before that, we were gone. 18 00:02:09,900 --> 00:02:16,080 I mean, the service was still there, but under law would know better than anybody else in this room. 19 00:02:16,080 --> 00:02:18,690 They were fragmented across the country. 20 00:02:18,690 --> 00:02:24,900 Primarily, we were responsible for provision of at the moment, we are responsible for a region of metropolitan services, 21 00:02:24,900 --> 00:02:28,890 which includes disease surveillance and epidemiology and production services, 22 00:02:28,890 --> 00:02:34,050 which includes environmental hazards, emergency preparedness, knowledge and intelligence. 23 00:02:34,050 --> 00:02:42,000 Very, very important at the moment. We have some data hubs which tries to actually provide local health profiles, 24 00:02:42,000 --> 00:02:48,300 so not only on communicable diseases, but also non-communicable diseases across the country. 25 00:02:48,300 --> 00:02:57,570 And then health and well-being, which includes screening, promoting and promoting health and promoting health. 26 00:02:57,570 --> 00:03:03,270 Since 2016, especially after the Ebola crisis, 27 00:03:03,270 --> 00:03:11,160 the Foreign and Commonwealth Office and even public of the joined hands to kind of improve our global health presence. 28 00:03:11,160 --> 00:03:20,970 And as a part of it, we have also been investing in non-communicable diseases, especially mental health and obesity. 29 00:03:20,970 --> 00:03:26,850 In terms of those particular two strands of work and the things that you offer 30 00:03:26,850 --> 00:03:32,340 at the moment is we undertake a situation analysis for that particular disease. 31 00:03:32,340 --> 00:03:37,560 We work, we bring together partners from non health policy. 32 00:03:37,560 --> 00:03:46,830 We also evaluate, for example, at the moment, we are also supporting evaluation of national health insurance in British Virgin Islands. 33 00:03:46,830 --> 00:03:56,250 We we undertake demand and forecasting. We look into the number of people who have been accessing services and we actually 34 00:03:56,250 --> 00:04:00,690 come up with forecast for what happens on this in the quarter going forward. 35 00:04:00,690 --> 00:04:09,140 We also do some work on health appointments. So this particular work, which I just mentioned. 36 00:04:09,140 --> 00:04:14,180 Is at the moment it's based in the Caribbean, and this would be very good. 37 00:04:14,180 --> 00:04:27,910 These islands, they are small island states. I'm very conscious that I got to go and sell these island states out in Virginia. 38 00:04:27,910 --> 00:04:32,300 So when you talk about these islands development, now that I talk to people, 39 00:04:32,300 --> 00:04:37,220 I'm going to these islands, they're all, you're going to have a lot of fun. It's fun. 40 00:04:37,220 --> 00:04:39,140 You know, it's beach. It's everything. 41 00:04:39,140 --> 00:04:47,060 And you would notice on the right hand side of this, you know, highlighted some of the demographic characteristics. 42 00:04:47,060 --> 00:04:54,680 These island cities are not as small as five thousand and Montserrat two in Bermuda, which is 65000. 43 00:04:54,680 --> 00:05:01,670 So Bermuda is somewhere in the middle of nowhere, actually. 44 00:05:01,670 --> 00:05:12,830 And then you've got these islands very close to Cuba and even the U.S. One of the things which you would 45 00:05:12,830 --> 00:05:22,640 notice is most of these islands are they belong to high income countries category of classification. 46 00:05:22,640 --> 00:05:27,680 For example, Bermuda and Cayman Islands, they are one of the richest islands in the world. 47 00:05:27,680 --> 00:05:34,960 So you would imagine that money is not a problem. We. 48 00:05:34,960 --> 00:05:47,740 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 49 00:05:47,740 --> 00:05:54,100 their mental health system was equipped to address the needs of people with poor mental health. 50 00:05:54,100 --> 00:06:07,410 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. 51 00:06:07,410 --> 00:06:13,740 But this is nested in other countries as it the brain damage names. 52 00:06:13,740 --> 00:06:21,810 So basically, it tries to take, you know, a baseline assessment of what's out there in the country, 53 00:06:21,810 --> 00:06:29,160 not just in health care, but also in non healthcare settings, whether people have access to care, 54 00:06:29,160 --> 00:06:34,500 whether they have counsellors in school, whether they are getting psychotropic medicines, 55 00:06:34,500 --> 00:06:39,910 whether there is a policy in place without legislations and so on and so forth. 56 00:06:39,910 --> 00:06:49,200 And so there are two aspects to it. So we did the quantitative analysis using the brain, which has been, I would say, 57 00:06:49,200 --> 00:06:55,350 validated yet very positive that it would have been used in five different countries. 58 00:06:55,350 --> 00:07:06,800 And this analysis has been a stepping stone for devising policies in this country and coming up the district mental health plans as well. 59 00:07:06,800 --> 00:07:13,760 And then the mutual aims, again, a very similar group, and it has been used in several countries across the world, 60 00:07:13,760 --> 00:07:20,810 including high income, low income, I believe in countries. We followed it up by field visits to these countries. 61 00:07:20,810 --> 00:07:31,290 We contacted stakeholders. Again, not limited to health care. 62 00:07:31,290 --> 00:07:40,910 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. 63 00:07:40,910 --> 00:07:49,940 So everybody, civil society, everybody and we try to focus broadly on these domains. 64 00:07:49,940 --> 00:07:54,740 So we wanted to actually see to what extent the policies are in place. 65 00:07:54,740 --> 00:07:59,360 Treatment coverage, health services, you know, assets in the community. 66 00:07:59,360 --> 00:08:08,270 And importantly, you cannot improve services if you do not have data to kind of know whether the services are in place, 67 00:08:08,270 --> 00:08:16,320 whether they are moving or not, you need data to kind of demonstrate any effectiveness. 68 00:08:16,320 --> 00:08:20,370 I'm going to take you quickly through the findings, I guess you want them. 69 00:08:20,370 --> 00:08:26,760 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, 70 00:08:26,760 --> 00:08:33,120 these places are actually amongst the richest places on Earth, literally. 71 00:08:33,120 --> 00:08:44,340 So for example, the moment I was like third or fourth, just after Liechtenstein and you know, you one of bar and other places. 72 00:08:44,340 --> 00:08:52,960 So. Although people when when you go there, everybody says it is a priority, he's a priority. 73 00:08:52,960 --> 00:08:59,260 I don't know who will come to that, but we've just just a few slightly that it is a political priority. 74 00:08:59,260 --> 00:09:07,100 What we gather the mental health policies of most of the plans and policies look [INAUDIBLE] and span. 75 00:09:07,100 --> 00:09:11,830 They actually look that has what it should be, according to international standards. 76 00:09:11,830 --> 00:09:16,780 Looks good. But is it all what it claims? 77 00:09:16,780 --> 00:09:21,630 Is it actually, you know, in place moderate? 78 00:09:21,630 --> 00:09:30,330 The focus because they got so much of money, the focus is on actually coming up with more specialists, specialists for everything. 79 00:09:30,330 --> 00:09:37,890 An island of 5000 population coming up with a forensic psychiatrist and asking me is we need a camp 80 00:09:37,890 --> 00:09:42,990 psychiatrist agility to learn adolescent mental health psychiatrist for the island population of. 81 00:09:42,990 --> 00:09:54,120 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. 82 00:09:54,120 --> 00:10:03,750 So 10 minutes on so. So there was lack of strategic approach to children's public health. 83 00:10:03,750 --> 00:10:15,270 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. 84 00:10:15,270 --> 00:10:19,890 So there was a single body of fund actually going towards how to block single block of funding. 85 00:10:19,890 --> 00:10:23,310 Nobody knows what's been happening and the treatment gap. 86 00:10:23,310 --> 00:10:29,700 Now this is the surprising bit, so we're not actually present this. So this is based on the prevalence data, 87 00:10:29,700 --> 00:10:34,950 which we actually denied of use model estimates from the global burden of disease studies and 88 00:10:34,950 --> 00:10:40,930 also the secondary data which we accessed from these respective governments that Friedman got. 89 00:10:40,930 --> 00:10:47,580 But this was surprising to me was 80 to 86 percent, which is similar to what you find in India. 90 00:10:47,580 --> 00:10:53,490 So many of the, you know, speak of the word you mentioned, all of you mentioned 80 to 85 percent. 91 00:10:53,490 --> 00:11:02,880 This officer, this should not be happening in this place, especially given that they are they have they have the resources. 92 00:11:02,880 --> 00:11:09,900 And so based on our findings, we we contributed to revising their mental health policies and plans. 93 00:11:09,900 --> 00:11:16,650 But again, ideally, we would like these systems to adopt all our recommendations. 94 00:11:16,650 --> 00:11:23,490 But when you presented it, their stakeholders picked up those things which are highlighted in yellow. 95 00:11:23,490 --> 00:11:30,720 So they were keen to kind of agree to our recommendation on revising the policy and then reviewing the funding arrangement. 96 00:11:30,720 --> 00:11:38,730 A quick quiz. Can anyone tell me actually where this photo would have been taken? 97 00:11:38,730 --> 00:11:44,130 It's what I read. I mean, it's one of these items. This. 98 00:11:44,130 --> 00:11:51,250 Again, nothing against it. Nothing against it, but. This one from a distance, making this fireworks exciting potential. 99 00:11:51,250 --> 00:11:55,250 It was like Cayman Cayman Islands. 100 00:11:55,250 --> 00:12:01,780 So again, how does that given you microphone? You know, there is no party game and everybody's happy. 101 00:12:01,780 --> 00:12:05,000 Everybody is rich. Not really. 102 00:12:05,000 --> 00:12:12,140 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. 103 00:12:12,140 --> 00:12:16,570 They are struggling to meet the ends. This was shocking, actually. 104 00:12:16,570 --> 00:12:24,130 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. 105 00:12:24,130 --> 00:12:31,360 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. 106 00:12:31,360 --> 00:12:41,320 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. 107 00:12:41,320 --> 00:12:47,360 I'm not consistent across the islands, but few islands have, so everything is out of pocket. 108 00:12:47,360 --> 00:12:57,100 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. 109 00:12:57,100 --> 00:13:01,810 But you know, the normal people, they don't. This one chicken, chicken, chicken. 110 00:13:01,810 --> 00:13:15,010 So for example, in India, where you would see stray dogs, animals and any guess where this photo was taken, which I haven't? 111 00:13:15,010 --> 00:13:19,600 And that's true that all over the place. Nothing against it as well. Again, nothing against it. 112 00:13:19,600 --> 00:13:24,230 Nothing against it. I'm just saying, you know it is. 113 00:13:24,230 --> 00:13:34,580 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, 114 00:13:34,580 --> 00:13:38,510 the public health is not being taken care of everything, you know, 115 00:13:38,510 --> 00:13:43,580 all the focus is towards actually creating a system and providing a tertiary system. 116 00:13:43,580 --> 00:13:48,890 So. So one of the ministers even asked me they should be ready. 117 00:13:48,890 --> 00:13:50,420 Not really. Probably not. Really. 118 00:13:50,420 --> 00:13:56,480 They should is doing a great job in government, and he's actually building up a multi billion hospital in Cayman Islands. 119 00:13:56,480 --> 00:14:01,670 Would you be able to actually link up with him and actually bring something else here in British Virgin Islands? 120 00:14:01,670 --> 00:14:11,330 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. 121 00:14:11,330 --> 00:14:18,380 I'm not going to delve too much, but there's no primary health care, at least, you know, 122 00:14:18,380 --> 00:14:24,380 even if there is a very basic minimum and especially for mental health, is non-existent. 123 00:14:24,380 --> 00:14:29,120 It's not integrated at all. So this was really shocking for me. 124 00:14:29,120 --> 00:14:37,960 I didn't expect that these islands would would have these many challenges. 125 00:14:37,960 --> 00:14:44,120 Forget about the. So you you you know, some of the speakers spoken eloquently about recovery. 126 00:14:44,120 --> 00:14:50,260 There's nothing about recovery here. They people, actually, there's a massive treatment gap. 127 00:14:50,260 --> 00:14:55,300 People end up in these services when they are in crisis and they are under treatment. 128 00:14:55,300 --> 00:15:01,630 They stay in these places for many years because their families just leave them. 129 00:15:01,630 --> 00:15:10,120 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. 130 00:15:10,120 --> 00:15:16,150 So they have very access these beds for many, many years and they're happy to pay them, 131 00:15:16,150 --> 00:15:27,840 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, 132 00:15:27,840 --> 00:15:34,290 the first one was to integrate mental health into primary health care and then 133 00:15:34,290 --> 00:15:37,460 support people with severe mental illness to manage their physical health. 134 00:15:37,460 --> 00:15:47,010 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. 135 00:15:47,010 --> 00:15:51,480 These problems in the media, they don't commit suicide. They die of physical ailments. 136 00:15:51,480 --> 00:16:00,180 So that was again, you know, mind and body, you know, treated are they're not treated together. 137 00:16:00,180 --> 00:16:05,670 And then in terms of promotion and prevention of poor mental health in the community, 138 00:16:05,670 --> 00:16:12,690 there is just like in in India, there's massive stigma, lack of awareness and discrimination. 139 00:16:12,690 --> 00:16:17,910 People, if you have a very difficult for them to actually know, 140 00:16:17,910 --> 00:16:25,260 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. 141 00:16:25,260 --> 00:16:30,480 So there was lack of communication between professionals. 142 00:16:30,480 --> 00:16:40,470 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. 143 00:16:40,470 --> 00:16:45,480 Housing was again actually highlighted as one of the key issues over there as well, 144 00:16:45,480 --> 00:16:54,870 because it's homelessness is not just as you mentioned, not just in India, but everywhere as well. 145 00:16:54,870 --> 00:16:59,100 These were the he thought, highlighted by patients. 146 00:16:59,100 --> 00:17:03,210 So again, going back to some of the parts which are highlighted by speakers already. 147 00:17:03,210 --> 00:17:09,120 What do patients want, you know, through share, health, wealth and happiness? 148 00:17:09,120 --> 00:17:13,800 It's not about actually merely treating people or providing them care. 149 00:17:13,800 --> 00:17:19,710 It's about to what extent they live that have their lives with their family. 150 00:17:19,710 --> 00:17:24,090 They may hold jobs. We have access to education, we have friends. 151 00:17:24,090 --> 00:17:25,410 That's what makes them happy. 152 00:17:25,410 --> 00:17:33,510 So the first thing which came out during our discussion was rehabilitation and recovery and rehabilitation means different to different people. 153 00:17:33,510 --> 00:17:41,070 But if you divide it by the person who is suffering from that or living with that illness, not like professionals. 154 00:17:41,070 --> 00:17:54,610 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. 155 00:17:54,610 --> 00:17:58,690 Information system was well, there was no information system. 156 00:17:58,690 --> 00:18:04,150 There was something in the primary and secondary care for physical health, but for mental health. 157 00:18:04,150 --> 00:18:13,480 A paper based records. Will people still use paper in these times, you know, and trust me? 158 00:18:13,480 --> 00:18:21,880 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. 159 00:18:21,880 --> 00:18:30,130 You can you do something about it? You know, your spending, your spending on personal services when you should actually turn it upside down. 160 00:18:30,130 --> 00:18:38,960 We should spend somewhere else. So the lack of transparent approach to monitor and evaluate there are no set of mental health indicators. 161 00:18:38,960 --> 00:18:48,040 I'm going to skip this, but the key two points, which I want to mention is. 162 00:18:48,040 --> 00:18:54,590 The only disease mankind has ever been able to eradicate. This one was. 163 00:18:54,590 --> 00:18:59,710 We have not been able to actually eradicate everything the medical care. Nothing, nothing. 164 00:18:59,710 --> 00:19:06,160 If there's one thing which all of you can actually take back to is only no in terms of modifiable factors, 165 00:19:06,160 --> 00:19:16,360 including ultimately only 20 percent of that is influenced by medical care that things which actually make people happy. 166 00:19:16,360 --> 00:19:19,870 Is outside the remit of medical care. 167 00:19:19,870 --> 00:19:27,790 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, 168 00:19:27,790 --> 00:19:37,870 come up with structures that support these other other things which are important, such as education, employment, and I'm going to get this. 169 00:19:37,870 --> 00:19:44,050 And again, I'm one of the things that my daughter actually, if you her and she keeps saying, 170 00:19:44,050 --> 00:19:50,590 she likes designate, so she keeps saying money can't buy her thing. 171 00:19:50,590 --> 00:19:54,640 No money can buy happiness. And I think it's pretty. 172 00:19:54,640 --> 00:19:59,650 It's very valid for these spaces. They have plenty of money and they have it on. 173 00:19:59,650 --> 00:20:05,380 All they are doing at the moment is spending here. Yeah. 174 00:20:05,380 --> 00:20:11,900 People need to refocus not only in India, but in Western world as well. 175 00:20:11,900 --> 00:20:17,560 You know, you need to invest. The majority of poor mental health starts before the age of 15. 176 00:20:17,560 --> 00:20:20,980 Why are we not talking about, you know, enough people? We need to invest. 177 00:20:20,980 --> 00:20:26,680 You need to invest early, start in schools. This is where you need more support. 178 00:20:26,680 --> 00:20:31,960 And this is where we need to have this radical transformation that we invest upstream rather 179 00:20:31,960 --> 00:20:48,810 than wait for somebody to actually require being imprisoned on these kind of admissions to.