The Mental Health Sustainability Gap

In designing sustainable mental health services, we need to fully understand our available resources and constraints across environmental, economic and social domains. Only then can models of care be developed that can be sustained into the future.

The Centre for Sustainable Healthcare have developed principles of sustainable health care that help us align resources with care models. These are prevention, lean service design, patient empowerment and use of new and low carbon technologies. Using these principles we can more readily see how services can shift to become more sustainable.

In kidney medicine, they have the luxury, at least initially, of having a clear focus on one resource intensive intervention; dialysis. They can refine and modify dialysis to reduce its economic, environmental and social impact. In mental health we do not have this luxury. But what we do have is what I call the mental health sustainability gap. This is the gap between when a patient develops mental health symptoms and when they need management from our resource intensive services.

If someone’s kidneys don’t work, they just need dialysis, (or a new kidney), but if someone has a mental health condition, there is perhaps more we can do to reduce the need for secondary mental health services to become immediately involved. 

Creating the gap…

Using the first two sustainable principles mentioned, we can create this sustainability gap between onset of symptoms and involvement with mental health services. Improving preventive strategies, (such as using early intervention teams, which reduce future presentations and help patients self-manage early signs of relapse), while designing lean services, (such as being more strategic about organizing follow up appointments and not offering 2 weekly appointments as standard), both serve to create the sustainability gap.

Maintaining the gap…

How do we support patients safely and effectively in this gap between presentation and service involvement? We can achieve this by focusing on the last two principles of sustainability health care. We can empower patients, (through education or peer support, to self-manage or monitor their conditions), and use technology (smart phone apps that can help to avoid triggers or that can remotely recognise signs of relapse, or online electronic CBT) to maintain this gap while meeting the needs of the patient.

There are obviously difficulties with applying these principles to every mental health care context, but using these principles more broadly across the system should lead to improved sustainability of mental health services. These will in turn demand less economic and environmental resources.