What does it look like?

Sustainability means many different things to many different people. Most people struggle to understand what it looks like. Prince Charles is big on it. Banks talk about it. Large multi-nationals put it in their branding, but what is it? Wikipedia says it is “the capacity to endure”. The wisdom of Wiki goes on to say “sustainability requires the reconciliation of environmental, social equity and economic demands”. The question is, why are we in mental health interested in it? Particularly when there are so many other things to be worried about! 

There is a growing realization that sustainability is actually really important in all healthcare settings. It goes without saying that there are increasing constraints on our dwindling resources. These issues could inevitably impact on our ability to continue to provide high quality care. But is that it? Is sustainability purely another way of framing the never-ending discussion about NHS cuts?

These are some of the (rather large!) questions I have been thinking about in my first month in my post as RCPsych fellow in sustainability. I will admit, perhaps not too surprisingly, that I do not have all the answers to these questions. But I have had some interesting meetings this month, which go some way towards working out what sustainability might look like in mental health services.

I met and spent the day with David Pencheon, director and James McKenzie, programme manager of the NHS Sustainable Development Unit in Cambridge. Meeting them both was inspiring. They talked about how we doctors can become ‘crisis junkies’ who thrive on sorting out the day-to-day clinical and managerial dilemmas that press in on us at all times. Of course, these problems are unavoidable, but David argues that we can tend to limit ourselves to these sorts of issues. He posed a great question; “how could we be more prescient in our practise rather than merely being prisoners of today?” He has a way with words… On reflection, I whole-heartedly agree. Doctors like being proactive in theory, but can tend towards being reactive in practise. So, sustainability in mental health is something about being forward thinking in our practise and, in a sense, lifting our eyes to contemplate the future of our specialty. Perhaps, in beginning to think about sustainability in mental health, we need to engage with potential future challenges such as increasing social fragmentation and the impact of the social networking revolution.

The fact that the SDU offices are in the Fulbourn Hospital building, previously the County Pauper Lunatic Asylum for Cambridgeshire, made me think about sustainability in the asylum era. In it’s beginnings it might well have incorporated some sustainable ideas, such as using green spaces to encourage the recovery of those with mental illness. Perhaps though, the end of the asylum era is a salutary lesson in sustainability to us all in mental health. The asylums, with their large numbers of patients and entrenched institutionalisation, became unsustainable to the point that we had to totally rethink the way we did mental health care.

We are all working it out together. I met with David Haslam, Chair of NICE. He was very interested to hear that improving sustainability actually involves changing clinical practice to ensure that we reduce our environmental costs and continue to meet the evolving health needs of society. Currently there is no mention of sustainability issues in NICE guidance. David stated that he considered sustainability issues important in healthcare. It will be interesting to see how NICE will proceed to address this issue.

Meting Sue Bailey, President of RCPsych, was also invaluable. She mentioned about how the charity MAC-UK are working sustainably with hard-to engage adolescents through smartphone apps. She thinks that sustainability in mental health also involves engaging with local authorities. In doing so, we can empower communities to engage with those suffering with mental health issues and increase public understanding of mental health.  So, sustainability in mental health also involves reviewing how we engage, not only with our patients, but also with the public. This makes sense in light of the negative press that psychiatry continues to receive, which can negatively affect our practise.

I will continue to try to develop this concept of sustainability in mental health in this blog. For those of you who are interested please follow me on @sustainablepsyc.

This coming month I will be attending Clean Med Conference, which is looking specifically at sustainability pathways to healthcare. I will tell you more about this in my next month’s blog.