Sustainable Mental Health Care

1. Sustainable Mental Health Care Dr. Sonia Sangha (CT3) Sustainability Representative for the Royal College of Psychiatrists – Yorkshire and Humber Trust Castle Hill Hospital, Lecture Theatre 22nd January 2014

2. Contents What is sustainability? Why sustainability is important Carbon footprint of the NHS Priority of the psychiatrist Transforming Education CSH Projects Implications Sustainable models of care and case studies Getting involved

3. What is Sustainability? Sustainability is a measure of long-term viability. Three Ps: People, Profit, Place. A sustainable healthcare system: “Sustainable healthcare is about ensuring we provide good quality health care today without compromising the ability of future generations to provide good quality health care.” In summary: delivers high quality care without exhausting financial, social and environmental resources.

4. Why Sustainability is Important Financial constraints are likely to increase over the next ten years. Demands on mental health services are likely to continue to increase. Global climate change has been described as the largest health threat this century. The Climate Change Act in 2008 has set targets, and the NHS has committed to reduce its carbon footprint by 80% within three decades. Society is changing rapidly with an ongoing technological revolution, a steeply rising UK population and increasing urbanization.

5. Environmental Aspect

6. Carbon Footprint of the NHS Analysis of the NHS carbon footprint shows that even if hospitals were fully powered by renewable energy, total emissions would only be reduced by one-fifth. Other solutions are needed to tackle the 18% of carbon arising from staff and patient travel, or the 60% from purchased goods and services, (mainly pharmaceuticals and medical supplies). NHS has committed itself to meet the Climate Change Act’s target of 80% carbon reduction by 2050, BUT...less of the same is not the answer. A transformation in clinical practice itself is required!

7. Sustainability needs to develop from buildings, energy and transport into transforming clinical practice

8. So... We cannot continue practising in the same way and stay within these limits.

9. What Should Our Priority Be As Psychiatrists? Should we as psychiatrists see the mental health of everyone living in the communities we work as our priority? Barefoot doctors in China are only paid by the healthy people in the community, thus motivated to maintain the health of the whole community. Mental health charities Mind and the Mental Health Foundation published the report ‘Building Resilient Communities’ - called on every local council to prioritise mental health within their public health strategy. Public health teams are now located within local authorities so NOW is the key moment to be making the case for public mental health. Alternatively, should our priority be social networking sites? Too ‘big brother’ like? Journal of Medical Ethics – article on the possibility of setting up a system on social networking sites like Facebook, where mental health services could ‘listen in’ and respond to certain words or phrases that are associated with either risk or relapse. - Could act as an early warning system and lead to rapid, responsive management by informing mental health workers of risk related messages. - Divisive subject but with the advent of the electronic age, health care professionals need to respond to ensure we remain a part of these communities.

10. Are we able to define mental health? How much do we allow our patients to define what mental health means to them? Are there structures or ways of living that can ensure mental health? Should we be defining the parameters of mental health as keenly as we have set about defining mental disorder? Would we see the mental health of the population improve?! Thinking sustainably in mental health involves asking these big questions! Demands on mental health services and rates of activity continue to increase...budgets do not.  Are there new ways of providing mental health care that reduce demand on services but keep psychiatrists at the centre? Could a change of focus be a solution?

11. Transforming The Centre for Sustainable Healthcare (CSH) is working with clinical specialties to transform healthcare for a sustainable future. In designing health systems of the future, CSH uses four principles of sustainable clinical practice: - Prevention - Patient partnership (supporting patients to take a greater role in managing their care) - Leaner care pathways - A choice of low carbon treatment alternatives

12. Change Can Happen Victorian Man: Men knew nothing; Women did everything! Early 20th C: Women’s right to vote Late 20th C : Women’s right to work 1990s: Men help raise children Noughties Man: Learned about looking good anti-wrinkle cream Maintaining health exercise

13. Man vs System Victorian Era – knew very little about mental health. 1950s – learned about medications. 1960s-70s – learned about social impacts. Noughties – learned about financial impacts. When will we learn to respond to environmental impact?

14. Environmental Clinical Practice; Energy use; Travel; Waste; Procurement; Buildings

15. Environmental Clinical Practice; Energy use; Travel; Waste; Procurement; Buildings Economic Cost of services Cost of resources Service models NHS cutbacks

16. Sustainable Healthcare

17. As psychiatrists we are aware of the social and financial aspects. We need to develop awareness of environmental aspects!

18. Education The impacts of the environment on health and healthcare should be part of the curriculum for medical students, doctors in training and all health professionals.  Clinical and professional values: - Understanding health within the context of social and ecological systems is important in fostering a more holistic and person-centred approach in clinical practice.   - Deeper understanding can also encourage individuals to explore the wider role of health professionals, not just in treating illness but in shaping the determinants of health. Leadership and management training: - Sustainable healthcare education is proving a valuable addition to clinical leadership and management training at both undergraduate and postgraduate levels. - Sustainability is a new motivation for clinicians and students to engage in service improvement, and has been described as the seventh dimension of quality in healthcare. A sustainability “lens” shows up opportunities to redesign care and eliminate wasteful processes, while involvement in  green projects develops an understanding of healthcare organisation alongside practical skills in project management.

19. CSH Education Projects Sustainable Healthcare Education (SHE) Network Jointly coordinated by Dr Frances Mortimer, Medical Director of CSH, and Ms StefiBarna, Lecturer in Public Health, University of East Anglia. In addition to its coordinating role, within the SHE Network, CSH is a leading contributor to curriculum development and creation of learning materials. Sustainable Specialty Fellowships - As part of our Sustainable Specialties Programme, CSH has pioneered the Sustainable Specialty Fellowship, seconding a clinician to work full time on sustainability for 1-2 years, before returning to clinical practice. - Successfully piloted in kidney care with the Green Nephrology Fellowship 2009-10 (funded by NHS Kidney Care).   - Allowed the secondment of a specialist trainee in renal medicine to work full time on sustainability of kidney care for one year. - The model proved very successful: harnessing the Fellow’s detailed understanding of renal care to address sustainability issues, increasing ownership of the programme among the clinical community, and supporting professional development of a trainee in both medical leadership and sustainable healthcare – enabling him to gain an MD. CSH is working to secure funding for ongoing Fellowship programmes in kidney care, respiratory care, mental health and other specialties.

20. GP Sustainability Scholarships – Severn Deanery - TheGP Sustainability Scholarships Programme is open to GP trainees in the Severn Deanery. - Scholars have half a day per week over 13 months to learn about sustainable healthcare and carry out a related project. - Educational supervision is provided by CSH. Pilot Teaching  CSH has developed and piloted teaching on sustainable healthcare in a range of educational settings, including: - University of Oxford undergraduate medical school (final year medical students). - Oxford Brookes University School of Health (inter-professional learning, as well as individual sessions with physiotherapy, occupational therapy and operating department practitioner students). - Postgraduate medical leadership development teaching: Foundation Year / ST1 Public Health (Oxford) London “Darzi” Fellowships in Clinical Leadership Department for Health CMO Clinical Advisor Scheme NHS Institute Improvement Faculty

21. Implications Wrong: we cannot afford to do it Right: we cannot afford NOT to do it Reality: we are already doing some of it! Realising the full impact of services helps us be more innovative when designing service improvements!

22. NEWS NHS could save £1bn by adopting green strategies used in kidney units BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f588 (Published 28 January 2013)

23. Sustainable Models of Care Specialist PD units Less reliance on medications Integrated care models – mental / physical Peer support groups Electronic health records

24. Case Studies - Infrastructure Salvage of reject water (Ashford, Canterbury, Stevenage). 3+ million litres water & £6,000+ saved per year. Energy-efficient lighting (Bradford). 2.3 tonnes CO2eq & £600 saved per year, improved environment for staff and patients. CENTREfor SUSTAINABLE HEALTHCARE

25. Case Studies – Process Improved waste segregation (Fife, Glasgow x6, Leicester). 50-85 tonnes CO2eq and £11-15,000 saved per year. Reduction in dx consumables (Cornwall, Fife, Glasgow). 10-26 tonnes CO2eq and £15-30,000 saved per year. CENTREfor SUSTAINABLE HEALTHCARE

26. Get Involved Join or Create a Network: You can join a community of like-minded people through our networks. Create podcasts, collaborate on articles and join discussion forums in order to share ideas about sustainable healthcare within your speciality or area of interest. You can even create your own network! Publish Your News: News articles, blogs or podcasts that you want to write about sustainable healthcare in general are welcomed. You can share these within a specific network or the entire CSH community.

27. Spread The Word:  If you want to be an ambassador for CSH then you can be sent the relevant materials and be given training. Volunteer:  If you want to get more involved and become a national volunteer or intern, then just get in touch with your specific skills. Contact Details: The Centre for Sustainable Healthcare, Cranbrook House, 287-291 Banbury Road, Oxford, OX2 7JA, UK t: +44 (0)1865 515811 info@sustainablehealthcare.org.uk

28. Mental Health Sustainability Representatives The Centre for Sustainable Healthcare is working with the Royal College of Psychiatrists to develop a network of those interested in promoting sustainability in mental health services. A 'call for sustainability representatives!' - Ambition to spread the network to every Trust across the UK. - Being sent to each mental health Trust sustainability lead and to clinical teams within each Trust. - The Royal College of Psychiatrists and College of Occupational Therapists agreed to put it in their newsletter. Now that Dr. Daniel Maughanis in post as the Royal College of Psychiatrists Sustainability Fellow, there is scope to broaden out this network of mental health professionals interested in sustainability.

29. Aspiration... That mental health services could help lead the way in promoting health services that are good for the environment and also good for patients and the communities they live in. If you would like to be involved, please contact: daniel.maughan@sustainablehealthcare.org.uk

30. THANKS Dr. Sonia Sangha (CT3) Sustainability Representative for the Royal College of Psychiatrists – Yorkshire and Humber Trust Castle Hill Hospital, Lecture Theatre 22nd January 2014