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Richard Gray

Richard Gray Professor of Nursing, Deputy Head of School, University Director of Research Degrees & Nurse Consultant University of East Anglia, Norwich E: richard.gray@uea.ac.uk. 1. Social gradient in health…. The better the socio-economic position the healthier the person.

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Richard Gray

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  1. Richard Gray Professor of Nursing, Deputy Head of School, University Director of Research Degrees & Nurse Consultant University of East Anglia, Norwich E: richard.gray@uea.ac.uk 1

  2. Social gradient in health… • The better the socio-economic position the healthier the person

  3. Poverty and mental health

  4. Do different, think about mental health care in 20 years time… Mental health policy: repetitionand regurgitation

  5. An unfinished revolution? “Care in the community”, “recovery”, “occupation and family life”

  6. Who… • Samantha Callan • Martin Baggaley • David Bolton • Paul Farmer • Peter Fonagy • Ivor Frank • Maggie Gairdner • Richard Gray • Matilda MacAttram • Chris Thompson • David Shiers

  7. The process… • Literature, hearings, polling

  8. Recommendations…

  9. Recommendations…

  10. Who consumes 40% of cigarettes?

  11. Who are NHS STOP smoking services designed for?

  12. Primary care: comorbidity the rule not the exception • Co-morbidity • The physical in the mental • Every patient with SMI requires physical health intervention • The mental in the physical • 50% of MI patients with develop depression, chances are it won’t be picked up or treated

  13. Recommendations…

  14. Enough is enough, how many inpatient psychiatric beds closed in 1997, 2001 and 2007?

  15. Where does the money go?

  16. Where does the money go?

  17. Where does the money go? Resource is trapped in inpatient provision

  18. Where does the money go? 100s of millions of GBP on services with an equivocal evidence base…

  19. People get cross when psychiatric beds close; but how many do we actually need?

  20. Inpatient care and the unintended consequences of crisis teams

  21. The experience of acute inpatient care

  22. Completing the revolution…

  23. How many beds? How many beds close each year? “Goldilocks…”

  24. The PICU argument • A nurse led service • Nurse consultants (who prescribe) • Calibrate how many beds

  25. Nursing… • Getting nursing working harder • Get pre-registration right • Getting mental in the physical and physical in the mental

  26. Mental health nurses are unfaithful… …Getting evidence based interventions into practice

  27. A fashion – PET, but does it work? • Family work, it works but we don’t do it

  28. Evidence based training… • Most training does not change practice

  29. Care brokerage and the CPA

  30. Three ideas… Addressing co-morbidity Inpatient units should be PICUs Care brokerage should be done by the third sector Being faithful

  31. Richard Gray University of East Anglia, Norwich E: richard.gray@uea.ac.uk 42

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