I want to consider the issue of those who suffer mental ill health and their carers.  I want to talk about how important they are, how important it is to look after them and how – when it comes to carers – the mental health authorities are all talk and could do better!

Something like a fifth of the population suffers from mental illness and it is estimated that in the UK there are 1.5 million caring for relatives suffering in this way or from dementia.

Carers are a desperately important part of the support medical care given to those with mental illness to allow their recovery or put them in a position where they can cope with their everyday lives.

The mental health authorities in Scotland have recognised the importance of an informal network of unpaid carers as a crucial part of the delivery of care and that they be” respected in their role and experience receive appropriate information and advice and have their views taken into account.” Which is apparently part of one of ten Millan guiding principles which went towards forming the Mental health (Care and Treatment) (Scotland) Act 2003.

Carers also face a tough situation.  Sure they come in all shapes and sizes and face an almost infinite variety of different situations across a broad spectrum of severity.  However, they all face certain things in common.  Carers all report feeling emotions of hopelessness, fear, guilt and isolation.  Often they find themselves utterly alone and overwhelmed by a situation they feel inadequate to deal with.  There is also plenty of evidence now that their physical health often suffers as well.

Caring is a tough gig and it is important.  But talking to carers they all, consistently, complain of being kept outside the loop.  They feel they are not well communicated with about their loved ones condition. They feel, despite the fact that they know them and their moods best, their views and observations are not listened to and, perhaps worst of all, they feel there is almost no information and support for them.

One carer said to me, “the mental health profession is just a bit rubbish when it comes to looking after carers!”

This is a view many professionals working with carers sadly share as well.   I’m told by some people working with carers that the principles of working with carers in Scotland have not yet been truly implemented.  And I’ve no reason to think England and Wales is doing any better.

More needs to be done.

To this end I want to praise the work done by Edinburgh Carers Council (ECC).  They recognise the need to look after and support carers.  They need the support and ultimately this aids the recovery of the original loved one and patient.  And this is more than a one hit.

As the medical model of looking after mental illnesses has moved from complete recovery to finding a way of living a satisfying and contributing life, so that ongoing support has to adapt for carers.

The ECC are developing programmes that support carers on an ongoing basis.  One programme I have come across is known as WRAP (wellness recovery action plan).  It has been adapted for carers and is about supporting them and equipping them to support themselves.  It aims to give carers a range of strategies and routines which are about looking after themselves.  Eating properly and getting rest and exercise is part of it.  Making time for yourself and having routines to recuperate are also important.  This is about leisure and doing some of the things you love.  If you are not making a life for yourself you will rapidly become useless to your loved one you care for.  It is also about self esteem and feeling supported; and it’s about giving access to information and practical support to navigate the mental health authorities, to participate in care and get answers and support when you need it.  The idea is improved physical and mental well being, less guilt, more energy and improved relationships which all means being a better carer.

It is just one programme but it is giving real and practical support to carers of those with mental health problems in Edinburgh today.

My plea is therefore this:

We need more of this for carers of all types.

The mental health authorities, who do a tough job and many great things, need to be better in practice at looking after carers rather than just talking about it in reports.

And, in these times of austerity, I can imagine programmes like this could be in the frontline for being cut-back.  My plea is that they are vital and ultimately better value in saved resources and medication bills as a result of the support carers give the mentally ill on their journeys to recovery and coping.

And this is how we should approach government spending. Forget about protecting front-line services for a minute. We actually want these firemen/cleaner roles to be unnecessary. They are not productive roles. They are generally restoration roles: Fixing people (in the case of medical professionals) and catching people (in the case of police) when they have gone or done wrong.

These roles are the areas of government spending we should be actively aspiring to reduce. But it is pure folly to reduce them when their workload is projected to rise. The government needs to identify policies, programs and services that will allow cuts in expenditure on these restorative roles. These cuts should of course be greater than the expenditure on the preventative measures that allow them to happen, but without any cost being transferred to society in the form of undetected crime or untreated illness.

I fear that the government has it completely upside-down. Their determination (and I think a largely cosmetic one at that) to protect the restorative “front-line” roles has meant that cuts are happening instead to existing preventative measures. So the burden on the restorative medics and police is increasing while much of the important support work that allows them to do their job effectively is crumbling.

You might argue that if there were these magic-bullet, preventative measures then we would be using them already. Hah! If you will excuse me I would like to describe a few that we have failed to embrace.

Drug policy reform is an obvious one, and not a surprising one to come from this keyboard. One of the most important lines in the recent drug policy motion was this: “At a time when Home Office and Ministry of Justice spending is facing considerable contraction, there is a powerful case for examining whether an evidence-based policy would produce savings, allowing the quality of service provided by these departments to be maintained or to improve.” Indeed, if we were to “nationalise” the cannabis market we could not only make savings in the policing budget, but actually gain income from taxation of the product and the jobs created to produce, distribute and sell it. The education on the early warning signs of psychosis that I hope could be delivered before first use of the drug could create massive savings in the mental health and welfare budget as psychotic illness is identified and treated early enough that long term illness can be avoided. Schizophrenia alone is estimated to cost England £6.7Bn each year.

With the average problem heroin user costing society over £50K each year, spending around £15K each year on treating the most problematic (and likely far more costly) in heroin maintenance clinics would again allow cuts to the jobs that clean up the chaos they leave in their wake.

In the wake of the riots this summer I heard numerous commentators express a desire to “strengthen families”. If they had only thought to Google “Strengthening Families” they would have come across this: www.strengtheningfamiliesprogram.org .  For every £1 spent, such programs can bring £9.60 in savings by reducing drug use and delinquency and improving school performance.   Have a look: here .   Can the government please start identifying evidence-based policies and applying them?

We could combine this with alcohol minimum pricing, moving cigarettes to pharmacies and selling e-cigarettes in newsagents in their place (not to children) www.guardian.co.uk smokeless-nicotine-cigarettes-government and perhaps subtle changes to the pub environment that might create more moderate drinking and less medical emergencies and fights www.icd.go.cr

These measures are just my favourites. People will know of all number of policies, services and programs that could create savings. Money has been spent on preventative measures that have been evaluated to save £5 for every £1 spent or something similar. The government is cutting these measures though. They are creating more mess. By mistakenly protecting the cleaners, they might cause them to be overwhelmed by filth (this is a metaphor for a broken society crumbling to dust [which is itself a metaphor-sorry] ).

Liberal Democrats have to stand up and say that we want cuts to the front-line restoration roles, but only after their burden has been lifted through radical, evidence-informed policies and expenditure. The financial crisis gave us an opportunity to radically shift government investment and policy into the preventative measures of the most remarkable value and effectiveness. We’ve blown it so far. We can not sit back and watch cuts which will plunge society into crisis. We need a two-step process of removing the work for our police, medics, and other restorative roles and then justifiably laying them off when they become a luxury.