Sustainability Series: a more sustainable approach to mental health care

We are pleased to welcome Dr. Daniel Maughan to the Sustainability Series this month. Dr. Maughan worked for CSH as the Research Fellow for Sustainable Psychiatry from 2013-2015 and is now the RCPsych Associate Registrar in Sustainability as well as a consultant psychiatrist. Much of Dr. Maughan's work on sustainable mental health care can be found on our publications page . 

The initial strides taken by our nephrology colleagues in addressing sustainability issues in health care were very impressive. They tackled resource use head on and found very interesting data about carbon footprint savings that could be achieved. Approaching sustainability in mental health is a different ball game. There is far less uniformity than in nephrology. There is no obvious starting point, like there is with kidney dialysis, which is fundamentally economically, environmentally and socially unsustainable for many good reasons. The variety of mental health care provision is extensive and there are far less technical interventions.

Despite these difficulties in approaching sustainability in mental health, there are also lots of opportunities that are specific to this area. These include the strong evidence base that nature-based interventions can improve a variety of mental health conditions and the fact that minimal resource interventions such as talking therapies, group-based interventions, exercise and mindfulness as well as psycho-education can all provide clinical benefit as well as positive social outcomes.

A major carbon footprint issue for mental health care is that of medications, particularly given those with severe mental illness have compliance rates of about 50%. This potentially means that around 10% of the carbon footprint for mental health is thrown down the toilet – not good. The trouble is that the issue of non-compliance is thorny and many have tried to address this issue for reasons other than carbon footprint, without much success. Although awareness of this waste of resource should add weight to this already pressing issue, I have found it tends to be a good way to impress upon mental health clinicians the importance of thinking sustainably.

I think the biggest opportunity to improve the sustainability of mental health care currently is by addressing the second principle of sustainable health care, that of empowerment. Empowering those with mental illness, their families and their local communities, be they proximal in a geographic or online sense, to manage the illness independently has much scope for improvement. The current dogma of the medical model is limiting both patient benefit and potential financial and carbon footprint savings. Many common mental health problems such as milder forms of depression and anxiety can be successfully managed without the need of medical input. Provision of appropriate psycho-education, adequate social support, availability of locally based meaningful activities and reducing stigma are all vital if a shift is going to be made away from the dominant medical model. Where primary or secondary mental health services are needed, there are already many strategies in place to provide high value care with as little waste as possible. But it is the step before services are needed which is where the most benefits can be realised for improving sustainability. Providing the right social support with high quality engaging resources to help people help themselves is key. 

1) Van Den Berg et. al. (2010) Green space as a buffer between stressful life events and health, Social Science & Medicine Volume 70, Issue 8, April 2010, Pages 1203-1210
2) Two reports, sponsored by RSPB: Bird, W (2004) ‘Natural Fit and Bird, W (2007) ‘Natural Thinking’ 3)