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Parts of NICE guidelines (psychosis & schizophrenia) which relate to OT.

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Parts of NICE guidelines (psychosis & schizophrenia) which relate to OT.

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NICE guidelines relevant to client group 

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NICE guidelines relevant to client group 

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Angela TTM method for depression and anxiety

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Dance therapy in mental health

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Julia - Annotated bibliography - schizophrenia

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Behavioural Activation with an added twist

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mental health website from BAME (black, asian, and minority ethnic)

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Podcasts and Videos | Mental Health Foundation

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Good mental health for all. Dedicated to finding and addressing the sources of mental health problems.

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Together: A leading UK mental health charity

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Together: A leading UK mental health charity

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Together is a national mental health charity working alongside people with mental health issues on their journey towards independent and fulfilling lives.

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Statutory: Crisis Overnight Support Service

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Statutory: Crisis Overnight Support Service

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Provides safe overnight accommodation for up to 72 hours for people experiencing a mental health crisis and is provided in partnership with three local providers of mental health supported living accommodation.

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Applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make all or some decisions for themselves.

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Social Care Institute for Excellence (SCIE)

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by empowering people to make decisions for themselves wherever possible, and by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision-making process

by allowing people to plan ahead for a time in the future when they might lack the capacity, for any number

Key messages

The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make all or some decisions for themselves.

The MCA is designed to protect and restore power to those vulnerable people who lack capacity.

The MCA also supports those who have capacity and choose to plan for their future - this is everyone in the general population who is over the age of 18.

All professionals have a duty to comply with the Code of Practice. It also provides support and guidance for less formal carers.

The Act's five statutory principles are the benchmark and must underpin all acts carried out and decisions taken in relation to the Act.

Anyone caring for or supporting a person who may lack capacity could be involved in assessing capacity - follow the two-stage test.

The MCA is designed to empower those in health and social care to assess capacity themselves, rather than rely on expert testing - good professional training is key

If capacity is lacking, follow the checklist described in the Code to work out the best interests of the individual concerned

Understanding and using the MCA supports practice - for example, application of the Deprivation of Liberty Safeguards

Reach

About two million people in England and Wales are thought to lack capacity to make decisions for themselves. They are cared for by around six million people, including a broad range of health and social care staff, plus unpaid carers. Those working in health and social care include: doctors, nurses, dentists, psychologists, occupational, speech and language therapists, social workers, residential and care home managers, care staff (including domiciliary care workers), and support workers (including people who work in supported housing).

A lack of mental capacity could be due to:

a stroke or brain injury

a mental health problem

dementia

a learning disability

confusion, drowsiness or unconsciousness because of an illness of the treatment for it

substance misuse.

Five key principles

The Act is underpinned by five key principles (Section 1, MCA). It is useful to consider the principles chronologically: principles 1 to 3 will support the process before or at the point of determining whether someone lacks capacity. Once you've decided that capacity is lacking, use principles 4 and 5 to support the decision-making process.

Principle 1: A presumption of capacity

Principle 2: Individuals being supported to make their own decisions

Principle 3: Unwise decisions

Principle 4: Best interests

Principle 5: Less restrictive option

Assessment of capacity and best interests decision-making (Sections 2-4, MCA)

What is mental capacity and when might you need to assess capacity?

Having mental capacity means that a person is able to make their own decisions. You should always start from the assumption that the person has the capacity to make the decision in question (principle 1). You should also be able to show that you have made every effort to encourage and support the person to make the decision themselves (principle 2). You must also remember that if a person makes a decision which you consider eccentric or unwise, this does not necessarily mean that the person lacks the capacity to make the decision (principle 3). Under the MCA, you are required to make an assessment of capacity before carrying out any care or treatment - the more serious the decision, the more formal the assessment of capacity needs to be.

When should capacity be assessed?

You might need to assess capacity where a person is unable to make a particular decision at a particular time because their mind or brain is affected by illness of disability. Lack of capacity may not be a permanent condition. Assessments of capacity should be time- and decision-specific. You cannot decide that someone lacks capacity based upon age, appearance, condition or behaviour alone.

The test to assess capacity

Two-stage functional test of capacity

In order to decide whether an individual has the capacity to make a particular decision you must answer two questions:

Stage 1. Is there an impairment of or disturbance in the functioning of a person's mind or brain? If so,

Stage 2. Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?

The MCA says that a person is unable to make their own decision if they cannot do one or more of the following four things:

understand information given to them

retain that information long enough to be able to make the decision

weigh up the information available to make the decision

communicate their decision - this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

Every effort should be made to find ways of communicating with someone before deciding that they lack capacity to make a decision based solely on their inability to communicate. Also, you will need to involve family, friends, carers or other professionals.

The assessment must be made on the balance of probabilities - is it more likely than not that the person lacks capacity? You should be able to show in your records why you have come to your conclusion that capacity is lacking for the particular decision.

Best interests decision-making

If a person has been assessed as lacking capacity then any action taken, or any decision made for or on behalf of that person, must be made in his or her best interests (principle 4). The person who has to make the decision is known as the 'decision-maker' and normally will be the carer responsible for the day-to-day care, or a professional such as a doctor, nurse or social worker where decisions about treatment, care arrangements or accommodation need to be made.

What is 'best interests'?

The Act provides a non-exhaustive checklist of factors that decision-makers must work through in deciding what is in a person's best interests. A person can put his/her wishes and feelings into a written statement if they so wish, which the person determining capacity must consider. In addition, people involved in caring for the person lacking capacity have to be consulted concerning a person's best interests.

If a person has been assessed as lacking capacity then any action taken, or any decision made for or on behalf of that person, must be made in his or her best interests

For more detailed information you should refer to the Code of Practice.

Case example: Assessing capacity

Anna Southcott (the patient's name has been changed), 76, has dementia and lives in a care home. She has asthma. Her capacity fluctuates. The district nurse attends to administer flu vaccinations. Ms Southcott is able to communicate.

Principle

The decision relates to administering a flu vaccination. The district nurse should start from the position of assuming that Ms Southcott has the capacity to decide whether to receive a flu vaccination, unless there is evidence to show that she lacks the capacity to do so (principle 1). Even if the nurse has to help Ms Southcott to make the decision, this does not mean she lacks the capacity to make it.

The nurse should not treat Ms Southcott as being unable to make the decision herself until all practicable steps to help and support her to make it have been taken, without success (principle 2). Only if this is the case should the nurse assess Ms Southcott's capacity to make the decision using the two-stage test.

As Ms Southcott's capacity fluctuates, the nurse should consider whether the decision can be postponed until she may have capacity to make the decision. The nurse will speak to Ms Southcott's carers about this, as well as asking about her condition and whether there are any contraindications for a flu vaccination - the following assumes this not to be the case.

Practice

Does Ms Southcott have an impairment of or a disturbance in mind or brain function? There must be an impairment of her mind or some disturbance that affects the way her brain works. She has dementia, so this part of the test is fulfilled to the balance of probabilities (more likely than not).

Does the impairment or disturbance mean that she is unable to make a specific decision, at the specific time she needs to?

The nurse must disregard Ms Southcott's ability to make decisions in general. The impairment or disturbance must affect her ability to make a specific decision at a specific time. The nurse will give her some simple information about why she needs a flu vaccine (her age and asthma), then will ask her to repeat that information. It may be that Ms Southcott has previously expressed preferences about having a flu vaccination, and this might provide a useful steer for the nurse.

In relation to the decision that needs to be made, the district nurse should decide on the balance of probabilities (more likely than not) whether Ms Southcott is able to:

understand relevant information about the decision

retain that information in her mind long enough to make the decision herself

use or weigh up (evaluate) that information as part of the decision-making process.

If Ms Southcott cannot do any of these three things, she is treated as being unable to make the decision.

The decision about Ms Southcott's capacity must not be based merely on her age, appearance, assumptions about her condition or any aspect of her behaviour.

The nurse decides that Ms Southcott lacks capacity to make a decision about receiving a flu vaccination and clearly records her assessment with reasons. Using best interests decisionmaking (principle 4) the decision is taken that in view of her age and asthma, it would be in her best interests to receive the vaccination.

Thanks to Andrew Alonzi of Nottingham Law School for his contribution to this case study.

The new roles, bodies and powers supporting the MCA

Attorneys appointed under Lasting Powers of Attorney (LPAs) - the Act introduces a new form of Power of Attorney which allows people over the age of 18 to formally appoint one or more people to look after their health, welfare and/or financial decisions, if at some time in the future they lack capacity to make those decisions for themselves.

Court of Protection and Deputies - the MCA created a new court and a new public official to protect people who lack capacity and to supervise those making decisions on their behalf. The Court is able to appoint a Deputy, for example, because a person has an ongoing lack of capacity. The Court will tailor the powers of the deputy according to the circumstances of the individual.

The Public Guardian - the role of the Public Guardian is to protect people who lack capacity from abuse. The Public Guardian is supported by the Office of the Public Guardian (OPG). The OPG maintains a register of LPAs and EPAs. It also maintains a register of the Court-appointed Deputies and is responsible for supervising them.

Independent mental capacity advocate (IMCA) - IMCAs are a statutory safeguard for people who lack capacity to make some important decisions. This includes decisions about where the person lives and serious medical treatment when the person does not have family of friends who can represent them. IMCAs can also represent individuals who are the focus of adult protection proceedings. The Deprivation of Liberty Safeguards introduced further roles for IMCA s.

Advance decisions to refuse treatment - the Act creates statutory rules with clear safeguards so that people may make a decision in advance to refuse treatment if they should lack capacity in the future.

A criminal offence - the Act introduces a new criminal offence of ill treatment or wilful neglect of a person who lacks capacity.

Code of Practice

The Code explains how the MCA works on a day-to-day basis and provides guidance to those working with people who may lack capacity. The Code explains the key features of the MCA in more detail, as well as some of the practical steps that people using and interpreting the law need to take into consideration. If you work with people who lack capacity and you are a professional and/or you are paid for the work you do then you have a legal duty to have regard to the Code. It is also relevant to unpaid carers who will be helped and guided by it.

Interface with the MHA

It will be important for health and social staff who support some client groups (for example, those with mental health problems, particularly those with severe and enduring mental ill health, or older people) to have an understanding of the interface issues between the MCA and the Mental Health Act 1983 (as amended by the 2007 Act). This will also include the need to have an awareness of the Deprivation of Liberty Safeguards.

Liberty Protection Safeguards

In July 2018, the government published a Mental Capacity (Amendment) Bill which will see DoLS replaced by the Liberty Protection Safeguards (LPS). This passed into law in May 2019. Under LPS, there will be a streamlined process to authorise deprivations of liberty. Read more here: Liberty Protection Safeguards.

LPS will go live on 1 April 2022

Download

All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:

Available downloads:

Mental Capacity Act 2005 at a glance

MCA e-Learning course: Recently relaunched with CPD accreditation

SCIE has produced a short video to encourage the sector to consider how LPS will seek to promote practice which aligns with human rights and the core principles and duties of the Care Act 2014.

View more: News

All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:

Register now Log into your account

Mental Capacity Act 2005 at a glance

Get SCIELine ebulletin & access all resources. Free MySCIE account

'Clear, informative and enjoyable. Feel much more confident about the MCA'. Nurse advisor.

View more: Training courses

'@SCIE_socialcare sector advice on best interest, mental capacity, DoLS etc are the best resource for these conundrums'. Occupational Therapist.

View more: Case studies

We deliver some MCA training as open courses, designed for individuals or small groups to attend.

MCA training

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by empowering people to make decisions for themselves wherever possible, and by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision-making process by allowing people to plan ahead for a time in the future when they might lack the capacity, for any number The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make all or some decisions for themselves.

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Callers can talk through any issue, listen and offer information and signposting.

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We offer an accredited confidential, anonymous and free (see note below) support, information and signposting to men anywhere in the UK through our helpline. Calls are taken by trained staff who are there to listen, support, inform and signpost. And because calls are confidential and anonymous we don't and can't offer a counselling service. We also offer a web chat service. In total our helpline and webchat services are receiving around 6,000 calls and chats per month.

OFCOM rulings mean that all calls are now free to make from landlines, payphones and all mobiles.

Calls are taken in order, so it's best to stay in a queue rather than redial.

Our London helpline is open 7 days a week, 5pm to midnight. Callers can talk through any issue, listen and offer information and signposting. Both services are confidential and anonymous - calls won't show up on your phone bill.

Calls are free from landlines, pay phones and all mobiles.

CALM is a member of Helplines Partnership (formally MHHP Mental Health Helplines Partnership and THA The Helplines Association) as well as being a founder member of the Youth Helplines Network. CALM's helpline has previously been accredited by MHHP and is accredited to The Helplines Standard.

Our National helpline is open 7 days a week, 5pm to midnight. Callers can talk through any issue, we'll listen and offer information and signposting. Calls are anonymous & confidential and won't show up on your phone bill. Calls are free from landlines, payphones and all mobiles.

Our London helpline is open 7 days a week, 5pm to midnight. Callers can talk through any issue, listen and offer information and signposting. Both services are confidential and anonymous - calls won't show up on your phone bill. Calls are free from landlines, pay phones and all mobiles.

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Helpline - Campaign Against Living Miserably

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We offer an accredited confidential, anonymous and free (see note below) support, information and signposting to men anywhere in the UK through our helpline. Calls are taken by trained staff who are there to listen, support, inform and signpost. And because calls are confidential and anonymous we don't and can't offer a counselling service.

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Statutory: Mental Health and Homelessness Guide

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Statutory: Mental Health and Homelessness Guide

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The Mental Health Act - Mental health services - NHS Choices

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Find out when you could be detained under the Mental Health Act, including your rights.

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This one is specific to Wellbeing. There are another 4 sections to the Act.

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Rethink Mental Illness is the largest voluntary sector provider of mental health services with around 200 services across England. They also create guidelines that statutory mental health services use for practice!
(IRIS guidelines for early intervention psychosis is a good one to check out if you're interested).

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We improve the lives of people severely affected by mental illness through our network of local groups and services, expert information and successful campaigning. Our goal is to make sure everyone severely affected by mental illness has a good quality of life.

Get advice and information

About mental illness

1 in 4 people will experience a mental illness in their lifetime. People can, and often do, recover with the right treatment and support. Our advice and information pages can help you learn more about conditions, symptoms and diagnoses, so you or a loved one can get the help you need.

Living with mental illness

Living with a mental illness should not be a barrier to a good quality of life. Our advice and information pages contain all you need to know about getting the proper treatment and support for you or a loved one and what you can do if you feel the help you are getting is not right.

Rights and restrictions

If you experience mental illness or care for someone who does, it is essential to know your rights. Our information pages has advice on mental health laws, rights and restrictions, social care, welfare, and resources about the police, courts & prison service.

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No matter how bad things are, we can help.

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1 in 4 people will be affected by a mental health problem in their lifetime - we are here to support them when they do.

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Provide courses for psycho-educational purposes, or general understanding of Mental Health and anything that may stem from it i.e. hoarding, drug/alcohol misuse. Only a few in the country. This is one in Camden. Open to service users, professionals, local residents etc. Promoting awareness and understanding!

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Recovery College | Camden and Islington NHS Foundation Trust

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Our Recovery College brings together two sets of expertise - professional and experience - in a non-stigmatising college environment. All of the courses provided at the college are designed to contribute towards wellbeing and recovery.

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Statutory: Acute Day Unit - Jules Thorn. 

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Statutory: Acute Day Unit - Jules Thorn. 

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MDT works with in-patients at St Pancras Hospital, patients at Rivers crisis house (near by) and some patients who live at home. Attended the Dance Movement Therapy here during PPA. Definitely an experience I'll never forget.

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South Camden Recovery Centre | Camden and Islington NHS Foundation Trust

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We offer assessment and treatment for people with mental health difficulties. The unit is structured around the group programme, with a broad range of therapeutic groups. We promote early discharge from hospital and prevents hospital admission.

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Example of non-statutory healthcare - MIND charity

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Example of non-statutory healthcare - MIND charity

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We’re Mind, the mental health charity | Mind

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We're Mind, the mental health charity. We're here to make sure no one has to face a mental health problem alone.

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Example of statutory healthcare  - Community MH Recovery Service

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Example of statutory healthcare  - Community MH Recovery Service

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Community Mental Health Recovery Service: Woking

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Woking Community Mental Health Recovery Service

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Published on

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Media, Education, Publishing

July 2014, Pristina - Vera Remškar sat at the conference table in the white room of the FTK office. She looked wistfully out of the fingerprint-smudged window.

"She drank Domestos bleach, a whole container of it," Remškar said.

She took a moment to gather herself.

"They had to chop up her insides... she is covered in scars. She was a beautiful girl. Is a beautiful girl," Remškar said, her eyes glassy.

The executive director of Fondacioni Together Kosova, was telling the story of a young girl who attempted suicide because of her depression. She had nobody to call or talk to before she decided to drink a bottle of bleach. No lifeline to hang on to.

"After the war in Kosovo, the suicide rate increased 400 percent," Remškar said. "We wanted to know what increased this high rate of suicide. The war was not the cause of this rate of suicide, it was the events that happened afterwards."

The aftereffects of the 1999 war are having tremendous consequences for the young people of Kosovo. Fifteen years after the conflict, the burdens of living in a post-war society are taking its toll on the younger generations of Kosovars.

Organizations such as Fondacioni Together Kosova are creating ways in which the young people of Kosovo can express their feelings, questions, and concerns. Nukjevet.net, (You're not alone) a website launched by FTK, looks to build a culture of seeking help by allowing people to post their mental health questions online anonymously. Once the question is posted, a certified psychiatrist will respond within three to four days.

But even with advances in mental health care, young Kosovars are still faced with difficult issues and a society that is not traditionally open about dealing with these issues.

"The youth is 60 percent of the population. They don't see future for themselves in Kosovo," said Sami Rexhepi, a neuropsychiatric doctor at the community-based mental health clinic in Pristina.

According to the 2013 World Bank report, Kosovo has the youngest population in Europe, with more than 70 percent of its population under the age of 35.

An evidence review by the Child and Adolescent Mental Health Unit found that war traumas, economic poverty, political instability, and transitional democracy are large factors in the quality of life for Kosovars. The review found that in this context, the increasing number of suicides in post-war Kosovo is becoming a large concern for policy makers. Before the war, Kosovo had the lowest percentage of suicides in Europe.

The evidence review found that suicide rates increased significantly in post-war Kosovo. Half of the reported suicides were by people between age 15 and 34 years old.

"Kosovo is still very closed. It is developing... people are still in survival mode. Some people go into criminality. Some people give up, some commit suicide. The society is under a lot of pressure. Everyday pressure with added hardship. Unemployment. The inability to travel or leave Kosovo," said Fried Didden, executive director at Kosova Health Foundation.

Many Kosovars feel like something is wrong with them because they are not accepted. They take it personally, Didden said.

This is a problem apart from the environment itself. The problem resides in socio-economic issues, he explained.

In 2014, the U.S. Central Intelligence Agency reported that Kosovo's citizens are the poorest in Europe. They have an average annual per capita income of $7,400. Kosovo is also considered the country with the highest level of unemployment worldwide among people below the age of 25, with a 73 percent unemployment rate.

"Suicide traits, mainly among young people have been increasing...This is because PTSD, lack of job opportunities, high level of poverty, and low level of education," said Skender Syla, head of the World Health Organization based in Prishtina. "The Kosovo society is transitioning right now."

The events that occurred after the war influenced children and young adults, Remškar said. They had to move to the city, they lost whatever possessions they had.

"They feel as if nobody likes them, nobody wants them," she added. "All of this affects their mental health directly."

A portion of young Kosovars were displaced during the war and were raised in different countries. Now they are being sent back to Kosovo.

According to Didden, they don't do well. At least 40 percent have developed mental issues.

"Imagine a child that lives in the EU for several years who does not learn the mother tongue of the home country. When the family is expelled, this has a much larger impact on the child than on the parents," he said.

The burdens faced by the youth in Kosovo often lead to depression, or another form of mental illness. That can lead to a loss of hope and thoughts of suicide.

"If you break your hand, I will fix it, and in six months it will be healed. If you cut your arm, I will bandage it, and in five days, it will be healed. But with your spirit, you will be immobilized," Rexhepi said.

The mental aftereffects of the war are not limited to young people.

"Consequences of PTSD are being faced now you can expect after 10 or 15 years," Rexhepi said as he took a long draw from his withering cigarette. "I had a husband and wife. He asked how to empower his wife because she was raped during the war. She's not guilty. It's not her fault."

Rexhepi released a smoky cough and then smashed the butt of his cigarette into an almost-full ashtray. He withdrew a nearly-empty cigarette pack and lit another.

"'I was not strong enough to protect her because she was my wife,' was something this man said. There were two brothers who watched their wives get raped," he added.

The war left lasting mental damage to people of all ages, he explained. The first-hand mental damage left on one generation will also have an effect on the next.

"The war leaves consequences, not only in this generation, but in the coming generations... There is a transmitting of trauma," said Melita Kallaba, a psychiatrist at the Kosova Rehabilitation Centre for Torture Victims.

The issues with the system stem from the way mental health is diagnosed and treated. Right after the war, the international community swept in to treat war victims and other mental patients. But since then, the international support has faded and left the ill-equipped Kosovar government to care for all mental illness issues.

Sihana Bejtullahu, a project coordinator at Fondacioni Together Kosova, remembers when the internal community provided aid.

"I was 9 years old after the war. International NGOs came in. They asked, 'Do you have nightmares, how do you remember the war?' Then they pick up 2 or 3 people from class. Year by year, those NGOs stopped their programs. After the war, there were about 1000 schools in Kosovo and only 46 psychologists. A school can have around 2000 children... There was a help line. A professor from Jordan created a help line with a psychologist. It lasted 6 months and then they ran out of funds."

According to Gani Halilaj, director of the Division of Mental Health, the total budget of the Ministry of Health for this year is 130 million. About 3 percent is directed to mental health. This is approximately 3.3 million.

The mental health network is divided in all of the regions of Kosovo.

Halilaj explained the steps of receiving mental health treatment: First, the client goes to the family doctor. The doctor diagnosis the patient's mental health problems and directs him to a specialized doctor. That doctor works in the clinic of psychiatry and decides if the patient has to stay in an integrated house. If the patience meets the criteria, he is accepted into treatment by the health system. Halilaj did not specify what the "criteria" for acceptance was.

According to some experts, that "criteria" aren't always fair for all patients.

"Kosovo presents challenges in regards to conflict of interests, corruption, lack of money and staff," said Skyla.

In some cases, the doctors won't treat mental health patients with the seriousness that is needed.

"If you are going through depression, they will call you crazy. It's much easier to talk to a friend. We don't have very strong institution that could help you... A lot of doctors that don't take you seriously," said Bejtullahu. "Private clinics, economic issues prevent this."

According to Remškar, the clinics are not ready to handle the mental health issues posed by young Kosovars.

"Suicide rates are still high. They are increasing. If something happens to a young person, they will send them to a clinic for adults... they aren't equipped to handle young people," Vera said. "The problem in Kosovo is the lack of services in place. There is a huge need for psychological help... There is a stigma about mental health... It is a huge problem to seek health."

Remškar worries that if the trend continues, suicide will become a behavioral pattern as it is in other countries.

She pushed back her chair and again gazed through the spotted window.
(Sarah McIlwain is a reporting intern at KosovaLive this summer in collaboration with Miami University in the United States)

"It is the future of this country," she said taking a deep breath and releasing a tired sigh. "Kosovo cannot afford to not deal with problems faced by young people when half the country is young... they should be the generation to move the country ahead."

Media, Education, Publishing

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15 years after the war, Kosovo faces a mental health battle

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July 2014, Pristina - Vera Remškar sat at the conference table in the white room of the FTK office. She looked wistfully out of the

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homelessness + mental health in California

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homelessness + mental health in California

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House Speaker Paul Ryan and President Trump have pledged to revamp our nation's welfare system for the first time since 1994. These changes could not come soon enough. The War on Poverty, which was launched in 1965, has cost three times as much as all our wars combined since the American Revolution.

Yet, after spending $22 trillion, this war remains a stalemate at best. And when it comes to homelessness, the numbers are moving in the wrong direction.

The Department of Housing and Urban Development recently reported that America's homeless population increased in 2017 for the first time since 2010. This trend is unacceptable. It must be reversed, and it can be if reasonable-minded people of good will on all sides have the courage to rethink their assumptions about how best to fight homelessness and poverty.

For too long, the conventional wisdom on fighting homelessness has said to put "housing first." On its face, this approach makes sense: Put people in housing and you end homelessness. Right? But decades of experience and results suggest this strategy is incomplete. What works, instead, is a holistic and community-led approach that puts individuals and families first.

A recent groundbreaking study on youth homelessness by University of Chicago's national Voices of Youth Count initiative exposed the limitations of a "housing first" model. The study found a strong correlation between homelessness and a variety of factors, including lack of educational attainment, unplanned pregnancy, substance abuse, mental health challenges, and low income.

Youth without a high school diploma or GED are 3.5 times more likely to be among the more than 4 million youth and young adults who experience homelessness each year. This was the single highest risk factor for homelessness.

Youth who are pregnant or parenting are more than three times as likely to experience homelessness. More than one out of three homeless young women are pregnant or parenting.

Meanwhile, 28 percent of youth were reported as having substance use problems, and 66 percent were indicated as having mental health difficulties, while experiencing homelessness.

Youth and young adults with lower household incomes were 162 percent more likely to experience homelessness than young adults with higher incomes. However, unemployment itself was not strongly correlated with youth homelessness. This suggests that employment will not by itself solve the problem. Instead, the focus should be on lifting youth out of homelessness through helping them obtain better-paying jobs, and the education and training necessary to secure such jobs.

Note that these factors that make people homeless aren't necessarily addressed by a "housing first" approach.

In San Diego, our organization, Solutions for Change, has lifted 2,200 children and 850 families out of homelessness. We're solving homelessness precisely because we're putting families and individuals first. We're providing the workforce development, life skills, counseling, and accountability necessary to provide permanent means of avoiding homelessness, rather than just a temporary roof over people's heads. For example, Lucy, one woman we served, escaped an abusive marriage and became homeless. Instead of sending Lucy and her five girls into temporary housing and hoping for the best, we invested in her family and provided them with the support they needed. Now graduated from Solutions University - our program of integrated services - Lucy has a great career is able to provide for her family.

Status quo approaches may not have worked for Lucy. And one-size-fits-all federal policies that elevate short-term "housing first" remedies for chronically homeless adults have failed to address the problems identified in the Voices of Youth Count report. In fact, putting youth in temporary housing without addressing the root causes of homelessness increases the chances they will become chronically homeless, while leaving them vulnerable to abuse and even trafficking.

In 2018, the homeless deserve our best ideas, not merely our good intentions. We need a new operating system and new approach that addresses challenges that exists today, not in 1965.

The "answer" to poverty and homelessness is that there is no national one-size-fits-all answer. And the decades-long failure to mitigate the problem has been the assumption that such an answer exists, that well-meaning national "experts" have it, and that local groups who dare approach homelessness from another angle are not worthy of federal funds.

In 2018, policymakers have the opportunity to make real progress in the fight against poverty and homelessness by measuring results over intentions. And in San Diego, we have an approach that works. Our principles and program might even serve as a template for other cities, although though we don't necessarily presume to know what will work best in Dallas, New York City, Baltimore or Cleveland.

Twenty million Americans are in deep poverty, and the homeless are often on the bottom rung. For 50 years, the federal government has treated them uniformly as poor, defective, and incapable, destined to be wards of the state. But social entrepreneurs across America are flipping that narrative on the bureaucrats who have insisted on the same approach for so long and failed to deliver results.

Local leaders are pioneering a new way of thinking about poverty and homelessness - a new operating system - that elevates local solutions above federal one-size-fits-all programs. The speaker and president, we believe, already share our view. We urge their colleagues in Congress and the administration to make 2018 a year of real progress on behalf of Americans who are longing for real hope and opportunity.
Chris Megison is the president and CEO of Solutions for Change. If you would like to write an op-ed for the Washington Examiner, please read our guidelines on submissions here.

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Rising homelessness requires a new approach to fighting poverty

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House Speaker Paul Ryan and President Trump have pledged to revamp our nation's welfare system for the first time since 1994. These changes could not come soon enough. The War on Poverty, which was launched in 1965, has cost three times as much as all our wars combined since the American Revolution.

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Charity in Surrey creating a 'buddies' service for those with a mental health illness

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A north Surrey charity is looking for volunteers to take part in a new mental health project which will "make a real difference in the local community".

Voluntary Support North Surrey (VSNS) is delivering the Amigo project, which matches volunteers with people who require support in their recovery from mental health issues.

Jenny Roberts from VSNS explained the scheme, which is funded by Catalyst's Welcome Project.

She said: "We're looking for volunteers who can be 'buddies' for people recovering from mental health issues.

"For example, someone might have had depression and would like to start an activity like a choir, a course or a gym class but that can be quite intimidating for anyone.

"So the buddy would go with them to that activity just to build their confidence and be there for them."

Volunteers will receive training across various fields including confidentiality, safeguarding, mental health awareness and more.

Jenny said: "The volunteers will be able to see the difference they make to someone's life first hand - a lot of people want to give something back and this is a way to do that."

VSNS chief officer Solette Sheppardson said: "Volunteers are essential to the success of the project and they will receive full training and support from us."

The charity is looking for "buddies" in Runnymede, Spelthorne, Surrey Heath, west Elmbridge and Woking who can take part in the daytime and/or evening.

Applicants should be 18 or over and can email buddy@voluntarysupport.org.uk or call 01276 707565 for more information.

Keep up to date with the latest news from around the county via the free Get Surrey app.

You can set up your app to see all the latest news and events from your area, plus receive push notifications for breaking news.

Available to download from the App Store or Google Play for Android .

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'Buddies' wanted for people recovering from mental health issues

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A north Surrey charity is looking for volunteers to take part in a new mental health project which will "make a real difference in the local community". Voluntary Support North Surrey (VSNS) is delivering the Amigo project, which matches volunteers with people who require support in their recovery from mental health issues.

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EIS struggling to meet NICE guidelines due to staff pressure and funding

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A key government target for caring for people with severe mental health conditions in England is being missed due to underfunding, research suggests.

People experiencing a first episode of psychosis should be seen within two weeks and get a quality care package.

But Liberal Democrat research indicates that while more people are being seen on time, few get the right treatment.

NHS England said "the analysis inevitably gives only a partial and dated picture of progress".

New care and treatment standards for psychosis were introduced by the Department of Health in April 2016.

The rules state at least 50% of people experiencing their first episode of psychosis should start a package of care recommended by the National Institute for Health and Care Excellence (NICE) within a fortnight of being referred.

Norman Lamb, the former Mare Minister who established the care standards, said responses to Freedom of Information requests he had made suggested "the treatment programme is not being properly delivered" in most parts of England.

While official figures show 72% of patients started their treatment within the two-week target in November 2017, Mr Lamb's figures indicate that fewer than a third of mental health trusts in England were able to offer patients the full NICE package of care.

Of the 45 mental health trusts that responded:

12 said they were able to provide the full NICE approved treatment

24 said they were not

five said they were making progress

Four didn't provide the information

Mental health: 10 charts on the scale of the problem Young people explain psychosis on film 'I was offered help two years later'
The typical treatment involves a combination of anti-psychotic medication, psychological therapies such as cognitive behaviour therapy (CBT) and family or social support.

"Could we ever imagine a situation where a cancer patient doesn't get the full treatment that the evidence says they need?" asks Mr Lamb rhetorically.

"The impact on peoples' lives of not making this investment is profound.

"You are left with - potentially - a miserable life, a life on benefits, a life with difficult relationships. And yet if we make that investment, we can transform lives."

'I thought I was the next Messiah'

Ali Mousa's first episode of psychosis lasted a fortnight.

"I thought musicians were trying to induct me into some sort of secret society," he says.

"I thought I was the next Messiah. It felt bizarre, but very real."

His behaviour, including walking down the middle of busy road, led to him being arrested and spending six months in a psychiatric hospital.

The 28-year-old praises the hospital, but says what made the real difference to his recovery was the support of his local early intervention in psychosis (EIP) team.

"If it wasn't for them, I wouldn't have been able to stand up on my own two feet again," he says.

"I didn't think I'd get support, to get housing, to get me a job, for someone to help build relations with my mum."

Ali says he is now fully recovered, and has been in a job, proof, he says, of the value of good care.

Pressure on budgets

NHS England has calculated that a proper care package will cost about £8,250 per patient.

But of the 17 trusts that answered Mr Lamb's question on funding, all but two (Rotherham, Doncaster and South Humber, and Oxleas) said they were spending less than that amount.

The pressure on budgets indicated by the responses is reflected in a report looking at the performance of EIP teams in the south of England.

The report says that of the 16 trusts providing EIP services in the region, not one is receiving the recommended level of investment.

If the expected investment in the service had been realised, says the document, an extra £15m would have been spent in 2017-18; the real increase has been £3.5m.

"There continues to be a gap between the rhetoric and investment reaching the front line," says the report.

Demoralised staff

The increasing demand for EIP services and the pressures it's putting on staff "is demoralising and driving many away from joining and staying within the clinical workforce", it says.

A member of Dorset Healthcare NHS Trust's Early Intervention Team was recently assaulted, the BBC has learned, after assessing a new patient alone.

The standard is for two staff members to initially meet new people, in part to protect them.

Evidence seen by BBC News indicates the trust is struggling to provide EIP services - with staff carrying higher caseloads than other nearby trusts and, in a number of areas, delivering fewer types of treatment such as CBT sessions.

Mike Kelly, Dorset Healthcare's head of mental health services, said: "We know there is work to do and we are recruiting staff to fill the vacant posts to enable the team to provide more support to people who use the service.

"Additional funding will also be required going forward to keep pace with demand."

NHS England said total mental health funding has risen faster than overall NHS budgets in recent years.

An official said: "10,000 people each year are now receiving treatment through the early intervention in psychosis programme, with over three-quarters of patients getting treatment within two weeks.

"The analysis inevitably gives only a partial and dated picture of progress in these services."

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Psychosis patients 'not getting best care'

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A key government target for caring for people with severe mental health conditions in England is being missed due to underfunding, research suggests. People experiencing a first episode of psychosis should be seen within two weeks and get a quality care package.

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Dad strangles daughter with severe anxiety disorder

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A mental health worker who killed his daughter in a caravan because he could no longer cope with her mental health problems, and then tried to murder her mother, has been handed a 10-year sentence.

Richard Kray was ordered to be detained in a psychiatric clinic until his treatment is completed, before being moved to jail, as part of a "hybrid" sentence he was handed when he appeared at Maidstone Crown Court on Monday.

The 64-year-old said he "lost the plot" and was "at his wits' end" with his 19-year-old daughter Olivia - who had a severe anxiety disorder - when he strangled her in the Westlands Caravan Park near Herne Bay, Kent, on July 21 last year.

He then went to the nearby home of his ex-partner Damyantee Cowan and also tried to strangle her.

In the months leading up to the attacks he told his sister Janice Wallace that it would be easier to kill them.

Kray admitted manslaughter by diminished responsibility and attempted murder.

Judge Philip Statman, sentencing, said Kray's ability to form a rational judgment and exercise self-control was "substantially impaired", adding: "I believe this was a unique set of circumstances very unlikely to be repeated.

"I'm sure in my own mind that every single day, whatever the sentence, he will think of what he has done."

Judge Statman, who described Ms Kray as a "loving and kind girl", said he had no doubt her father loved her and tried to support her to the best of his ability with the "best treatment possible".

But he said her needs became "intense" in the weeks before she died and he lost all interest in life.

He added: "This is not a case where her needs were ignored in any way by you or by her doctors and by the NHS as a whole."

After telling police where his daughter's body was, Kray said: "I couldn't let her suffer any more, so I just, I know it sounds callous, but I couldn't think of anything else to do.

I'm at my wits' end for months and months. I know it's no excuse."

Ms Kray had battled mental illness since a young age and was dependent on her father, the court heard.

In 2016 health professionals noted her parents had "reached the end of their tether with her".

The court heard of numerous and repeated occasions where Ms Kray would call mental health professionals and police if her father left her and would text him saying: "Help".

Less than a week before he carried out the killing, he told Ms Cowan: "Let's crash the car, let's all be killed together", when his daughter was badgering him while he negotiated busy traffic on
the way back from a trip to Bluewater Shopping Centre.

He told the mother of one of Ms Kray's friends: "I'm just so, so tired, I've been at work and now I'm having to deal with this. It's every bloody day.

"You know what I've even thought about killing the pair of them. Obviously I wouldn't, I love her, she's my daughter."

But three days later he strangled her in the caravan where he lived.

Then he went to Ms Cowan's house and pretended he was waiting for their daughter but grabbed her by the neck with both hands and pressed his thumbs hard into her throat while making a "deep growling noise".

She was "frozen with panic" but eventually managed to break free and escape to a police station.

Kray will serve half the term on licence.

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Man given 10-year sentence after killing daughter with mental health problems

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A mental health worker who killed his daughter in a caravan because he could no longer cope with her mental health problems, and then tried to murder her mother, has been handed a 10-year sentence.

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Patients with severe mental illness waiting up to two years for NHS treatment, BMA finds

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Patients with serious mental health issues leading them to self-harm or attempt suicide are being left to wait as long as two years for specialist support because of an NHS "blind spot" on waiting times, an investigation has found.

The British Medical Association (BMA) has warned that thousands of patients are waiting more than six months for access to psychological "talking therapies" to help them cope with negative thoughts and feelings.

However the true extent of the waiting time problem is likely to be much larger.

The BMA investigation found that just one in 10 local NHS clinical commissioning groups (CCGs) who and just over half of mental health trusts keep track of how long these patients are waiting.

Doctors warned of a growing inequality faced by people with serious mental health problems who often need both medication and face to face therapies but have seen little improvement.

This contrasts to the efforts made in improving access to support for mild anxiety and depression thorugh the targets in the Improving Access to Psychological Therapies (IAPT) programme.

The BMA made requests under the Freedom of Information Act to all 207 CCG, the bodies responsible for commissioning NHS services, and 54 NHS mental health trusts to ask them about waiting times for accessing talking therapies.

The organisations were asked about access to DBT (dialectical behavioural therapy), CBT (cognitive behavioural therapy), family therapy and dynamic psychotherapy.

Of the 183 CCGs who replied, nine out of ten didn't record any waiting times for talking therapies in severe mental illness.

While 22 out of 47 responding mental health trusts also don't keep these records.

Of those who did keep records the BMA found 3,700 patients waited more than six months, and 1,500 waited more than a year.

The longest waits were in Leicestershire, where patients waited two years, and Essex and Derbyshire, where they waited for a year and a half.

But in Croydon more than a hundred children with a severe mental health problem were made to wait more than six months.

The BMA spoke to 20-year-old psychiatry student Nicola Mattocks who needed DBT and was self-harming and regularly taking overdoses, but had to wait a year and a half to get support.

"It had to get bad enough that I was hearing voices telling me to kill myself before I was taken on," Ms Mattocks told the BMA.

It was about 18 months before I got the specific help I needed. When I got it, it was really useful, I learnt so much and made a book of things I can do when I'm feeling a certain way.

This could include routines like watching a film when she's feeling sad, however two years ago she experienced mental health relapse and found she was back to square one.

"I was trying to get help again and I had to go back to the very back end of the waiting list.

"It feels like a battle I can't win.

"I can't put into words how serious it is, and the cost of waiting is immeasurable.

"While people are waiting, they're still desperately trying to numb the pain they're feeling, and while they do that inevitably some will die."

Dr Sue Mizen, chair of the medical psychotherapy faculty at the Royal College of Psychiatrists said for severe mental illness "there is no comparable strategy" to the IAPT scheme.

"Policy makers must wake up to the fact that without strict measuring and recording of the therapies on offer, they are not only failing to provide adequate treatment for patients with severe and enduring mental health problems, but are also wasting vast amounts of money in the process by not providing patients with the appropriate psychological response.

"This results in repeated use of revolving door admissions leaving underlying problems unresolved."

Dr Andrew Molodynski, BMA consultants committee mental health lead, said: "There is increasing inequality between people suffering mild to moderate mental ill health and those with severe mental illness.

"Without the right therapy, some patients deteriorate and become more vulnerable, being passed from GP surgeries to emergency departments unable to find the most appropriate treatment for their illness."

"Funding for talking therapies should be protected so CCGs can ensure funding reaches services that need it most before it's too late."

Leila Reyburn, policy and campaigns manager at mental health charity, Mind, said: "It's not uncommon to hear of waiting lists of well over a year for certain non-IAPT services.

"This isn't acceptable. We know that when people get the help they need early on it can prevent them becoming more unwell.

"Making someone wait months and months to start a therapy risks making their mental health much worse, which isn't good for the person and isn't good for the NHS. We need to see significant investment in non-IAPT talking therapies."

NHS England was approached for comment but had not responded at the time of publication.

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Patients with severe mental illness waiting up to two years for NHS treatment, BMA finds

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Patients with serious mental health issues leading them to self-harm or attempt suicide are being left to wait as long as two years for specialist support because of an NHS "blind spot" on waiting times, an investigation has found.

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and finally all our money is still going to Virgin Care

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Jeremy Corbyn has strongly criticised the government after Virgin Care walked away with £328,000 of Surrey taxpayers' money following a contractual dispute over the provision of services in the county.

Virgin Care reportedly received a six-figure cash settlement from the NHS when it sued the health service after losing a bid to provide various health care services in the county.

The private firm, part of Richard Branson's Virgin empire, took legal action against six Surrey clinical commissioning groups (CCGs), as well as Surrey County Council and NHS England in November 2016.

Addressing Theresa May during Prime Minister's Questions on Wednesday (January 10), the leader of the opposition party used the incident as an example to criticise the government for allowing private companies to "siphon" off public service money.

"Part of the problem of the NHS is its funds are being increasingly siphoned off into private companies, including in the health secretary's area of Surrey," said Mr Corbyn.

"Even more money has been siphoned out of our NHS budgets into private health companies."

Mr Corbyn also highlighted the fact the CCG responsible for health secretary and South West Surrey MP Jeremy Hunt's constituency was also involved in the settlement.

He said: "Even in our health secretary's area of Surrey, the CCG was forced to pay money to Virgin Care because it did not win a contract.

"Will the Prime Minister assure patients that in 2018, less NHS money, intended for patient care will be feathering the nests of shareholders in private health companies?"

Mrs May responded: "Under which government was it that private access and private use of private sector service increase?

"The increase we have seen in private health companies working in the health service wasn't under the Conservative government, it was under a Labour government."

However, Mr Corbyn is not the only person who has expressed concern and anger over the large sum awarded to Virgin Care.

Last month, more than 50,000 people signed a petition , launched by Steve Priddy, demanding Richard Branson's firm "return the NHS 's money".

"When the NHS is under severe financial pressure, it cannot afford to lose this money," read the petition.

Surrey's Liberal Democrat opposition at County Hall also slammed the private care company and called for a scrutiny investigation into SCC's dealings, which led to the payout.

Leader Councillor Hazel Watson said: "It appears likely the county council has paid out hundreds of thousands of pounds to Virgin Care but Surrey residents will never the know how much public money was used to settle this case.

"This is money that could have been used to fund vital public services, which are already being cut by the Conservative-administration at County Hall, rather than settle expensive legal disputes.

"I am therefore calling for a scrutiny investigation into what the grounds for the dispute were, how the county council interacted with the CCGs with regard to the procurement and what went wrong, and for more transparency on the amount of public money that the county council has spent with regard to this case."

'Satisfactory conclusion'

In a joint statement regarding the settlement, a spokesman for Guildford and Waverley CCG previously told Get Surrey : "The parties are pleased to confirm an agreed resolution on the litigation concerning the Surrey Children's procurement has been reached to a satisfactory conclusion for all parties with detailed terms confidential to the parties."

When previously approached for comment about calls for an investigation, SCC declined to respond.

Keep up to date with the latest news from around the county via the free Get Surrey app.

You can set up your app to see all the latest news and events from your area, plus receive push notifications for breaking news.

Available to download from the App Store or Google Play for Android .

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Corbyn slams £328,000 Virgin Care settlement in Surrey

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Jeremy Corbyn has strongly criticised the government after Virgin Care walked away with £328,000 of Surrey taxpayers' money following a contractual dispute over the provision of services in the county. Virgin Care reportedly received a six-figure cash settlement from the NHS when it sued the health service after losing a bid to provide various health care services in the county.

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OT's encouraging the country to talk more about mental health concerns

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6:43pm 1st February 2018

1 in 4 people will experience a mental health problem this year, but will struggle to open up.

Time to Talk Day (1st February) encourages not only those who suffer, but for everyone to have the opportunity to talk and not sit in silence.

It's 'time to change' - those who are experiencing stress, anxiety, depression or low self-esteem are encouraged to share their feelings with others.

More than 7000 people have been treated across Surrey since April 2017.

The NHS provide free services such as counselling and cognitive behavioural therapy, which can be arranged online, by phone, in one-to-one sessions and in group therapy.

Nina Nwaosu, Lead Occupational Therapist at Surrey and Borders Partnership NHS Trust, says Time to Talk is a great initiative to take down those barriers: "If you can talk about it, you stand a better chance of understanding of what's going on for you.

"More importantly, getting the help that you need. A lot of people feel they need to hide it and that it's something to be embarrassed about or ashamed of, but it's really not."

"People will realise that they are not alone in how they are feeling and that other people are struggling with the same thing - from that comes the feeling of solidarity, acceptance and more often than not hope that things will get better."

A walk-in service is available in Guildford and offers support to anyone with emotional and mental health needs.

The Safe Haven in Walnut Tree Close is open 6pm-11pm 365 days a year and acts as a safe environment for anyone over the age of 18 - appointments aren't necessary.

There are also several other Safe Haven locations in Aldershot, Epsom, Redhill and Woking.

For anyone aged between 10 and 18, the CYP Haven in Guildford offers young people the chance to discuss their concerns with professionals in a friendly and safe environment.

Dr Sophie Norris, GP and Clinical Lead for Mental Health and Dementia at Guildford and Waverly CCG said it is important for us all to talk about mental health: "Wherever you are, take the time to talk about it whether it is with your friend, colleague or family member.

"Alternatively, free NHS mental health support can be sought through counselling from Improving Access to Psychological Therapies, at a Safe Haven, by telephoning 111 or by visiting your GP.

"These services are staffed with appropriately trained mental health professionals who are there to listen, give support and can signpost to other organisations who can help during a crisis."

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news - time to talk 2018: encouraging people to talk about mental health

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Time to Talk 2018: Encouraging people to talk about mental health

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6:43pm 1st February 2018 Time to Talk Day (1st February) encourages not only those who suffer, but for everyone to have the opportunity to talk and not sit in silence. It's 'time to change' - those who are experiencing stress, anxiety, depression or low self-esteem are encouraged to share their feelings with others.

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Sorry it's the daily mail

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'Cancer pre-hab' includes cycling, weight-lifting and running on a treadmill

Initiative is part of a £200million strategy to transform cancer care in Britain

Those who took park returned to pre-surgery fitness after only six weeks

Exercise classes on the NHS are slashing post-operation recovery times for cancer patients from half a year to just a few weeks.

The 'cancer pre-hab' - offered before an operation - includes cycling, weight-lifting and running on a treadmill twice a week.

The initiative is part of a £200 million NHS England strategy to transform cancer care and comes after research at Southampton University saw bowel-cancer patients benefit from exercise programmes.

Those who took part in weekly cycling sessions returned to their pre-surgery fitness levels after six weeks, while fitness levels for those who didn't participate either dropped or remained at the levels post-treatment.

The programme is now being piloted at gyms and cancer-support centres across Hampshire, Liverpool, London and Bristol.

Surgery is required for almost 80 per cent of cancer patients and recovery can take up to six months, with half of operations resulting in serious complications.

Major surgery can take even longer to bounce back from if patients have previously undergone a course of chemotherapy, as toxic drugs attack healthy cells as well as cancer cells, causing nausea, low energy, loss of muscle and a rapid decrease of overall fitness.

The Royal Surrey County Hospital is enrolling 50 cancer patients in a 15-week course which starts during or just after chemotherapy treatment, and six weeks before operations.

The course is held either at local hospitals or participating gyms, with a personal trainer present to coach people through each hour-long exercise session.

This programme is available only to patients facing a ten-hour procedure for oesophageal cancer, which involves two incisions to the stomach and the chest.

Mr Javed Sultan, consultant surgeon and leader of the trial at the Royal Surrey, said: 'The impact of this surgery is like being hit by a bus.

'You wouldn't run a marathon without doing training so why would you go into surgery that will have a huge impact on your body without any preparation?'

Patients at other trusts are being offered hour-long fitness sessions twice a week for six weeks, with additional low-intensity exercises done at home three days a week.

Six sessions with a psychological coach, also at gyms, are offered to help to keep patients motivated.

Roger James, 71, from Guildford, left hospital just eight days after a ten-hour operation to remove a tumour from his oesophagus in November 2017.

He feels his rapid recovery wouldn't have been possible without his pre-surgery exercise regime.

'I've always been quite active,' he says. 'So when the oncology clinic mentioned the exercise trial, it made perfect sense.

'Getting fitter would obviously make me more able to withstand the surgery.'

Mr James went on the trial while having chemotherapy in July 2017.

'The result was brilliant,' he says. 'Everyone expected my fitness levels to plummet after chemotherapy, but they actually changed very little because my body was fitter.

'Within eight days I was at home and looking after myself. Now, three months later, I am pretty much fully recovered and can get on with my life.'

The Royal Surrey pre-hab trial is partly funded by Macmillan and The Royal Surrey Minimal Access Therapy Training Unit.

lTo find out more about exercise-based trials nationwide, visit macmillan.org.uk and search for clinical trials, or call their support specialists on 0808 808 00 00.

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The 'pre-hab' gym classes for cancer patients

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'Cancer pre-hab' includes cycling, weight-lifting and running on a treadmill Initiative is part of a £200million strategy to transform cancer care in Britain Those who took park returned to pre-surgery fitness after only six weeks Exercise classes on the NHS are slashing post-operation recovery times for cancer patients from half a year to just a few weeks.

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Research released today by mental health charity Mind reveals serious problems with the planning around discharging people from mental health hospitals. The survey of over 1,000 people[1] who have been in hospital in mental health crisis, found:

One in three people (38 per cent) felt they were discharged from hospital sooner than they should have been

One in five (21 per cent) were given no notice at all that they were going home. This even happens when people have been in hospital for a long time - one in three people (33 per cent) in hospital for more than a month were given less than 48 hours' notice that they were being discharged or no notice at all

Two out of five people (37 per cent) said there was no plan for further care and support, contrary to guidelines

Less than half of people (44 per cent) said managing their mental health or self-care was considered in plans for leaving hospital

Only half of people (51 per cent) said their accommodation needs were considered in any plans, and less than a third (29 per cent) said that money and benefits were considered

The days and weeks after leaving hospital after a mental health crisis are critical. People are at high risk of suicide in the first week after leaving hospital and if they are unsupported they risk becoming unwell again and ending up back in hospital.

It is important that care plans for ongoing support are made before people leave. NICE (National Institute for Health and Care Excellence) guidelines state that plans should be made for people's ongoing care from admission or as early as possible from when they go into hospital.[2] There should be a written plan that is put together in collaboration with the person receiving care. Yet nearly two in three people (66 per cent) in the survey said they were not given a written care plan and one in four (23 per cent) said they were unaware of any plan at all.

As well as ongoing mental health care, planning for additional support with housing and finances should be included when people leave hospital. But around half of respondents said that these things were not well considered or, in some cases, considered at all. This risks people being sent home to unsafe or uncertain housing or financial situations that will have a negative impact on their recovery from crisis.

Mind has produced a booklet[3] to help people plan for their care when they leave hospital after a mental health crisis and a briefing to show what can be done to support people.

Phillipa is 34 years old and has been diagnosed with both emotionally unstable personality disorder and a long-standing eating disorder. She was in hospital in January 2016.

"I'd been in my local mental health unit for a week, when one morning I woke up to be told that there was a taxi waiting for me downstairs, and to get ready. Dazed and confused, still half asleep, I didn't understand. Did I have an appointment? Was I visiting somewhere? Did they have the right person?

"Within minutes I found myself in the taxi, with all my belongings shoved into four bin liners. Handed not enough medication to get me through the weekend, I was now off suicide watch and, with a staff member, apparently headed for my local Community Mental Health Team (CMHT).

"I didn't know the time, if I had my door key, if I had money on me or if I had my bus pass. No one could explain what had just happened. How would I get meds at the weekend? Did I have food in the house? Did I have money on the electricity meter, the gas meter? Did my phone have battery? What would I do? Was there anyone around this weekend? How will I get home from the CMHT?

"My brain froze. I went into a state of shock. Was I even awake? I cannot do this. I don't think most people could have coped, and in my already fragile state of mind, I really had no chance."

Paul Farmer, Chief Executive of Mind, said:

"It is shocking that so many people are being sent home from hospital before they feel like they are ready to leave, with no appropriate plan for the care of their mental health. This is not good enough. It is a tragedy that so many people so very recently leaving the care of hospital are being left to cope alone, and are at risk of losing their lives.

"Whether you've been in hospital for days or for months, when you come out you need the right care and support to help you stay well. Appropriate planning while you're in hospital is essential. Help with things like housing or finances can make a huge difference, and you should at the very least have support to look after your mental health.

"Leaving hospital and coming home can be daunting. You need to feel prepared and confident you will get the support and services you need to help pick up the pieces and continue getting better. Providers must urgently make the improvements needed for everyone in their care."
[1] Mind survey of 1,221 people (2017) [2] National Institute for Health and Care Excellence (2017) Transitions between inpatient mental health settings and community or care home settings [3] Mind, Planning for Recovery (2017)

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One in three people sent home from hospital too early - with no plan for further mental health care

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Research released today by mental health charity Mind reveals serious problems with the planning around discharging people from mental health hospitals. The survey of over 1,000 people[1] who have been in hospital in mental health crisis, found: One in three people (38 per cent) felt they were discharged from hospital sooner than they should have been One in five (21 per cent) were given no notice at all that they were going home.