Cassandra Geisel in Conversation with Will Higham: Unraveling the Complexities of Community Mental Health Systems

Navigating the complicated maze of community mental health is no small feat. Will Higham joins us with insights reflecting his experience from years of working in community mental health across the UK. In conversation with Cassandra Geisel (MBACP), TaSC member with experience in working in community based suicide prevention, we gain an understanding of co-production in mental health services and the necessity for responsive, justice-oriented healthcare systems. As we traverse the shifting political terrain of the UK, Will's personal experiences become a lens through which we examine the broader implications of mental health policies and the urgent need for government-led health initiatives. The conversation looks at the current state of mental health in the UK and how it is at a point of humanitarian crisis. Something different needs to happen. Can we rely on the upcoming elections to spark that change?

Forming alliances within the healthcare sector, especially in mental health, is akin to a delicate dance—one that requires balance, precision, and an acute understanding of community needs. Our discussion turns to the challenges of integrating smaller community groups with larger NHS structures, the significance of equitable funding, and the balance between clinical and social health models. We discuss the importance of clinicians venturing beyond the confines of therapy rooms to engage in deep partnership work, and the transformative power of such alliances in strengthening mental health support services for everyone involved.

The conversation goes on to reflect on the critical role of local initiatives in propelling national health missions forward, particularly in the realm of mental health. The conversation examines the nuance between therapy sessions and a client's socio-environmental conditions. We explore how policy decisions impact communities grappling with health inequalities and the importance of recognising the gaps in care that are often filled by grassroots organisations. How do we, as therapists, learn from the knowledge and assets that exist in community spaces? What does collaboration across the mental health sector look like? The conversation ends in a call to action for cross-sector collaboration, recognizing the collective effort required to address the mental health crisis and inspire a more resilient, healthy society.

Website: Together, we can transform community mental health (rethink.org)

This Podcast is sponsored by Onlinevents 

Transcript

Cassandra Geisel: 0:00

Hello everybody and, yeah, very, very excited to have Will Higgum here to speak to us today at TASC, really thinking about the intersection between community mental health, therapy and social change. So, yeah, I'm going to hand it over to you, will, to just give us a bit of an introduction and kind of how you got into this world of community mental health. And, yeah, over to you.

Will Higham: 0:26

Well, thank you, cassandra.

Will Higham: 0:27

So I've just finished six years leading the community mental health unit at Rethink Mental Illness and that was really an attempt, out of the charity that concentrates on people who are severely affected by mental illness, to try and look at how we met the needs people stated they had where they were when they had them.

Will Higham: 0:50

So essentially bringing together a kind of alliance of organisations in an area the NHS, social care, but also charities that might help people on things like debt or welfare or any issues that they come, so you can look at the whole of someone's needs in an area. And Open Mental Health Somerset, where we started our first pilot, beginning to see its long, slow work that by knitting everything together you can meet people's needs way ahead of the kind of blue lights and the A&E and all of the sort of capacious services that people draw on because they're waiting months, years for the treatment they get, even if that is the right one. So very much based in a mixture of the clinical and social model and addressing what it is people say they need. So co-production has been absolutely at the heart of the work. I hope that gives some flavour.

Cassandra Geisel: 1:47

Yeah, and I'm curious what personally kind of brought you to the world of mental health.

Will Higham: 1:54

Well, I've always been a campaigner in the charity sector and there's two things really.

Will Higham: 2:00

One is the conversation about mental health that we congratulate ourselves for corporately, I think, as a country over the last 10 years seemed to me to have a danger in it and an unfilled potential.

Will Higham: 2:15

So the danger is that in thinking that we're better at talking about depression and anxiety, we don't really get into the kind of SMI end of things and we think that the job has been done. And I think the stigma around SMI remains incredibly strong and we're seeing, actually politically at the moment, the beginning of a reaction against that conversation, as though just greater awareness was what was driving mental illness, rather than some things we'll probably come on to discuss later. And the second thing is I've had in my life around me, in my family and personally I think, two episodes of extreme anxiety, and both of those, even in a what you might call a well-appointed life where you've got friends, loving family and you've got the resource to seek help, almost capsize me and others. So you do realise that where the concentration of mental illness is and mental ill health in this country, it often falls on people whose own resources are already strained and there is a massive social justice element to improving mental health care.

Cassandra Geisel: 3:34

Yeah, thank you so much, and I think it's really always interesting to me to get a bit of the personal as well as the kind of professional background to start the conversation. Well, as the kind of professional background to start the conversation, you touched on something that I think we've been hearing in the news very much recently and I actually read your piece around sick note culture and that leads into kind of the question that I have, which was around the kind of current political landscape for mental health in the UK, especially with the upcoming change in leadership.

Will Higham: 4:04

The likely change. So I think, um, I think you can kind of take a russian doll approach and start with the mental health world itself and it's clear there that, um, politically we haven't really had the drive to bring through the mental health act. There are obvious restore resource constraints. Um, you know the figures are not well recorded on how long people are waiting, but you know it's really common to hear of people waiting years for residential beds if that's what they need, all those, that being the size of the waiting list.

Will Higham: 4:38

I think also, coming out of this world and having a month, you know, with family and cooking and everything else, I've realized how much strain people within that world are under. Very serious committed people, whether clinicians or managers, have been living under massive strain through COVID and through everything else. So there's an immediate kind of resource and enabling legislation issue around the sector. But I think, more broadly, if we look at what the determinants of mental health, you know, the last decade in terms of promoting anxiety and other things, through pressure on living standards, through isolation, through the loss of services, has been absolutely devastating and I think the increasing severity of presentation and early presentation of mental illness is a massive, massive challenge. So I think that is what whatever government wins the election this year presumably will have to deal with.

Cassandra Geisel: 5:47

And if there is that change in leadership, what do you sort of anticipate the effects on mental health or mental health workers or therapists might be?

Will Higham: 6:00

I think the first thing to say is if there's a Labour government elected, no one was expecting that two, three years ago. So the speed at which Labour has kind of had to put together a governing platform is remarkable. So I think there is work there still to do and influence still to be had. I think the best way of thinking about it is within the thing that Keir Starmer always says, but I don't think has been widely interrogated, which is about a move to mission led government. So there are five missions for a Labour government, if there is one. One of them is improving health, and I think mission led government does sound like a bit of jargon but it's rooted in a public policy approach.

Will Higham: 6:46

The example that's always given, exhaustively given, actually, is the Moon mission. So President Kennedy stands up and says we're going to do this impossible thing. No-one knows how to do it, but the resources across government and bringing in other sectors as well, are directed towards an aim. Now, obviously, health is much more complex and human and organic than getting to the moon. I'm not saying that getting to the moon was easy, but I think the thing about the approach that's meaningful is looking across the whole of government.

Will Higham: 7:19

So we've just mentioned benefits, you know, and, and the wider public realm, um, you know what's their role in creating mental health, in in stopping uh, in helping people recover, but also what is the role of um of other sectors. So I think claire murdoch, as director of mental health, has been really brave and right to call out the gambling industry um around its impact on mental health and what's the role for communities in the voluntary sector. We know, certainly from the work I have been doing, that very often something that's peer-led, something that is culturally appropriate, something that's rooted in the community, can be part of the patchwork of meeting the needs someone says they have alongside clinical support. So I think we have to think, you know, about what would make that kind of mission to create better mental health, to be a better place, if you're unfortunate enough to be unwell, for your recovery, what that means like in that kind of holistic way.

Cassandra Geisel: 8:18

As you're talking. I'm thinking about some of the work that you've done in areas around the country like Grimsby or Somerset, and I was just wondering if you could maybe speak to the tone of the environment in a in a place like Grimsby and how that links in with the sort of what you were just talking about yeah, and I don't want to be um down on a place and I, you know there's a lot of kind of sort of almost like uh, sort of despair tourism really in the way that places are talked about and there are assets everywhere.

Will Higham: 8:51

So the real job is getting to those assets and supporting them to help people help each other. But there is no doubt, say in the five years I've been going to northeast East Lincolnshire, you kind of have the storied loss of the fishing fleet, which was both the source of employment and identity to the town. But I think also you have the loss of the kind of consumer society. So I was really, you know, struck looking at the shopping centres that were built on the old industrial sites and are themselves now closing down, you know, because you're ending up with quite an atomised environment where the kind of everyday interactions that might, you know, get you through are gone.

Will Higham: 9:36

I mean, if you get out at the train station, there's an enormous church there, grimsby Minster. It has one part-time member of clergy and quite a few people turning up because they have memories of the place or it feels like a place of safety to them. But even that huge building has just got one person in it some of the time. So I think what you're seeing is, on top of the post-industrial sort of displacement, which is enormous in terms of identity, activity, progression, meaning all the rest of it, there is also a kind of shuttering up of the whole town. So you know, I was speaking to some community organisers who are trying to pull everything together there. They're doing everything, they're staying at the Weatherspoons. It's a lively, warm place and one of the few remaining in what's increasingly a shuttered up town. But that's the impression.

Cassandra Geisel: 10:27

I mean, the challenges are really real, but at the same time, when you get in there, you do find an enormous amount of civic pride and assets that just need to be brought to bear I'm thinking of that asset-based community development model and I'm wondering if you could speak a bit to that way of working and what you found has been useful over the past five years in your post.

Will Higham: 10:56

Well, I think the thing about, I mean, the emotionally exhausting part of the work is bringing together alliances.

Will Higham: 11:03

When you get to an area I mean I remember one of the first is bringing together alliances. When you get to an area, um, I mean I remember one of the first areas we went into. We had a really good meeting with lots of little charities, lots of big charities, and then two of the big charities cornered me on the way to the railway station for a cup of coffee, got out a piece of paper and started trying to divide up the money they thought the nhs would put into this work. You know the bit of actually getting people to work in deep partnership, so that you're directing funds to, for example, a small community group that's rooted in another cultural, traditional language rather than just sending work their way, that you're deeply listening, that small organisations have got the same voice, that organisations that may help people, like Citizens Advice, who are very good, but all veterans charities feel comfortable moving into the world of mental health explicitly. I mean we're all in it, but people have previously felt undersupported to move into that space organisationally, previously felt under supported to move into that space organizationally. Bringing all of that together just from the community side is really tough. I think the drumbeat that goes through it has got to be um, the needs of the community. That is the kind of thing that crosses over the organizational divides. But once you've done all of that, once you've assembled um and it'll look different in every area the the full kind of flotilla of organizations that can meet people's needs.

Will Higham: 12:30

As stated, you then have the fun of trying to connect to the nhs, um and the nhs.

Will Higham: 12:37

No, the business of getting a new way of contracting, a new way of recording data, a new way of recording data, a new way of working through the NHS is extraordinary, and I say that you know fully, knowing how many brilliant leaders have made it happen, but the problems they've had on the way. So, for example, one area we went into we ended up handing out £600,000 in the pilot year of NHS funds to community groups that met specific unmet needs. So you know there were groups for isolated men, there were groups for different communities, you know, making sure that there's a place to go for people who weren't getting help. Now I know how many people sort of got that help, but because we couldn't record it in the first year in the right way, what it looked like is six hundred thousand pounds had just disappeared and the number of contacts, people that had had gone down. So the challenges are really real, both within sectors and then when you bring together the sectors, you know, and obviously social care is vital.

Cassandra Geisel: 13:41

Getting the bandwidth out of councils that are facing bankruptcy to really do things differently is really tough and I think the thing that stands out for me through all of that is this emphasis on deep partnership work and I'm wondering how you can imagine sort of therapists and community mental health coming together in a more collaborative way, because I think it evokes a lot of fear on both sides and I think people can be quite precious on both sides around you know areas and and capacity and and kind of putting their stake in something and I'm just wondering what does that deep partnership kind of look like to you?

Will Higham: 14:24

Yeah, I think I mean there are real. I certainly a lot of clinicians I work with are questioning about, you know, the need to do a lot more, but at the same time, if you're a clinician and you're working really hard and you're doing something useful every day, finding the time to kind of evolve in other ways, um, and then you know moving. Obviously the kind of attachment to the clinical model is absolutely right and real, but working out how that fits into a more social health prevention model is something. Now I think the profession is challenging, you know can is challenging in in a positive, in the right way for the profession, um. I.

Will Higham: 15:08

I think, though, that the, the, the kind of mission um rooted in an area, can bring people together.

Will Higham: 15:18

I mean, if you look at an organized, if you look at something like um, go back to northeast links, brilliant trust there called navigo, which which is actually a community interest company, you know they're in a position where they've got a walk in crisis centre.

Will Higham: 15:34

So fantastic, they've actually bought the garden centre in the town to provide employment. But, you know, for people who are on that stage of their kind of rehabilitation, if that's right for them. But how big, how much can a mental health trust do if, at the same time, the sort of lump of demand is growing massively? So my sense of this is that you do have to respect the different needs and assets and character of areas, but that national mission around health creation, of which mental health is in some ways the most accessible I'm sorry about that, um, um, you know that has got to be rooted. You can have a national kind of mission. It's got to be rooted in local communities where you're really talking to people about what they need and what's there. And I think clinicians of all sorts play an absolutely vital role in that, both in their insights, the skills they bring and also the sway they have within the system to actually make something different.

Cassandra Geisel: 16:44

Yeah, there's a real thing happening between the national and the local level and, I think, thinking about the power and the distribution of that power and how and where the change can really really happen, and so it's trying to marry these things that feel quite difficult and it's making me think about the tension between individual interventions and then community interventions and I'm just wondering if you have any thought on, yeah, that tension of community support and individual support yeah, it's really.

Will Higham: 17:16

Um, I mean just to start on the community stuff first. I think if you look at areas of really high health inequality, really high demand, I just think it's useful to pause for a moment and look at how policy works in those areas. You know there's no, you know I'm thinking of to use an example from another world, just you know, and not to draw anything from it except the numbers, just you know, and not to draw anything from it except the numbers. If you look at the criminal justice system, the concentration of expenditure on a few postcodes is absolutely mammoth. And I think if you look at some of the areas where there are great health needs, massive amounts of resources are not going in there but being sort of drawn out of them. Really.

Will Higham: 18:06

So the cost of not helping someone for three years, not meeting their needs, and then, you know, putting them in a private um rehabilitation center, is enormous, it's absolutely enormous.

Will Higham: 18:17

The cost of um to use another example, the cost of uh not providing local social care for for for kids and then having to ship them 100 miles to be in a static mobile home um, you know, provided for uh by um, the private sector is absolutely colossal. So there are huge amounts of resources drawn out of areas that you need to look at how you unlock and help areas be able to sort of resource and meet their own needs wherever possible. But also you've kind of got a kind of restive policy environment where a good idea possibly comes along and then two years later, before it's had a chance to embed, it's moved on so that the picture on the ground of trying to keep up with leveling up, trying to keep up with, you know, the regeneration programs that came before it, is absolutely confusing. So I think, to go back to your question, I think if you've got this national mission, you need to have some state stability of resourcing and some local kind of autonomy to work out how best to achieve that mission in an area.

Cassandra Geisel: 19:34

I'm thinking about. It's on my mind clearly the sick note sort of conversation that was happening and the onus that then gets put on the individual and I think the individualization of mental health and it being solely down to the person, and I think often then it feels like individual, one-to-one care is the kind of only way forward if all the onus is on your shoulders. And so I'm wondering how does that individualization of mental health affect play into this conversation about kind of policy and wider yeah, I think in policy terms.

Will Higham: 20:04

So nothing you know. Like many other people in life, I've found therapy extremely useful and really respect the art you know and the science and the practice of it. So this isn't in any way to diminish that. But if you say, move down a model of just thinking, we can take away social care, we can take away the built environment, we can defund education, but then we'll put in a therapist in a school or teach people how to be resilient. You're in a very dangerous territory there, because you're sort of trying to teach people how to cope with things they shouldn't have to cope with. How to cope with things they shouldn't have to cope with.

Will Higham: 20:40

There's a practical side to that, you know, which is how much can you help someone in 50 minutes a week if they're returning home to a noisy, stressful, damp ridden environment? You know what is, you know you might have some, you know some purchase there, but you'd sort of want to look at the whole person's needs and at its worst, and you kind of get this sometimes. You're kind of want to look at that, the whole person's needs and at its worst, and you kind of get this. Sometimes you're. You're kind of at the policy level, particularly with kind of the, the sort of teaching and school side of it, you're dangerously near talking about how to educate people to live in reduced circumstances, how to be behaved, how to be good um, or non-workers, as the case may be, and I think that's why you need that kind of whole person, whole community model.

Cassandra Geisel: 21:28

Yeah, I couldn't. I couldn't agree more, and I think it's a tension that definitely exists inside of me, as someone that's worked in community mental health and is training to be a psychotherapist, and I think it's actually why I really thought this conversation was worth having, because I don't know if there are any answers right now, but I think the more conversations that we have around this, the closer we can get to something that feels more cohesive and sitting alongside rather than one or the other, because I think right now it does very much feel like it's either this or that, and I'm sorry to interrupt On the basis.

Will Higham: 22:06

This isn't the Today program and I've done lots of. I'd be interested in hearing a little bit more about how you set up that question.

Cassandra Geisel: 22:14

Hmm.

Will Higham: 22:16

Which bit the bit about how you manage that kind of question.

Cassandra Geisel: 22:19

that's still to be resolved around the community model and the therapeutic model which started at the same time and actually has been a pro but also a con, in the sense that every day I kind of grapple with the tension that exists between the two things and really being on the ground, listening to communities, listening to local organizations, getting the feedback from very traditional mental health services like IAPT and we can go on to that in a minute, because I have some questions around that too and the feeling of being really let down, really not seen, but then experiencing firsthand kind of the changes and shifts and yeah, I guess not to sound too idealistic, but real sort of moments of connections that happen in one-to-one therapy and how you can acknowledge all the sort of systematic limitations but try to exist within them to the best of your ability.

Cassandra Geisel: 23:40

But to me personally it's very much about acknowledging all of it rather than kind of pretending it's not there or thinking that your mental health exists separate to the systems that you're embedded in, because I think we live in a world, we live in a body in the world and we have to engage. And so if you're walking and you're leaving the therapy room and you're going to housing that's full of mold, what are you going to do? Just to use that example that you used earlier. And so, yeah, I struggle, I struggle with it, but I think it's something that can be, yeah, more collaborative, and what I've seen happen is that collaboration between clinical and communities at my post in suicide prevention.

Will Higham: 24:34

I agree, and there are ways of doing it and just one sort of allied thought that is unformed, just reflecting over the last six years. I think this is kind of going to sound like an academic. More research is needed, um, but there's um. Not there's anything wrong with academics, but there's um. There's a question I have about, about the healing power of agency in your own life and being heard, um.

Cassandra Geisel: 24:58

I don't know how you'd measure that, but the business of having the needs you've stated, men, and having some power in your own world, which you know we've seen a bit in the work, I think does also deserve more looking into yeah, I, I couldn't agree more and I think, um, it's, it's that, and I think it's a really sort of delicate dance between these things around the real acknowledgement and facing towards, I think, the levels of oppression that we're existing under, but then trying to cultivate and find that agency. But I also really hear what you said earlier around. I don't think it should be just about building people's resilience towards something that they shouldn't be resilient, have to be resilient to, and I think that's probably where the tension lies mostly for me. Um, is that point of like, what actually are we? What is health? Uh, what is thriving? What does it look like to live a good content, good enough life?

Will Higham: 26:02

um, yeah, yeah, and certainly as I I know you. Even if you've got your immediate needs met, there's still enough to deal with. It's not like anyone's going out of business soon yes, yeah, exactly, yeah, exactly.

Cassandra Geisel: 26:20

On the note of IAPT and traditional mental health services, what are your thoughts on on that current system and how could we navigate?

Will Higham: 26:30

I think I don't want to be the NHS talking therapies is. I mean, I think of it as like a really good component that that needs a system to fit better within, if you know what I mean. So I don't want to criticize it in its own terms. It's. It's like, um, you know, you, you've kind of um, you've got a really good bit of a system, obviously, but but there isn't the rest of the system. So there are ways in which, um, I think the psychological side of it fall, you know the overall system fall short. I mean one is I think the provision of kind of psychological, psychotherapeutic support for SMI is patchy stroke week across the country and I think also that there's a lot of work to be done within systems in creating the confidence to treat people in the community. You know it is, I think, under-researched how to handle, how to handle to use the old fashioned terms personality disorders and eating disorders within the community, because you know these are, because, um, it's not a sort of always a drugs and pharmaceutical-led intervention. So the the research is a different sort of research and you find pockets of excellence where people are getting the help they need in the community, but overall you get um, a lot of fear about the levels of risk. So people are waiting until you know that they can be handed over into a fully managed environment and the risk be contained, um, and I think that needs a lot of work.

Will Higham: 28:07

I think then there's so there's that sort of dimension. There's another dimension which is um, the effectiveness, and this goes back to our earlier conversation, cassandra, so I'll keep it brief. I've heard um, and I can't, unfortunately, cite it. I remember talking to a psychologist a few years ago who was saying that the success rate of talking therapies for people who are unemployed after a year was incredibly lower than it would be if someone was employed and had that aspect of their life sorted. So we need to look at um. You know that the basket of needs that people will bring in usually and I think some of the work with navigators around severe mental illness, you know, really shows that.

Will Higham: 28:52

You know and certainly community crisis houses that when people come in, it will be with a whole suite of issues, um, and, and how are those met, whether that's housing, family breakdown, domestic abuse, all of those, how can that be kind of all dealt with at once? And I think then there's also the questions about the psychological model as it sits in that broad sense and different communities and really being able to reach and different communities and really being able to reach to assess how you can kind of meet the needs of historically underserved communities best as well. So I think if you think of it as a kind of excellent sort of component, able to do a lot quickly and efficiently and be measured, which is unusual in the world of mental health, you know, where we don't even know how long people are waiting for those things, it's great. But you know, robert, what's the other stuff that needs to fit around that to make a kind of coherent system or ecosystem?

Cassandra Geisel: 29:57

yeah, there are a few things that I want to pick out of what you just said, but one of the ones you just mentioned around measurability, and I'm not sure if you are familiar with sort of the idea of CBT as the main modality that is regularly offered through NHS and IAP services and other approaches, approaches, other therapeutic approaches, and I'm just wondering if you have any kind of comments on, yeah, cbt and its dominance in iapt versus I'm not.

Will Higham: 30:30

I mean I think that there are a lot of other approaches that will meet people's needs. I'm not going to sort of. You know, the cbt can be, in my experience, very helpful for some people and the right thing. But, um, you know that there are. You know the availability of um, dbt and other therapies, the availability of um, you know approaches that might help people with more complex diagnoses. You know is really really tough, it's really patchy, but the danger here is letting you know this really sizable intervention be judged by what it isn't rather than what else isn't there. What else isn't there. So I think, um, I think we do need a complete revolution in the kind of psychological psychotherapy you take approach that's available for other conditions. You know that things have moved on.

Will Higham: 31:31

I mean, I still do come across the odd psychiatrist who, when relaxed, will say that you know, these things are hopeless, all sorts of conditions, and there's nothing known and nothing done. And we know that that isn't the case. So, from the research to the practice, moving through into the community, a much more kind of sophisticated toolkit around psychological interventions, because no one would ever accuse talking therapies or IAPT of being a Swiss army knife. It's more like a great big sort of steam hammer. I'm not saying it's hammering people, but it does. You know it does, it does its thing. We need, we need a. We need a. We need a much more varied toolkit.

Cassandra Geisel: 32:16

Great image. I think it really sums it up. And that thing about being expensive and covering a lot of ground. It leaves me thinking about the idea of risk and what I've heard, I think working in community mental health speaking to people who have been deemed too high risk but are in desperate, desperate need for support. Yeah, I guess, just wondering. I actually don't really know the question, but thoughts around risk, the fear that's associated and maybe why you think that fear is so high.

Will Higham: 32:51

Yeah, I mean, I'm just going to take it from the individual's viewpoint first, and the image that I always have in my mind is the airport from hell, when you would kind of join in queues to seek help and this is people who are seeking help. There is a huge well of undressed need out there, which is, you know what the signal culture conversation is missing. If everyone who needed help, then we'd really be in trouble. Note culture conversation is missing. If everyone who needed help did it, then we'd really be in trouble. Um, so you're kind of joining a queue, you get to the end of the queue and you you find that you've been in the wrong queue, but you know you're too sick for this queue or you're too well for that queue. There's sort of announcements over the tannoy. The whole thing's confusing.

Will Higham: 33:30

Um, that is too often the picture of kind of seeking help and I think the risk thing is really crucial because it creates that kind of terrible zone where you're too sick for some of the help on offer, like IAPT, talking therapies, although locally people will bend the rules.

Will Higham: 33:52

You know, but you may not be sick enough or fit the criteria for you know, early intervention of psychosis, or you know, but you may not be sick enough or fit the criteria for, you know, early intervention of psychosis or, you know, or for the mental health trust to sort of take you on their book, so to speak.

Will Higham: 34:03

And I think that that risk element that it creates for the individual, these jagged edges, these cliff tops where you can't get need until you're way up there, and these bits when, once you're passed off, you're kind of you're dropped.

Will Higham: 34:18

So it's really certainly in supported housing, where you're taking on a lot of people from residential environments, there's all these cliff edges to someone who should, you know, should be fully focused on their recovery, you know. So try and get someone who was under the care of a mental health institution, try and get them trying to get in contact with a team a week after to say that they're having troubles is really hard. If you're running supported housing, they're off the books and then, similarly, supported housing itself will have its own lifetime. So people are moving out now, you know, out beyond um, beyond help. So I think, understanding how you manage risk in that environment and I understand how difficult it is for nhs colleagues and I understand how um traumatic it is for staff to go to an inquest and their question closely on it. Have they done everything they can?

Cassandra Geisel: 35:16

and I understand the sheer, the difficulty of being a person with the best intentions facing community anger, um, but working out how we do that differently is absolutely crucial and as you're talking, I have this image of like when you're attempting to get care, being kind of in that nucleus of health, but then you like get further and further away as the time goes on, and then that's, I think, where these gaps start to really appear, and I think you hear it again and again is there, just isn't that cohesive support, no, and it needs to match.

Will Higham: 35:53

Um, we all know what mental you know managing one's mental health looks like. It is not a linear industrial process. There's going to be moments that are really bad and bleak, which, if they can be helped in a timely way, might not necessarily mean a full. You know full re-experiencing of whatever it is you've been through. You know full re -experiencing of whatever it is you've been through, but you know to have that support be dialed up and down around someone's needs is ultimately the efficient system.

Will Higham: 36:24

You know, we've run our. The reason why the airports analogy was in my mind is that they run around the convenience. You know they run around the expensiveness of planes and pilots and the people that sort of herded around to try and make that maximized. And I think ultimately in mental health it's got to be a different model where you're thinking the most humane and efficient thing is meeting the full spectrum of someone's needs when they first are experienced, and helping them to feel better but also to carry on in work. And you know, you know the loss of employment through mental illness is rife. But you know you're helping them carry on, support their networks, their families, whatever it is.

Cassandra Geisel: 37:12

And maybe this is an ambitious sort of question, but what do you think that newer model could look like? Very big one, but worth asking.

Will Higham: 37:26

Well, we did the years ago Rethink Mental illness report called Building Communities that Care which is this work and there's also I just recommend there's a huge number of follow-up publications and webinars. So in the in the you know obviously unlikely um event that I haven't made a lot of sense. There's a lot of resources there to look at um and to really follow this through and find more about what the models mean. But for me, the heart of it is something we wrote in that report, which is we will know, this has succeeded when every area has a plan for how to be the best place possibly can be if you're unwell, to recover and to live and to have your needs met. But also every area takes pride in being that place and I think that's where you've got to take the national mission around.

Will Higham: 38:15

Health and mental illness is a huge part of our health crisis as a country. You know, as Michael Marmot was saying in earlier this week, the problem here is not the sick note culture, it's we're a chronically unwell nation, um, and we need to fix that. But I think what that looks like locally is a cross-sectoral approach. So obviously there is a massive role for clinicians and the NHS. But social care how are we meeting those needs? Are local employers looking at whether they can design to an extent, stress out of their roles, whether they can better support people through life transitions, without the choice being kind of firing or keeping. You know what's that flexibility? How are people finding pathways into work just to stick with employers? Are the, you know? To go back to the gambling point, you know, are the industries debt gambling whatever that are effectively have a hidden business model of preying on vulnerability?

Will Higham: 39:19

Um, what does the environment look like? Is there a place to walk? Um, what is the role for the voluntary sector so taking pride in being a place which promotes good mental health? You know there's a huge amount of need that can be met. Everyone's individual needs will be different but, speaking broadly, um, social connectedness is obviously a vast part of what supports mental health. How does that get encouraged? And I think we have seen, certainly during COVID, the ability of the public to mobilise around something I think I'm trying not to mix metaphors too much I think there's the mental health crisis that's looming, has in its scale a kind of humanitarian element that this is really, really bad. And I think that kind of sense of mobilising an area, and I think that kind of sense of mobilising an area really led by both clinical expertise and really listening to what people say they need and mobilising all the resources in.

Cassandra Geisel: 40:23

It is the way that it has to go, and it will look different in Taunton to how it will look in Grimsby, but that would be my, my utopian approach yeah, I'm glad you just used the word humanitarian, because that was actually going to be my next question, which is around what do you think moved you to have this humanitarian approach when it comes to mental health?

Will Higham: 40:50

I know you've touched on it already, but, yeah, well, I mean let me define the term so I'm really clear. So I mean um, I mean the level of need and the stress on the existing services is at crisis point. So you're looking at interventions that are that take that into account. Um, and you're also looking at um areas where there's been such a long degradation of uh to meet needs that you're not just looking about putting up in-year resources, you're looking at recapitalising them and building new systems, because you can't have 10 years of a kind of massive withdrawal of investment into the built environment and houses and everything else without that being more than just an in-year. Here's 10% more to do a little bit more of what you do, massive withdrawal of investment into the built environment and houses and everything else, without that being more than just an in-year. Here's 10% more to do a little bit more of what you do.

Will Higham: 41:42

And when I say humanitarian, I'm thinking of the response that we have after a disaster, and I think it's very hard for individuals within the system, who are doing their best and want to have hope, to do anything other than think I must work a bit harder.

Will Higham: 41:59

Like you know, I seem to be on an analogy fire, um, like boxer and animal farm.

Will Higham: 42:05

You know, there's that thing of wanting to hope and wanting to do what you do and wanting to believe that you know it being difficult to believe that, that a lot more is needed. So I think, believe that you know it being difficult to believe that a lot more is needed, so I think that there's a bravery in saying in parts of the country, this is a disaster and we need to do things differently to respond. So during COVID we saw a huge amount of innovation let into the system and how to meet people's needs. I remember about a year after someone running a trust saying, sadly, the bean counters are now back, that you know some of those approaches that could be tried, uh, but also I think you know we're going to need a whole, a whole social response, um across sectors, to come in and help promote the you know, the creation of health that leads in to my next thought, which is around how do you think therapists, both in the nhs but also private practice, could mobilize more to support?

Will Higham: 43:11

this. Yeah well, um, I think you know this is the beginning of a conversation, right? So let's not be definitive here, even if I did have a ready answer, but I think there's a few things. So, I mean, the first thing to say is is that the role of therapy is is absolutely vital. So doing what you are doing, so to speak, it is already great.

Will Higham: 43:40

But then I think there's a thing around leadership within systems. So, if you're working in the NHS, the clinical leadership to do things differently is transformative. It's not, it can't be a kind of purely a kind of bureaucratic imperative. It's got to be driven by passionate leaders and I think, um, to go back to my thing of wanting local plans, um, you know, if you, if, if that, if you accept that, I think the role of clinicians and therapists in in leading to that, really understanding what in your area, are the barriers to recovery, what are the sort of needless creators of mental ill health? You know that process of working out what people are saying, bringing them into the conversation, what are the assets in the area that is vital for clinicians to be involved in?

Cassandra Geisel: 44:36

What are the assets in the area that is vital for clinicians to be involved in, and would you say you are optimistic about these changes at the moment?

Will Higham: 44:50

Always got hope. I'm just going to add one other thing, though. I think there's a barricade to be, to be peopled at the minute, about the conversation on mental health and where that is going. And certainly, you know, it may seem a small thing, but the letters into the newspapers, the kind of things are saying actually we haven't gone and made all this up or suddenly become snowflakes is really really important for for for this, because this is, you know, this is this is a big seismic shift backwards going on.

Will Higham: 45:17

Um, yeah, I'm hopeful in the sense that I don't think my route to hope is through despair. So I think things are so bad that we can't carry on as as things are. I think we are about to have a change of leadership. Um, as I said, I haven't had a lot of time, but I know that there's at least the asking of serious questions and I've been really keen to see I'm glad to see, actually Keir Starmer's focus on the hard to reach health issues rather than just the kind of stuff. How do you really tackle SMI, help people who are living with severe mental illness? How do you look at health inequalities. I think a serious asking of the right questions. So I hope, although it will be difficult, that we will find a path through.

Cassandra Geisel: 46:06

Yeah, I think it's really important to try to carve out that hope, especially in times of despair, and I think the potential change in leadership is both exciting and scary, based on what they're inheriting. Um, and so do you. Would you say that you have faith in the potential shift of government?

Will Higham: 46:31

well, it's um, what do you do about an everything problem? So you know, our politics has been dominated through my active life by a few big issues, one at a time. You know, um, the iraq war, um, I mean leaving out the 90s where we had to sort of make up problems, um, and I was not really interested in it anyway. But, um, the iraq war, the kind of banking crash, brexit, real obsessive focus on you know, a few issues Cost of living now, which we're not looking at in terms of its human impact at all.

Will Higham: 47:06

It's just talked about as though it's an arithmetical problem, a kind of. You know, the way in which you have to tackle, um, the problems that the likely next government has identified around health creation, around great opportunity for young people, around net zero, um, around crime and around growing the economy, um, I'm leaving out, by the way, that stuff happens. So you know, we've seen a lot of stuff happen that needs reacting to over the last couple of years, particularly internationally. What you do if you've got an everything problem like that is you've got to look at your models of leadership, because simply, kind of departmentally pushing down the green papers, the white papers, the kind of budget settlement, isn't going to make a difference in time and I think it really comes back to me for this mixture between kind of national priorities and then cross-sector action that comes together locally. So I think if you've got an everything problem, you can't solve it for people. You need to give people the tools to solve it where they are.

Cassandra Geisel: 48:12

Which feels really empowering actually, which feels really empowering actually, um and I'm just aware of the time and wondering if there's kind of any final thoughts, because that to me feels like a very hopeful note, but also an empowering note and a note that feels yeah, I'll just say really quickly that I think the um for me I never expected being an interest in mental health to lead into an interest in local government.

Will Higham: 48:38

I was never, you know, suspecting that.

Cassandra Geisel: 48:40

But I think this thing of looking at the Marmot Report of how much the poorest areas have been hit, and then this work in looking at the assets and the voices in those areas, looking at how you rebuild and recapitalize, for me is the big pathway from despair to hope yeah, and my reflections on that just in my in my time and grassroots suicide prevention work, is the assets that do really exist in communities, um, and the need for trust, and I think that goes back to the risk conversation, the need for trust, and I think that goes back to the risk conversation, the need for trust in those communities that are filling the gaps that we're talking about. It is often the charity sector, the third sector, that are filling these gaps that exist. And so, yeah, the trust, the hope, I think it's all there, the hope, I think it's all there. It's just how can we all, therapists and community mental health alike, yeah, move towards it together.

Will Higham: 49:42

How do we not depend on heroes and pilots, as in pilot projects, is the great question, and I hope, cassandra, if you don't mind me saying that, you'll put up a link to your work, because it's brilliant work and should be seen widely.

Cassandra Geisel: 49:54

Thank you, thank you very much. Yeah, it's been an amazing time um working in northwest london on on the suicide prevention program. So, yeah, we can share it in the um resources at the end perhaps, um, but yeah, thank you so much will for for taking the time to come and speak with us today. I think you know the way I see the intersection between um today. I think you know the way I see the intersection between therapy and social change is by having really wide conversations from people from all parts of the mental health arena sit down together and talk. So I'm really grateful that you yeah, sat down with me too perfect.