Mind the Gap - The Reality of Health Inequalities and their impact on Mental Health Services

Right now, in parts of the U.K., people are dying decades earlier than they should and others are facing the realities of severe mental illness needlessly. This is because of the unfair strain being placed on their bodies when they don’t have the things that we all need to keep healthy. 

These things include access to a warm home, healthy food, and a safe place to live. We also need to be free from the stress and worry that comes from struggling to make ends meet and enjoy the benefits that come from healthy relationships. These examples can be viewed as building blocks for a healthy life, which when combined, form a protective shield against ill health. 

On the other hand, when we don’t have these things, the strain on our bodies makes us more likely to suffer ill health, both physically and mentally. Missing these building blocks creates health inequalities - meaning some of us are more likely than others to become ill, simply because of the circumstances they live in.  

The compounding impacts of health inequality

Having health inequalities specifically increases the chance of developing severe mental illness. And here comes the triple whammy – having a mental illness can make finding work, building relationships and leading healthy lives all the more challenging. This fractures the protective shield even further, compounding the risk of becoming unwell.  

However, missing some of these building blocks doesn’t simply increase the likelihood of an individual getting a mental illness - it can also impact the way in which service users access care, experience this care, and ultimately the level to which they benefit from the care they receive. These are challenges that NHS Mental Health Trusts and providers are already working on tackling.  

Missing these building blocks and having health inequalities means people are more likely to be ill, and face challenges in getting the best care just because of where they are born, grow, live, work and socialise. This isn’t right. And although we can’t change all these life circumstances people face, we can provide people with more equal opportunities to get the support they need. This is where digital technologies can help. 

Waiting lists in mental health

At the end of February 2024, over 1.92 million people were in contact with mental health services across England. This figure is rising, and a worrying report recently published by the Health Foundation, suggests the strain on services will only increase. With this number requiring services, waiting lists which are already under pressure and are at risk of increasing. 

There is much less data around waiting times across mental health services than elective physical health care, due to the current target driven nature of access to acute services. But it's important to remember that for the service user, waiting time for an intervention is more important than simply the time to their initial assessment, where intervention does not necessarily occur. Some shocking research, published by the Royal College of Psychiatrists, highlighted that these “hidden waits” force more than three quarters of mental health service users to seek help from emergency services, while 48% felt that waiting for treatment had contributed to a deterioration in their condition. 

This evidence shows that service users need support and guidance while they are waiting - for the symptoms they are experiencing, to aid in navigating the health system and to support them to deal with the challenges associated with missing any protective building blocks for health.  

Where digital solutions can help: 

• Digital technologies can be a source of high-quality, personalised information and education resources, empowering service users to Wait Well. This can be presented in a different language, with culturally appropriate explanations, potentially resulting in behavioural change which can make a lasting impact on someone’s wellbeing.

• Signposting service users to local support groups and organisations who can help with challenges related to the wider causes of ill health.  

• Reduction in barriers to some early intervention initiatives like talking therapies through different mediums.  

• Finally, digital technologies support self-help such as improving sleep and exercise. This can come in the form of health trackers, mood diaries or other forms of self-management applications.  

Access to appointments 

Despite all the negative talk around waiting lists, mental health services are delivering more appointments across both talking therapy and acute services than ever before. Yet despite this increased provision, problems may still arise when people need to access their appointments.   

Imagine Karen, who is a single parent, with irregular work, who is due to receive some talking therapy via a face-to-face appointment. These appointments can often last over an hour and to attend her appointment Karen must catch two buses. There is the very real likelihood that Karen will struggle to attend that appointment - not because she doesn’t need it or want to attend. But because she is worried about losing her job, is unable to arrange childcare or simply is not able to afford the bus fare. She has what we call stacked inequalities - several of the building blocks described earlier are broken, multiplying the effect the health inequalities have. 

When Karen can’t attend her appointment, the care she needs is delayed - both prolonging distress and potentially making the condition ultimately more difficult to treat. For the providing organisation, this is also a wasted resource at a time where every opportunity to connect with service users is critical.  

Where digital solutions can help: 

• Use digital technologies to help identify and predict those at highest risk of DNA’s (Did-Not-Attend). 

• Empower service users to take advantage of being able to better schedule an appointment in a way that maximises their ability to attend. 

• Understand the challenges to attendance in your local population. 

• Co-design solutions with service users to try and overcome those barriers to attendance where there is an element of control. 

The challenge is huge, but now more than ever it is time for the spirit of the “Stockdale Paradox”, where we need to maintain optimism about what we can achieve, while also confronting the brutal facts of the current reality. And no fact can be truer than this quote from a famous non-clinician, Albert Einstein, who once said that the very definition of insanity is “doing the same thing, in the same way and expecting different results”.

The future of Mental Health is about less transactions, and more interactions - we need to change how we engage and manage service users, to support those most in need. To learn more about DrDoctor's patient engagement platform is leading this change, check out how our solutions are combatting some of the biggest challenges in Mental Health.