Disadvantage and inequality: it’s time to stop ignoring “difficult” mental health challenges By André Tomlin A few months ago, I was invited to become a Trustee of Centre for Mental Health and last week I had my first meeting with the rest of the Board. I’m delighted to be joining this august charity at such an important stage in their development. I have valued their work for over two decades, but have especially appreciated the difficult furrow they have trodden in recent years, focusing as they do on physical health, wellbeing, inequality and multiple disadvantage across the life course. I am most drawn to them by their commitment to helping the people who are most in need of mental health support. I started working in mental health 20 years ago. I’m an Information Scientist and my first job was in the Department of Psychiatry at Oxford University, working with John Geddes to help set up the Centre for Evidence Based Mental Health. I learnt a lot about mental health, research and technology in that post; enthusiastically spreading the word about evidence-based practice to anyone who would listen. I find psychology, psychiatry and the brain endlessly fascinating, so a career working with charities, the NHS, universities and professional membership bodies really appealed to me from the word go. I also have my own lived experience of mental illness, which you can read about here and here, and I’m sure that this has also spurred me on to make a difference for other people. I have valued [the Centre's] work for over two decades, but have especially appreciated the difficult furrow they have trodden in recent years, focusing as they do on physical health, wellbeing, inequality and multiple disadvantage across the life course. In 2011, I started the Mental Elf, which aims to help people keep up to date with the latest reliable mental health research. The elves spend their days (and sometimes their nights) reading and appraising mental health research and working with a big team of expert bloggers to synthesise and summarise it for people who need to use it. Research shows us that, on average, it takes 17 years for a new piece of important mental health evidence to have an impact on frontline practice. Clearly, this needs to change. The mental health research landscape is huge and one of the challenges of my role is to decide which recent evidence to write about in our elf blogs. There’s enough high-quality research published every week to have individual elves on depression or dementia or anxiety or psychotherapy or youth mental health...the list goes on and on! My job is to decide what’s important and could have a positive impact on frontline practice. On average, it takes 17 years for a new piece of important mental health evidence to have an impact on frontline practice. Clearly, this needs to change Increasingly I am drawn to “difficult” mental health topics, because I am appalled by how little support we in the UK give to the thousands of people living in poverty, with a long history of disadvantage and severe mental illness. Of course, we should celebrate the mainstreaming of mental health conversations that has happened over the last decade. It’s great that we are talking more about topics that have historically been ignored. However, I’m concerned that our national mental health conversation continues to side-line the very people who need it most: those who suffer from daily stigma and discrimination. I would like to see more focus on mental health inequalities, inpatient care, homelessness, prison, substance misuse, “personality disorders”, physical health in severe mental illness, loneliness and social isolation, employment, crisis care, and suicide prevention. These are “difficult” topics because the lives of people living with mental illness and a long history of disadvantage are often chaotic. These are not problems that can be solved with a simple diagnosis and prescription. I’m concerned that our national mental health conversation continues to side-line the very people who need it most: those who suffer from daily stigma and discrimination Tackling these topics (and many more) has been a real focus for me in recent years, and what I’ve found encouraging is that there is a great deal of high quality evidence being produced that we can draw upon. Commissioners, policy makers and politicians looking to improve the ways we support people affected by mental illness, disadvantage and inequality should take heart, because we have a great deal of evidence that can help to transform lives. Of course, the solutions are not neat and simple to implement, but they are evidence-based and effective. It’s music to my ears to hear that my campaigning colleagues at Centre for Mental Health won't accept anything but a system-wide, cross-department response to all those who need mental health support. I strongly believe that this is what we need, and I look forward to playing my small part in driving this agenda forward with Sarah, Andy and the rest of this great group of people. André Tomlin is the driving for behind the Mental Elf and National Elf Service. Check out his bio here.