For our last episode of 2022, Sarah Hughes, outgoing chief executive of the Centre talks to Thea Joshi about her time at Centre for Mental Health. She reflects on the preconceptions she had about policy and research before joining, and the shift in her understanding about how we create change. They discuss what’s changed in mental health over her time at the Centre, and what needs to happen next.
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- Our report with NHS Confederation ‘No wrong door’, a vision for mental health, learning disability and autism services.
Music by scottholmesmusic.com
Alethea Joshi (AJ): So, Sarah, welcome to the podcast for your very final time as our Chief Executive at the Centre.
Sarah Hughes (SH): Thank you. I’m very happy to be here. I’m very happy to be speaking to you, especially Thea. But it feels extraordinary and weird that it’s my last one is very weird.
AJ: I mean, we might have you back on in the future, but you know
SH: Invite me back.
AJ: We will we will, mates’ rates! No, I’m really happy to have you on here today. But it does feel very weird. Lots of mixed emotions. So we’re speaking today, because if anyone doesn’t know, Sarah is very sadly leaving us at the Centre. She’s going on to be the Chief Exec of Mind, which is wonderful for Mind. It’s wonderful for the mental health sector. But obviously, we are really going to miss you, Sarah. So this feels very strange. But I’m excited for the future. But we just wanted to get you on today to really kind of look back a little bit, look forward. And you know, look at where are we going in 2023.
SH: Thank you, Thea for having me. I mean, the reality is, is that, you know, being at the Centre has been the most powerful experience of my career so far. So I’m really keen to talk about it. I’ve got loads to say. And I think that one of the things about moving around the mental health sector is that you’re never really far away from where you come from. In some ways, whilst I am moving to another organisation, of course, I also in some ways feel like I’m just crossing the corridor, and won’t be far away. And I’ll be looking on at the Centre, doing all sorts of fantastic things next year, probably with a little bit of is it “green eyed monster”?
AJ: Yeah, it’s green. Yeah, I think we definitely feel that too. And so without going into the cliches, you will always be a friend to the Centre. We know that. And I mean, there’s so much I want to ask you about and we’ve had conversations in the past about kind of how you were when you came into the role, what you thought of the Centre, what you thought of lots of things and how that’s maybe shifted. And so I was kind of just wondering, if you wanted to talk us through a little bit about a few of the things you’ve learned about while you’ve been with us?
SH: Well, I mean, oh, my God. So whilst I’ve worked in mental health for, it’s actually nearly 33 years.
AJ: You don’t look that old, Sarah!
SH: Well, thank you so much. Face cream!
SH: I think the deal is, is that coming to the Centre, after spending the majority of my career in service lands, the Centre was probably my biggest learning curve of all my jobs so far. And that includes, you know, going into a prison environment, that includes going into complex service provision. And the reason why is because I think I came into policy and research with a whole view of what it is. So when you’re in Service land, you think, and rightly so, often, that that’s all there is, right, that that’s where the most important work is done. And that you live, I think, with a perpetual frustration, that some of the things that you know, in service land, do not always appear in policy decisions and research. And I really felt the gap between the two was so significant, I thought, well, they can’t even be on the same team. Right? There must be something wrong here. And so when I arrived at the Centre, I was really quickly taught a massive lesson about the complexity of our policy, structures, frameworks, how decisions are made, how research is used, how long it takes to get to talk to the right people, what kind of aspects of research will make the difference for one politician versus another one. I found out that you had to have a level of diplomacy, that frankly, anyone who knows me really well, knows I don’t have naturally. So I remember watching Andy having one of those early conversations about policy and looking at him thinking, Oh, that’s what it is. Because it was an absolutely beautiful lesson in saying some really tough things to really important people without being thrown out. And I literally thought, that is like a miracle. Now, I’m in no way saying therefore, policy and research is more important than service land or the other way around. What I really think is that they have to operate together. And the special thing at the Centre, which I think makes us different from everywhere else, is that real depth of understanding compassion, commitment to equity and social justice. A real truth telling, that is really founded in strong evidence that’s both from lived experience, that our professional experts are able to look at. Both from a kind of specialist point of view, but from an academic point of view. All of these things conspire to help us make sense of what happens in mental health. And so I came in thinking I knew it all. And actually, I didn’t, funnily enough. And so for the first year, I mean, let’s face it the first year for me, it was very much about making sure our organisation could survive because it had gone through such a lot of change. So that was my job number one. And, you know, asking myself the question, the really deep question, are we still needed? Because I don’t believe organisations should exist for organisation sake. Right. But very quickly, you you see the Centre’s value to the sector. And I was told really quickly, why the Centre was so important, not only to policy and research, but people in services. And of course, I knew that because I had read and implemented stuff that the Centre had published. So you come to the Centre knowing that there was this resource, there was this kind of brain that operated, that we all deeply needed. And so I still look back at those early conversations I had with Andy and others in the team going, why can’t we just say that? Why can’t we just do this? Why isn’t our research saying this? And being told that it is much more complicated. And whilst we’re not satisfied, ever, with the pace of change, because I don’t think the Centre is never satisfied with the pace of change. I think the Centre truly understands the intricacies of the policy world, and why it’s important to really translate evidence in a way that can be understood by everybody. And that fundamentally takes time. It just does. And so I learn a lot about that a lot about diplomacy, and a lot, frankly, about how incredibly difficult it is to particularly help politicians and decision makers make decisions based on what we see is really good, sound evidence. And so the other bit of learning was what what are the other factors around the table? And some of that is about relationships. Some of that is about coalitions but relationships are key.
AJ: And the context that you’re speaking into as well, right. Like none of this is speaking into a social or political vacuum. And obviously, we’ve seen that recently with the budget, in the middle of a cost of living crisis. And trying to work out how we land our messages and share the evidence in a way that will get understood and received.
SH: I’ve just spent a week with 60 feminists from all around the world. And it was an extraordinary time, I have to say, although, well, I won’t say what I was going to say. Because I was going to say all of the men were in trouble when I came back. But so, in that week, we talked a lot about how do we influence policy today? Because the truth is, the other thing that I’ve learned being at the Centre now for six years is that when I arrived pre pandemic, we could influence policy in a particular set of ways. Now as we are post pandemic, we are post the murder of George Floyd, we are post some of the biggest challenges in terms of European policy with the war in Ukraine. Well, not post, we’re in the middle of it. And now we’ve got the cost of living crisis. So all of these things come together. And frankly, it means that we have to influence differently, but I don’t think any of us have got those answers exactly yet. What that means, what that will look like. But what I know is at the Centre, is that whatever way we influence, it’s deeply embedded in those values, but also deeply embedded in what will make the biggest difference, both immediately but also in the long term. So you we always have that double track in mind. Yes, we want to help people today. We’re going to publish a report, you will see that report by the time this podcast comes out. One of our reports is talking about what is the mental health and autism and learning disability sector going to look like in 10 years time. So we always have to do both things. And in some way, also hold on to hope when all hope is lost, because it’s really easy right now, to be despairing. It’s really easy to think how the hell are we gonna get out of this? But actually, the Centre doesn’t want to sit in that place of hopelessness, which is why we’re so solution-focused. And that’s not because we don’t understand the complexity, it’s because we understand the complexity.
AJ: And I’d love to talk to you later about that hope. But I think as you were speaking, what came to mind is, for me, what I would say is that the Centre is about its research, but its research with passion, and its research with heart, and its research with hope. We’re not just kind of going, oh, poverty is bad. I wonder how that affects people’s mental health from like a dispassionate place. We’re independent, and we are thorough, and we are not kind of being led by whatever we think is going on. It’s research based, but actually, we care, and we really believe that certain things need to happen so that people are not struggling with their mental health. And we do have a vested interest in that, we’re coming from that value of, of lived experience and bravery and courage. You know, we’re not just doing this for the lols. We’re doing it because change needs to happen. So this is not a dispassionate academic look at research on what’s going on. It’s with a purpose.
SH: Absolutely. And that that was the other thing that I think I assumed when I came in that policy and research, or as policy-wonkers, as I know, people refer to, I thought it was a kind of stale old business, to be honest. And I thought that, you know, there’s a lot of people that had sat around just with that kind of academic lens, not really, truly understanding. And that is just not what I found at the Centre, in any way. So yes, we have got some of the most gifted academics, gifted thinkers, I think that they’re our version of Apple’s Genius Bar, frankly. So I totally see that. But I also found a kind of level of passion that I wasn’t anticipating, and a level of strident belief in the work that we were and still do, at a real kind of relentless, ruthless pursuit of transformation of, making sure that people were going to get access to the best help at the right time. And I think that, alongside that, as we’ve moved through some of the most difficult kind of years of everybody’s life, it enabled us to really strengthen our perspective. And so, you know, we know that whilst we undertake a lot of, research and we do a lot of the policy thinking. We also know that so many other organisations are doing it too. And our power, I think, as an independent organisation that doesn’t deliver services, is to enable them to convene networks of people around central subjects. So we’re able to kind of convene people around poverty, and we can convene people around, inpatient beds. All of the things that people don’t really know, often, what to do, what other organisations and people with lived experience, think, and then what to do about it. And of course, the problem we’re in now is not so much that we don’t have the solutions. It’s a lot to do with that policy landscape piece, and how we can build together a narrative that really achieves this ambition around equality and mental health. And I think at some point, we have to replace equality with equity. Because I think that equality in some ways leads us to a place of something that’s probably not strong enough for what we need to see, effectively.
AJ: I’m going to pick up on that now because we obviously talk a lot about mental health equality, equality, mental health equity, etc, etc. And I think there’s probably an assumption that I’m making that everyone knows what that means, and I certainly didn’t when we started talking about it, so I’d love to know from from your perspective, how you explain that when people are asking you what are you banging on about at the Centre.
SH: Yeah, I mean, I think that I often just use the language of social justice, which is very much about – (which comes from, I suppose the fact that I am a feminist leader in a way). And so I do see, all of the work that we are thinking about all of the time, without doubt, has been underpinned by an issue of social determinants, the political landscape. And so those things conspire, I think, to make people’s lives very difficult. So we just take poverty as an example, I gave a presentation this week, to a group of third sector organisations, community groups, and it was a great experience, I loved it. And the reason I loved it was because this group of people probably hadn’t seen a presentation quite like ours, which is very hard hitting, it’s really kind of, you know, pushing an agenda that they may not have, you know, talked about or explored before. So, you know, we say things like, racism is toxic to people’s mental health. So if we could tomorrow, literally eradicate racism, literally eradicate poverty, and give people safe homes, we would see such a dramatic reduction in mental illness, that, it’s hard to understand why we don’t just do that, you know, it just feels really easy. Of course, all of those things are fraught with so many other complications. And people’s understanding of, you know, why people are more vulnerable, if they’ve got serious mental illness is still quite, quite fragile, in a way. And I’m talking to this group on Monday, bunch of councillors, you know, local authority councillors, as well, saying that, look, you see it in your local authority areas all the time, that what people are coming to you for is help with their daily lives. And we know that if we can intervene early enough, or create the conditions for health, then we’re we’re doing something not only for the greater good of society. But frankly, we wouldn’t be seeing the numbers of ambulances outside A&E, we wouldn’t be seeing inpatient beds filling up, we wouldn’t be seeing people going in for treatment for things that they would have had six months previously, or ending up in A&E in a mental health crisis. And so it feels to us that that’s the challenge, as we go into a time. And we’ve been here before austerity, forced the government and decision makers to make decisions that harmed us as a nation, there is no two ways about it, the evidence is really clear. But we’re still not in a place where we’ve really accepted that learning. And this is not a party political point, actually, this is a point about how we get governments to turn the tide, whatever side of the bench that they might be sitting on, because actually, we can’t have lots of good prevention stuff, without also having really good service delivery at the end as well, you know, so all of those things I accept. But we’re in a place where we’re making these binary decisions. And until we stop this binary perspective of we can fund that, but we can’t fund this. It’s tricky.
AJ: Exactly. And also, we’re obviously fully behind preventative support. And that’s a feature of the report that you mentioned earlier on. But it kind of feels sometimes that it’s like giving with one hand and taking with the other. So providing preventative support for adults or for young people is so so crucial. But if on the other hand, you are taking housing out of the equation, or putting very punitive behaviour policies in schools, these these things don’t add up and we’re not really going to see that change, if we’re not doing a genuinely holistic, you know, that kind of mental health and policies approach.
SH: No, it just is literally, that. I have these conversations with external groups. And we have, we talk about what would it be like if people were not living in poverty. And I saw the other day that there is a pilot being tested in Wales, to give young people a minimum income for a period of time to help them transition out of school into employment and into their lives. And you know, whilst we can’t predict the outcomes of that research, I imagine what we already know about those sorts of schemes, that giving people the opportunity to make decisions in a connected supported way. People make decisions that will enable them to thrive. That’s what people do. And so I think that what we also have to move away from is a kind of inbuilt cynicism about what people can, will do if they’re given an opportunity to transform their lives. And I think that we’ve never really tested that idea. You know, certainly in my teenage years, it was very much that social mobility. And there was, it was very much talked about, we don’t really talk about it as much today, because social mobility demands investment. But when you are given that investment, things happen, you know, I had all of my university fees paid, can you imagine that? All of them paid. And I also got paid to live. I mean, I also worked 105 jobs, but that was my choice. But the fact is, is that, you know, I was given that opportunity, and now that doesn’t exist. So even in that small way, those levers when they’re kind of pulled out of communities, and we see the impact for decades to come. And it’s just that frustration I think I have with policy, which is we’ve got the answers. You know, I know, they’re not the always the answers you want to hear. But if we’ve been saying the same thing, every year for the last 40 years, I mean, maybe I don’t know how else to say it. But nonetheless, it’s still the same.
AJ: Yeah, and I totally agree. And, and this, it links back to what you said earlier about that frustration, and how we hold that frustration and things not moving quick enough with the diplomacy, to make progress plus the hope to not kind of just sit in a despondent heap. And, I mean, we’ve kind of touched on this already, but I was sort of thinking about the time you’ve been here, six years, and, you know, what you see has changed or developed or shifted in the mental health arena, since you joined us.
SH: So I would definitely say pre pandemic, we were on like this epic roll. Right? So we have the Mental Health Act review, that was led by Simon Wesley, we were involved in that work. I was astonished that some of the recommendations that came out well, in fact, all of the recommendations that came out of our group, which was looking at autonomy, were taken on board, and committed to which was really such a great feeling that we knew that this legislation was going to fundamentally change people’s experiences of the Mental Health Act. So that that was just quite amazing. And of course, because of the pandemic, we’ve effectively experienced a two year storm on that. So that’s a really tough pill to swallow. Because, you know, all of that work is still there, we know it’s going to happen, I mean, it is going to happen, but not in the time that we would have liked. And also now in a time, when there is less money to implement all of the things that we wanted to implement. So pre pandemic, all of the recommendations were possible, because the country was very kind of feeling like, yes, we can do this, we can make these investments. And we can see that they make sense. And mental health was a really clear top priority for the government. We also saw, you know, great progress in, you know, investment into some of the services that really do make tangible differences, like individual placement support a kind of national rollout. So we’ve seen all of that. So you know, some diversion, you know, when I arrived, it was like 60%, in play, right. And then pretty much pre pandemic, which was like two years and a bit on, there was virtually 100% coverage. And directly related to much of the work that the Centre had led on. So bearing that in mind, those things were really happening, and most of those things are still happening. So we’ve still got an investment into liaise and diversion. We’ve still got that investment into individual placement support. We’ve still got that promise for the Mental Health Act. But it’s now complicated by all sorts of other things, all sorts of other factors, which is we really need to tackle the kind of advancing race equalities agenda and we’ve got a massive ally and leader and just genius in Jacqui Dyer, who’s really motored on this work in a way that nobody else could have done. Actually, I have to say, it’s her that’s been able to kind of get through to the system. And so that work really comes up the agenda. So as we’ve gone through, and we’ve seen health inequality, not just appear as a result of the pandemic, because it didn’t just appear. But I think we saw it in ways that we didn’t see before. And I think people who hadn’t seen it before suddenly saw it. And then there was this new commitment to saying, Okay, actually, we really have got to be serious about that. So in a way, things are very different now to what they were pre pandemic, they’re different in terms of what some of the priorities are. So whilst the NHS have got the long term plan, which is, you know, a ball that is rolling down that hill, we’ve got the integrated care systems, which I do believe, will give us the biggest chance at that integration that we want to see between health and care, and the third sector and all of the stuff that we know, makes a difference. But we’re all doing that, during a time of significant transformation, significant pressure and uncertainty. So what we see happening is that kind of progress, stalling, then maybe a couple of steps back and then progress again. So in some ways, I think, not all has been lost in terms of what we had before the pandemic. But I do think mental health is in a sort of tricky place of playing catch up, because you know, things have taken over, or making a case against a load of other cases that are being made about what people need. And so I think the only answer is really to join up with organisations who are really interested in that kind of advancing race equality and that equity piece to make sure that we’re really motoring on that social determinants agenda. Because if anything, that is the thing that will make the biggest difference, that is the thing that we need to focus on. But the pandemic is not entirely over. And I think that’s the other thing, isn’t it? People think, oh, the pandemic was gone. And maybe the pandemic is not the right word for it, you know, because there is an epidemiological gauge, probably we’re in that’s, you know, technical. Nonetheless, we’ve got inpatient wards that have been set as COVID wards, were set for a flu epidemic, if we don’t get people in for their flu jabs. So it’s there’s a lot of competing tasks. And so coming back to that bit about what will make the biggest difference now, who will help us make that difference? And how can we work with them in a way that means we’re partners, not kind of throwing stones at each other trying to kind of win a war of words.
AJ: Yeah. 100%? It’s that diplomacy piece again, isn’t it, which is definitely not my forte. And I was reminded again-
SH: It’s why we get on so well, Thea!
AJ: – But when you were speaking, I was reminded of Barack Obama, who makes that point. And I think his recent book where he was talking about progress, and he was saying, I mean, in political terms, but I think we’re seeing it now as well, that you know, progress isn’t linear, and you kind of take a massive step forward, and you think, Wow, it’s amazing, we’re doing so well. And then you get knocked back. And for us, that was the pandemic and some of the political turmoil that we’ve seen and a million other things. And then, you know, but it’s that it’s that piece about hope, isn’t it, and that things will progress again, and that all is not lost all the work that’s been done, it’s not lost, but as you say, choosing prioritising the things that are going to make the biggest difference at what is a really tricky time for for the country, really?
SH: Yeah, absolutely. And I think what I would say is that I don’t think we can ever underestimate the impact that the Centre has, on the broader kind of landscape of mental health and care. One of the things that I’ve been very fortunate is that the Centre, all of the people at the Centre are pretty magic. So I was saying somebody other day, that, you know, the thing about leaving the Centre is not just leaving the Centre as a kind of institution of brilliance, but also leaving the people, right. So that’s tough, because I think I said it to you our lovely development time that we had together all as a team, that when I came to the Centre, it was you and Emma, that had really taught me something about the way we spoke to each other. You know, so you two, I think, were at the forefront of our culture, of the way in which we conduct ourselves and speak to each other and I really learned that from you. I’ve really learned a load from, you know, Kadra who is like a, you know, well, she is a walking brain because she carries her brain everywhere, obviously she does. But she’s got such a big ability about all sorts of things that sometimes just don’t occur to me. You know, Jan, who is somebody who has taught me a lot about clarity, you know, I see the world in grey, right? My world is grey. But people who see everything like that need people who also can say, well, this bit is black and white. And this bit I can see, it’s either that or it’s this. And Jan is one of the those people and I absolutely love her for that. And thank her for all of the support that she’s given. And then Agnieszka, of course, our finance guru, who I have to say is, and I don’t want anyone to steal her. So when I’m saying this, I’m also reminded that Andy is probably sitting there looking at this going, she’s advertising our staff, basically, I’m so sorry, Andy. But nonetheless, they are brilliant! Agnieszka, our finance person who just is able to help us think through big decisions in a very kind of straightforward way. And who again, I always say to new people who come in, yes, I’m the Chief Executive, but Agnieszka says no, it’s a no, right, just let’s be clear about that. David, who we’ve got for research, you know, Ed policy, Em doing the Equally Well, Zak doing our training. I mean, everybody in the organisation is one there, because they want to be there. So there is no doubt they’re there, because their values align, that it makes sense to them. But they are also brilliant. And so I’m going to miss everybody a lot. And I know that it’s going to take me a while to shake that off. But as I say, I am going to be only around the corner. And it turns out that me and Andy are going to be in a lot of the same meetings together. So probably, I’m going to see him more now than I ever did before, which is totally fine by me.
AJ: You’re just moving chairs. That’s all!
SH: I’m literally moving chairs. But my time at the Centre has been just magic, it really has. It’s not always been easy, and I’ve been challenged within an inch of my life, at times, specifically around the diplomacy thing I have to say. But nonetheless, it has taught me an extraordinary amount. And if it wasn’t for my time at the Centre, there’s no way I could have been Chief Exec at Mind. So, they are interlinked.
AJ: And obviously, we did pay her a lot to say that guys, all that nice stuff about us! I don’t think Emma and I were – we were completely oblivious to the fact that we’re setting the culture.
SH: You were so so lovely and kind to me!
AJ: I mean, right back at you. But for me, I think you have brought such a passion and determination and urgency. And it’s what you were saying about you’ve learned patience, and bearing with the frustrating pace of change. But you have also given us that sense of urgency and boldness, which I’m so grateful for. And I think what was a, this, we might not keep the same because it might just be me telling you, I love you. And for me, Sarah’s gone. For me. What was so special is really early on, you shared a blog with us on our website about your own lived experience, and that has always really stood out to me, as you know, leading with vulnerability and leading out of lived experience, as opposed to kind of keeping at arm’s length. And so that’s a really massive kind of legacy, I think that you have left at the Centre, which I’m so grateful for.
SH: Yeah, so you’re right, I am crying already. I’ll be crying literally for the next weeks. Yeah, because in some ways that I don’t know, another way of doing it. I am a human being first. And I see everybody as a human being first, and then I see what their role is, which sometimes gets me into trouble.
AJ: If you don’t like someone.
SH: You know, it’s pretty dire. But so I really do think that being able to share that. And of course, you have to be able to see that it’s going to be received with care. So I knew that it was going to be received and and looked after. And, you know, so when it went out there, the response was really interesting, but I’ve never really not told people you know, so it’s always been out there. But this is a very kind of specific outing statement. And I think it would be great to see more people in leadership positions to do that. Partly because I think we want to be human beings, we need to lead as compassionate individuals, but also we can’t be afraid. And the reason why I really do believe that the people that we work with, in mental health services and so on, they’re carrying the risk. So they carry the risk in their lives every day of, you know, experiencing distress, not getting the help that they need, not being advocated for. So the risk in sharing our own experiences is really very small in relation to that risk. And so, you know, I’m not kind of forcing colleagues to do that. And some people don’t experience mental illness. Yeah, there are people out there. But nonetheless, I think if you do, creating that safe space to sort of talk about it and own it, and, and also, it gave me a very public opportunity to say thank you to the people that have looked after me at my worst times. And I know that my CPN at the time, read it, and that she really appreciated that. So again, you know, we are we are supported to recover by services, and we mustn’t forget that either.
AJ: Yeah. And as we’ve said, your vulnerability paves the way for other people to do the same. And then we create a more compassionate, honest workforce. So that’s the dream isn’t there? Sarah, thank you for today. But thank you for everything. It’s been an absolute joy. We are really excited to see what the future holds and to see you take Mind from strength to strength, and we will obviously be there supporting you all the way but thank you for everything.
SH: Thank you Thea.