Following RSPH’s recent report on the changing uses and misuses of health trainer services, Alexia Ollivier, Health Inequalities Lead for Cornwall and Isles of Scilly Health Trainer Service, gives us her view
Cornwall, known for its rugged natural beauty, isn’t often seen as an area of high health inequalities yet they exist nonetheless. In the most deprived areas, life expectancy is 5.3 years lower for men and 4.2 years lower for women than in the most affluent areas. We have been running the Health Trainer Service in Cornwall for nine years now. Our aim is to work with the most disengaged and excluded people to help them make positive, healthy changes to their lifestyle, with the ultimate goal of changing their behaviour one step at a time.
A Health Trainer is not clinically trained, and is not a specialist in any medical areas except communication. It is in this discipline that they are experts. The Cornwall team are ‘real’ people who empathise, respect and understand the barriers people are facing in their lives. They’re role is to listen and hear.
Recently, we have been receiving more and more referrals for clients who have moderate to severe mental health problems. We have always worked with clients who have mental health issues, but not specifically on their mental health. There are, or should be, specialists for that. However, the reality is that clients are being referred under the auspices of ‘healthy eating’ or ‘social isolation’ when clearly their mental health is not stable enough to allow them to make meaningful behaviour changes. Our non-medically qualified Health Trainers are expected to support these clients because there is nowhere else for them to go.
We have also seen more clients coming to us with a very late diagnosis of autism. For one client – let’s call her Morwenna – this came as a great relief. Her life of 54 years finally made much more sense. Morwenna is an amazing lady who tries everything that is offered to her and is always keen to get involved. She is very open about her experiences and has written a book to help others understand what it is like to live with the condition. However, autism is not the only issue Morwenna's faces, she also requires further mental health support.
Morwenna was lucky to get funding for 12 sessions with a specialist psychologist at the Pearl Centre in Truro, which was fantastically helpful. These sessions have now come to an end, as have her six sessions of Talking Therapy, and there is nowhere else for Morwenna to go to. When she did speak to the community mental health team, she was told her suffering is not bad enough to require more help, and they cannot intervene until it is.
So when Danny Boyle tells us via the Equality for Mental Health campaign, that the inequality in the support provided between physical and mental health is “an injustice that harms so many lives”, he is absolutely right. When the Government won’t listen to us, we can only hope that they will listen to Danny. It is impossible to think that if you were in A&E you would be told that your pain wasn’t bad enough for the doctors to treat.
Where can Morwenna get the ongoing mental health support she needs? A lot of agencies re-refer clients to the health trainer service because they don’t know what else to do, and to be fair to them, I have no other suggestions either. Yet can we really expect an A4C Band 3 Health Trainer, no matter how amazing they are at their job, to be the one to fill the gaping hole in support being left by too many cuts?
RSPH’s new report, Minded to Change, has shown that our experience in Cornwall is one that is reflected across the country, with many inappropriate referrals to health trainer services that are seen as a ‘dumping ground’ for clients with severe mental health issues. Health trainer services do not have the resources or expertise to deal with these issues. We just want those agencies that do to work constructively with us, so we can all help our clients attain the best life they can.
With deeper cuts being made to the public health budget and the provision of health trainer services, the situation is likely to get worse. What choices will be left open to Morwenna and people like her if the last safety net is taken away?