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The fact that cities and urban centres can increase stress in individuals is well recognised.  There is a correlation between living in a city and a range of mental health problems, although this doesn’t automatically mean urban life has to have a negative impact on our wellbeing.  Cities concentrate on a range of factors, both positive and negative. So, a city may suffer from pockets of deprivation, high rates of crime and pollution, but also provide good educational opportunities, access to modern medical care and stimulating public spaces.  However, as anyone who commutes through a big city will know there is a lot of stress about.

This was brought home to me this week as I attended a two-day training course.  Other attendees came from across London and the south-east of England.  The organisers had clearly worked hard to identify a location within the Greater London region that meant regardless as to where your journey began reaching the venue would provide a challenge of navigation and endurance.  It is perhaps a good thing that the topic being covered was Mental Health First Aid.

Fortunately, the course was exceptional. It offered a great deal to managers or those whose work areas brought them into contact with mental health issues even if they had not had any formal training in the subject. There is also a lot about looking after your own mental health.  If you get an opportunity to go on a course like this I recommend grabbing it.

Travelling to this non-exotic and highly inaccessible location did provide me with more time than usual to reflect and think.  Naturally enough I was considering about the progress made in terms of mental health.  Certainly, there is now greater recognition of the issue.  A number of high profile individuals have been very open about their experience with mental ill health.  Time to Change and Thrive LDN have done much to help reduce discrimination and stigma.  The statistic that one in four people will have a mental illness in their lifetime is embedded in the public consciousness. It can sometimes feel like improvements in treatment services are lagging behind, but profile raising, encouraging people (and politicians) to talk about the issue does help secure resources. So overall it feels like progress is being made.  I was feeling generally positive until I thought about dual diagnosis.

There are two subjects which always trigger a stress response with me.  Sometimes this can even lead to a degree of aggression (albeit normally revealing itself as noisy exasperation).  Dual diagnosis is one.  Hepatitis C the other.  Both were issues I became aware of early on in my drug and alcohol policy work.  Twenty years later I struggle to understand why we have not made better progress.  It can make me angry. This is especially true in regard to Hep C, where new drugs offer so much promise, but that is for another week.

So dual diagnosis.  It is far from uncommon.  Indeed, for many drug and alcohol services most of their clients will have a mental health issue.  Likewise, mental health services have significant numbers of clients with existing or a history of substance use problems (although it varies massively depending on the diagnosed condition).    Obviously, many people within this group have complex problems and require specialist and long-term support.  But for many people seeking help they find themselves falling between services. 

This partly reflects the discussion over which issue has primacy.  Should the mental health issues be treated first?  Or do we need to deal with the drug use or drinking first.  This debate is reflected in a mountain of research which consider whether drug use caused a specific the mental health condition, or has it perhaps aggravated or triggered an underlying problem. Or is it the case that the drug use may be self-medication?   These are all valid questions and the accompanying arguments are good in terms of attracting grant funding, stimulating debate and progressing professional careers.  Of course, I recognise that these are not just abstract points and can have important benefits in guiding more effective treatment and approaches.  But from my perspective the plight of the individual, the family and friends has too often been lost.  We have not focused enough on closing the gaps between services (often unintentionally encouraged by commissioning practices), of bringing different disciplines and professions together.  If professionals often struggle to navigate treatment pathways, then something has gone seriously awry. Drug and alcohol treatment and mental health services should not be in competition.  

We live in demanding and rapidly changing times.  Our populations will experience various stresses and threats to their physical and mental health and effective, resource, smart, responses to these stresses and threats requires new ways of thinking and new collaborations, but we must never lose sight of the individual.

Wednesday, May 15, 2019
The confidence we have in our health systems is at the core of how we use and, hopefully benefit, from them. If we lack confidence in the benefits of going to see our GP for a health check, seeing a nurse about a travel vaccination or asking advice from the local pharmacist why would we bother? In terms of dealing with drug and alcohol problems the importance of a positive therapeutic relationship or alliance is recognised not just as being a pleasant “extra” but being central to aiding recovery. It has an important role across all fields of treatment. There are also benefits where a society has faith and confidence in those that oversee and provide healthcare systems and treatments at a population level. By and large, despite many complaints and challenges, the National Health Service in the UK remains a highly valued and trusted part of our society. And rightly so. But that doesn’t mean we should shy away from acknowledging where things have gone horribly wrong.
Tuesday, April 30, 2019
In England, the Easter public holidays see many of us get a four-day weekend. Schools are on holiday, roads are jammed, airports overflowing and much of the country indulges in chocolate, either in the form of eggs or bunnies. This year we also enjoyed some great weather. Fortunately, May looms, which brings another two holidays for us to recover from previous holiday excesses/hard work (delete as appropriate).
Thursday, April 11, 2019
Let me start with a big thank you to Liverpool, and especially the team from John Moores University, for another outstanding City Health conference. The impressive surroundings of Liverpool Medical Institute- a monument to the 19 th century’s commitment to science as well as its obsession with ancient Greece- proved to be an ideal venue. It contains a wonderful historic library, a selection of surgical and medical tools that bring a tear to the eye, and portraits of those who have contributed to the development of public health and modern health care, including some rather fearsome looking characters.
Wednesday, February 28, 2018
Welcome to my initial blog for City Health International. My intention over the coming months is to look at developments in research, politics and the media through the prism of urban health and what it may mean for the City Health community (so pretty much anyone reading this). While my background is in national and regional policy work around substance misuse, with a more recent interest in crime and anti-social behaviour issues, I will be looking at a much broader range of topics. Before we embark on that though I shall briefly explain how I got involved with the phenomenon that is City Health and how that helped extend my horizons beyond alcohol and drugs.

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CITY HEALTH INTERNATIONAL EVENTS

CHI Melbourne 2019

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CHI Liverpool 2019

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CHI Odessa 2018

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CHI Basel 2017

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CHI London 2016

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CHI Barcelona 2015

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CHI Amsterdam 2014

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CHI Glasgow 2013

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CHI London 2012

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City Health International
Founded in 2012 City Health International is a network of individuals and organisations engaged in the study of and response to structural health issues and health behaviours in the urban environment.
For the first time in history the majority of the world’s population now live in urban environments and the proportion continues to grow. As national governments struggle to deal with the pressures and demands of growing urban populations against a backdrop of financial deficits and uncertainty, it is increasingly left to those working at a city level to provide the leadership and support needed to tackle key health issues.