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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, April 01, 2020
Everything is changed. COVID-19 and responses to it have seen dramatic and fundamental changes to how life is lived around the globe. International travel has come to a near complete halt, much of the world is under some form of lock down with businesses, schools, shops, pubs and cafes shut. Our economic and social reality is now unrecognisable from that of only weeks ago.
Tuesday, March 10, 2020
Clearly the current health focus is strongly centred on Covid- 19 and related issues, as it has been for the past few weeks. It is a demanding situation for politicians, officials, and indeed all of us, especially those working in our healthcare system. One of the major challenges we face is increasing understanding and encouraging changes in behaviour, while also avoiding panic and overreaction. Trusted and accurate information is clearly essential, both for those who have a key role and for the general public. We are certainly seeing more of England’s Chief Medical Officer and Chief Scientific Adviser in the media than usual. In the current situation, politicians are not only keen to hear from experts, but also happy to let them step into the spotlight. While we still see sensationalist headlines, there are also visible benefits of this approach, with more measured and informed elements within the media coverage- though this is less evident on the outer reaches of the online universe. Before I move on to other topics, let us reflect on the significant additional pressures being placed on our frontline health providers. They deserve our gratitude and, in many instances, much improved terms and conditions. Let’s hope that when this coronavirus issue passes the staff that so many rely on are not overlooked.
Monday, February 10, 2020
Public health is front and centre of the media currently, with concerns about the coronavirus outbreak, which was first identified in the Chinese city of Wuhan, splashed across almost every front page. With confirmed cases now reported in numerous countries across the world, we face the possibility of a pandemic. As several experts and commentators have pointed out, in our modern, highly interconnected world no epidemic remains a local concern. This, of course, makes for frightening headlines- which, in turn, calls for calm and informed responses.
Wednesday, January 15, 2020
So here we are: 2020. Let me start by wishing all of you the very best for the year ahead. I have, occasionally, been accused of an inclination toward cynicism and a failure to look on the bright side of things. So, for my first blog of the year, at least, I am going to be determinedly upbeat. You can judge for yourself how long it lasts. This sense of optimism is influenced by the fact that the end of 2019 saw some positive signs in the world of substance misuse. While it was something of a mad scramble against time, we managed to pull together a high quality and well-supported pan-London Christmas alcohol campaign. I am very grateful to colleagues who delivered the key elements of this work and to everyone who supported it. Some, in fact, went well beyond the call of duty to engage with our colleagues in the blue light services. Although we will not have any data in terms of its reach and impact for some months (I will update you), what I can confidently say is that many individuals and organisations liked the messaging and tone. I like to think it is helping contribute to Londoners having a more considered and healthier relationship with alcohol, though there is a way to go yet!

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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.