All Party Group News 2008-9

15 July 2009

Men's access to health services

The issues raised by National Men's Health Week (NMHW) 2009 were examined in the group's meeting on 15 July.

Parliamentarians came to hear the Department of Health's Director of Health and Wellbeing, Dr Will Cavendish, the Director of public health in Knowsley, Dr Diana Forrest and MHF's David Wilkins.

NMHW focused on men's use of health services it challenged the NHS to design services to meet men's needs and challenged men to make better use of health services and to improve their health.

In Knowsley the PCT and local authority run Pitstop - a successful project targeting men with information and services.

Pitstop started in 2005 after local life expectancy statistics showed previous work had no impact men's life expectancy. The programme was launched with £1m funding from the local council's neighbourhood renewal budget and uses marketing techniques to reach men - for example work with local men told them not to use NHS branding and suggested a car analogy. This use of social marketing continued with the recruitment of a marketing specialist and work with the Men's Health Forum.

Dr Forrest said "MHF was really helpful working with us on our own versions of the Man mini manual, Knowsley Man, and a Knowsley front page for the malehealth.co.uk site."

David Wilkins introduced MHF's briefing paper 'Challenges and Choices - Improving health services to save men's lives'. He referred to the recent reports on men's high rates of cancer and diabetes and how lifestyles and use of services are thought to be factors.

Using statistics from a Danish study he highlighted men's low use of primary care relative to women and relatively high rates of hospitalisation. Denmark has a comparable primary care system to England and the figures take account of women's use of services for reproductive health.

As well as the work done in Knowsley there are examples of plans or action in this country. The National Chlamydia Screening Programme developed a men's strategy after seeing how few men were being checked, the Bradford Health of Men project has taken services to men in different locations and MHF worked with BT on Workfit, a weight loss and physical activity scheme.

He summarised the recommendations in 'Challenges and Choices - Improving health services to save men's lives' which calls on the NHS and the government to improve men's access to services and to help spread the best practice that does exist in some areas.

Dr Cavendish also spoke about challenges. For example, the toll that long term heavy drinking takes on men and balancing the need to tackle the rates of smoking among young women with the smoking related deaths of older men. The complexity in these issues is a reason there is no single men's health strategy. However, when Change 4 Life expands to include adults next year the desired outcomes will be focused on men.

Speaking from the floor, Jean Arrowsmith from Coventry expressed surprise that the Marmot review into health inequalities does not cover men's health. Dr Ian Banks said that the Department of Health was supportive of work to improve male health - the chlamydia strategy and funding of MHF's work on Bowel Cancer screening are good examples of this. However, in some regions progress and take up of best practice has been poor. He asked if MPs and peers would commit to pressing the government on these issues.

Dr Forrest was asked about the decision not to use NHS branding for Pitstop and explained how Knowsley men told them that the NHS was seen as authority telling them what to do and that a friendlier brand would work better. Dr Cavendish added that a lot of work had been done on NHS branding but that even national campaigns look at the audience and decide what is appropriate. For example, the Frank and Change 4 Life campaigns do not use NHS branding but the stop smoking work does.

Closing the meeting Howard Stoate MP said that while there were some good national and local programmes the figures on men's health and use of services show more is needed. He would press the government on this and called for other parliamentarians to do this same.

• View the slides used in Dr Forrest's presentation.
• View the slides used in David Wilkins' presentation.

20 January 2009

Men's mental well-being

Members and visitors packed committee room 17 for the group's meeting about men's mental well-being on 20 January.

Dr Howard Stoate MP, chair of the group, opened the meeting by highlighting how women are far more likely to be diagnosed with a mental disorder, however if you look at broader signs of mental distress there are many men who have now diagnosis but are struggling to cope. For example 75% of those who kill themselves are men, 73% of people who go missing are men and men are three times more likely to become alcohol dependent.

The first speaker was Professor Louis Appleby CBE, the government's national director for mental health and professor of psychiatry at the University of Manchester.

Professor Appleby focused on suicide but said that understanding the male psyche was important. He said that whilst the overall suicide rate had fallen by almost 14% since 1997 there were still significant differences by gender and age.

Whilst men are still about three times more likely to take their own lives this fact hides many variations, for example there has been a significant fall in men aged 20-34 taking their own lives but the rate in men aged 35-49 has remained steady.

Professor Appleby moved to the issue of prison suicides. Nearly half of these took place in the first month of the person being in custody and most of the rest took place within the first year. A history of drug dependence is the biggest single diagnosis in the suicides. However, there is also a link between release from prison and suicide with many taking their own lives in the first 28 days after release.

There have also been changes to the methods of suicide. Car exhaust asphyxiation was the most common for men aged 15-49, however this has been replaced by hanging since EU rules made catalytic converters more common then compulsory.

Dr Frank Keating is a senior lecturer in health and social care at Royal Holloway University of London. He spoke about African and Caribbean men and mental health.

Men in these groups have higher rates of unemployment, poorer housing, lower academic achievement and higher school exclusion. They also have higher rates of admission to mental health services, lower rates of referral by a GP, higher rates of referral by the police and higher rates of compulsory admission.

Dr Keating argued that we need a systemic change, a stronger black service user voice, a change in individual practice and a multi-disciplinary, multi agency approach.

The spiral into mental illness can be broken by understanding:

• Personal histories
• broader societal conditions
• black people's lived experiences
• survival in the face of multiple adversities.

David Wilkins is the author of the Men's Health Forum's paper on mental well-being, 'Mind Your Head — Men, boys and mental well-being'. He summarised the paper and briefed people on more recent mental health work by the Men's Health Forum.

The paper recommends that:

• Public policy should aim to improve men's mental well-being.
• There must be greater recognition of male-specific indicators of emotional distress.
• Services must adapt to meet men's needs more effectively.
• Mental health promotion aimed at men and boys should take explicit account of "traditional" masculinity.
• A national initiative is needed to help men achieve mental well-being.

David Wilkins went on to talk about the broad influences on men's mental well-being including the link between mental health and other markers of social deprivation, the link between work related stress and work-life balance but also unemployment. Older men's isolation and the mental health of gay men were also covered.

He said we need to explore the idea that there may be male specific indicators of depression which are currently under recognised by clinicians.

He updated people on the Forum's BME men's mental health project and announced that MHF had just been awarded government funding, through the National Institute for Mental Health in England, for a scoping study on men's mental health.

Dr Stoate PM thanked the speakers and opened the discussion.

Professor David Sallah is working on MHF's BME men's mental health project. He said that black men's psychological make up, especially in terms of personal histories affects interaction with mental health professionals but there is no understanding of this among professionals. However, there is also a poor understanding of mental health among some in the black community.

Dr Keating added that knowing how to work with histories is a problem but not one that is restricted to black men.

Jennie Williams from Inequality Agenda said that the training of professionals needs to change so that people see mental health services as somewhere to go for help, not somewhere to fear.

Toby Williamson from the Mental Health Foundation spoke about older men taking their own lives. He said that the rate is on the increase and could match that of young men. This is more important as the number of older people grows.

Professor Ian Banks, president of the Men's Health Forum, said that this year's National Men's Health Week will focus on access to services and will look at these points.

Dr Stoate related his experience as a GP. When referring patients they will often be turned away unless they are already suicidal as they are not high risk enough for the limited counselling and treatment services.

Jane Powell and Dr Elaine Church from CALM, Andrew White and Greg Gilbert made further points.

David Wilkins paid tribute to the work of CALM and their success in reaching boys and young men about mental well-being.

Professor Banks responded to a point from Derek Maylor of the Communication Workers' Union and referred to the work the Forum has done on using the workplace to reach men with health information and services.

• View the slides used in Professor Appleby's presentation.
• View the slides used in Dr Keating's presentation.

14 October 2008

Group working on men's health at work

As almost 100 MPs back a parliamentary motion calling for more action to use the workplace to improve men's health, the All Party Group on Men's Health met to quiz the government's national director for health and work.

Alongside Professor Dame Carol Black were Jo McCullagh the men's health specialist at Sefton PCT and David Wilkins the author of the Forum's policy briefing 'Improving men's health by taking action in the workplace'.

Dame Carol referred to the Forum's court case event in which she played the judge. The event caused Dame Carol to question whether general practice was the place to serve men. She highlighted the important role the workplace could fill in providing a venue for public health work, especially for CVD and COPD screening.

Jo McCullagh presented a summary of Sefton PCT's extensive work targeting men at work. They have run work targeting seafarers, truckers, bus drivers and cab drivers.

12% of the seafarers had paid for sex in Merseyside in the last year. Sex was often unprotected. Understanding of STIs was poor. Sefton's  successful programme has been adopted by five other UK docks and internationally.

Sefton's initial survey with 170 truckers found only 7% ate five or more portions of fruit or vegetables a day, 44% never exercised, 38% were  smokers and 77% were overweight or obese.

Cab drivers in the area have a similar lifestyle.

Sefton PCT's team used services targeted at these men. For example a pictorial booklet was produced for the Seafarer Sam project, and the few words translated into the seven most common languages used by seafarers.

Truckers were targeted with subsidised fruit, cross of St George sun visors with men's health messages, and canteen staff were trained in healthy dinners.

The team at Sefton PCT won a £7500 QNI Innovation and Creative Practice Award for a healthy lifestyles programme. This grew into a project that saw eight drivers trained to give health information; In less than a year (49 weeks) they spoke to 26,149 people about healthy lifestyles. Free one month gym passes were issued, over half (103 of 200) were used and of these 60 purchased gym membership.

The need for the PCT to comply with the public sector gender duty is a key factor in its increased support for men's health work.

The lessons from Sefton's work? Involve men, use existing mainstream services, take services to men in workplace and recreational sites and  do provide mixed gender services.

David Wilkins spoke about the Forum's 'Improving men's health by taking action in the workplace'.

Seeking to improve health by delivering services in the workplace is entirely in tune with present government policy on offering wider choice to and on prioritising action to tackle health inequalities. Furthermore, the Gender Equality Duty now requires NHS bodies to find ways of reducing gender differences in use of services. Targeted initiatives delivered in the workplace can help with that. 

Research suggests that good health is good for business too. A healthier workplace is more efficient and more cost effective. 

A positive experience at work is, in itself, a precursor of good health - although it should be noted that the reverse of this is also true. Indeed, it could be argued that one of the most important steps to better health in the working population would be the elimination of of poor working practices — in particular the "long hours culture”.

The MHF advocates local healthy workplace planning partnerships involving business, the NHS and trade unions. MHF recommends a specific concentration on the health of men - although action in the workplace has equal potential to improve the health of women. It is important too, that the NHS should become more flexible.  Many services currently thought of as exclusive to the surgery settting could probably be delivered in the workplace. 

The three speakers answered questions and took part in a discussion with group members and invited guests that included Steve Boorman, the chief medical officer at Royal Mail, and Professor Alan White from Leeds Met University.

• Read more about the Colin the Cabbie in Jo McCullagh's article from Occupational Health magazine.