Dr Chris Manning is the mental health policy lead for the College of Medicine. He worked in the NHS for over 20 years – 15 as a GP. An experience of severe depression which left him unable to work for six months increased his interest in ‘whole person’ medicine.
Chris founded and ran Primhe (Primary care mental health and education) for 10 years and was also Chair and a trustee at Depression Alliance and thereby acquired a lot of Third Sector experience.
His depression continues to be medically managed, giving him a unique insight into life on both sides of the doctor/patient divide. We spoke to him about what his vision of good medicine is, and what he thinks the big issues are now in healthcare.
What message do you want to feed into the College of Medicine about mental health?
I’ve been advocating with members of the Board about the importance of compassion in healthcare, and helped to organise Robin Youngson’s talk earlier in the year. It’s important to remember that NHS staff as well as patients are affected by compassionless environments. A happy workforce are better able to help patients, especially those marginalized and stigmatized by bad attitudes and worse: mental health patients are always particularly vulnerable to this.
I also think that the division between mental and physical health is a false one; it’s time to dump Descartian dualism. When I was severely depressed, it was the most physical thing that had ever happened to me. Mental health is as physically driven as every other human function and permeates who we are and all we do.
What do you think the triggers were for your own depression?
I was a perfectionist in a very high stress job, and the inevitable happened. The drivers for depression cover the entire bio- psycho-social- spiritual context: I’d just moved, had a second child and it was the year of Chernobyl. The effect in the long run is to give you a greater sense of the ridiculous and trivial – it’s like having psychotherapy with a gorilla and no stones of self are left unturned; I learned that our biology is not our biography.
Do you think your own experience of depression has affected how you approach patients as a doctor?
I think the seeds of wanting a more equal partnership with patients were always there. I trained at a hospital in Brent which was surrounded by quite a tough area, and the attitude of the senior staff – people like Keith Ball, Ewert Jepson and Richard Asher. Many of us had first degrees and were coming to medicine with more maturity, and had chosen to avoid those hospitals with a very hierarchical way of approaching medicine.
It’s important to see the person beyond the patient. I am a doctor, but that is not all I am – similarly all us, when ill, are more than mere ‘patients’, or worse ‘service users’; we are all people first and foremost. Institutionalisation is not just about structures and buildings, but attitudes and terminology.
How did this affect how you approached General Practice during your 15 years as a GP?
I think I let my own personality bubble out, and wanted to use my role as a community enabler and connector. For example, I remember separately being visited by two patients from Colombia both of whom were suffering from various symptoms, which I addressed – but whose underlying problem was really loneliness and homesickness. I got their permission to put them in touch with each other: what happened after that was none of my business, but they both stopped needing to see me as patients.
Back then there wasn’t quite so much anxiety about drawing lines between roles. But even now there is a lot doctors can do to make their spaces a community hub: running user and peer-peer support groups, using surgeries as meeting spaces. I developed a database of people with Parkinson’s disease who agreed to be available to the newly diagnosed and help them, by sharing experiences, in dealing with their own journey.
What do you think the challenges are that we face in healthcare at the moment?
It’s sometimes hard to tell the difference between diseases that are becoming more prevalent and those which are simply being mentioned more. All the same a whole raft of very unhealthy states face the young in particular at the moment – eating disorders, alcohol and substance abuse, truanting, bullying and obesity. These all tie up with alienation, poor built environments and the depersonalisation people feel in a globalised world.
You can see the link between society and health when you read the statistics about Glasgow: the discrepancy between life expectancy between rich and poor in that city is 25 years; each train stop on the London Underground travelling East lands you at a place where people live one year less.
One in four or five people can develop a mental illness, with considerable overlap (as both cause and effect) with long-term conditions such as diabetes, heart and lung disease and many many others are long-term stressed or distressed. Work has become the defining feature of our culture, so it’s not surprising that people suffer mentally when they are out of work in particular. People, populations and communities need to be built on values, connectedness and attachment; work is therapeutic when it delivers on these (and other) key principles and we need not just to be focused on the health of the economy as the sole output and purpose of our lives on this planet, but on our sense of meaning and value – beyond mere money.
It’s vital that we have mental health on curricula for all healthcare practitioners and those working with distressed members of the public, including the imparting of self-care principles and practice and peer-peer support and mentoring to such key workforces.