S3E6 – Why is North East England so mentally unwell? With Alisdair Cameron

W: Hello, my name is Will Sadler and I am the co-host of Lively Minds, the podcast about mental health challenges that go beyond the ebb and flow of the everyday. I am proud to call North East England my home. This region has much to be proud of. From the invention of the passenger railway in 1825 to today’s thriving life sciences, automotive and renewable energy sectors, North East England has long been a hub of innovation. Our cultural legacy is equally impressive, and with the Royal and Durham Dales, the rugged Cheviot Hills, and the pristine Northumberland coastline, our natural beauty leaves visitors in awe. And yet, we are also a region that struggles.

 

In today’s episode, we’re diving into one of the region’s most pressing challenges, mental health. North East England has the highest per capita use of antidepressants in England and Wales, and has recorded the highest suicide rate in England for three of the past four years.

 

Why is our region struggling so much with mental health? And how can we improve wellbeing for everyone who calls the Northeast home?

 

Unfortunately, due to some technical issues, Ellie couldn’t join us for this conversation. But I sat down with Alistair Cameron, who is co-director of ReCoCo, an independent peer-led mental health charity in Northeast England to explore these questions.

 

[upbeat music]

 

W: Welcome to the show, Alistair.

 

A: Hello, hello.

 

W: Could you start by giving us an overview of the mental health landscape in the Northeast?

A: The Northeast is not unique in the challenges it faces in terms of mental health. It’s almost like a, the nation in microcosm, all the issues that feature nationally feature largely in the Northeast. I mean, statistics tell us many things, but they always need a little bit of interrogation. But we don’t fare very well on any of the, the indicators that the government sits by. We are particularly poor on people with anxiety and depression, we’ve got high rates of people using A&D for mental health, we have lots of people in receipt of enhanced benefits for mental health reasons. We also have shorter life expectancy, higher rates of suicide, et cetera. And those all give some insight as to the picture, but, for want of a better term, for a whole host of factors, we don’t have good mental health outcomes in the region, despite the fact that for many years, we have had services which have been rated by CQC, et cetera, as being very good services. So clearly there’s something going on, which points to there being a disconnect between statutory, i.e. NHS mental health services, and the levels of demand and the levels of need that are out there.

 

In the Northeast, we get a little bit overlooked. When there are new initiatives and new bits of funding, the Northeast is seen as a little bit off the map. And when it is considered, we’re, we’re seen as one block, the Northeast. Sometimes they’re put in, put in North Cumbria as well. And when you consider that’s an area that reaches, by some definitions, from Berwick all the way down to North Yorkshire. It’s a lot of people, and it’s an awful lot of territory as well, a lot of ground. So it’s dispersed population, many different centers, which means that it’s hard for services to reach everybody, when they are as dispersed as they are, it’s also hard for services to function just across sheer distance. You know, if you look at the way the NHS is organized, for example, got ICBs and ICSs.

 

W: ICB, ICS, sorry.

 

A: Integrated Care Board, Integrated Care System. They are notionally a kind of strategic planning and commissioning entity for the NHS, deciding where money gets spent and where priorities lie. And the footprint that we have is almost unworkable, which, just in terms of the geography, which it makes life very difficult indeed. But I think overwhelmingly our region is one that has seen mass de-industrialization, seen no real meaningful long-term replacement for the old heavy industries that sustained the region. And so that economic decline, which leads to urm, lower incomes, leads to lower standards of living, obviously that has an effect upon people’s sense of worth, people’s sense of purpose. And then you factor in all sorts of other pressures, whether they be short-term or medium-term pressures upon people’s wellbeing, and you realise actually we’re, we’re not in a particularly strong position, so that it’s little surprise when you hear people’s life stories and what’s gone on for them and their family circumstances, et cetera, that they will have poor mental health.

 

W: Yeah. There’s two things there that are really interesting. The first is even within the

region, there is what sounds like the risk of a bit of a one size fits all approach, not taking into account all the different facets of what is a geographically large and actually relatively sparsely populated region compared to others? Is that?

 

A: Well it is, I mean you’ve got very dense centres of population like Newcastle and Gates and Sunderland which you’ve got your usual inner city pressures and problems, urm and then you’ve got a very sparsely populated area Durum Dales or North Northumberland where people are miles and miles and miles from the nearest establishment for help. So a one-size-fit, fits-all category isn’t going to work, you’ve got to rural-proof things but also be able to meet the needs and pressures that arise from inner city living as well. So, it’s that contrast which I think makes the ICB struggle, ICS’s job difficult. Yeah, its, its, I don’t have any ready solutions I am afraid.

 

W: But it’s interesting in a way that we’re going to be talking soon about what more bespoke methods could be used for the Northeast, until now I was just thinking of that as what bespoke methods need to be used for the Northeast on a region-wide basis. But actually what you’ve introduced there is this idea that one of the issues that there is at the moment is that within the region there needs to be bespoke approaches to different parts of the region.

 

A: Either that or you need to overhaul the entire infrastructure and say actually we need to overhaul the transport system, for example, to allow people easy access to centres of excellence for this, that and the other. So it yeah it’s not straightforward and there you know there’s no denying there are some pockets of privilege in the Northeast as well where people have nice meaningful contented existence and they’ve got pockets of extreme poverty amongst the worst in the country. So it is tricky.

 

W: The other thing that you mentioned there was the socio-economic challenges facing the region as well and as you were referring to at the beginning we do struggle on quite a few indicators. Second highest child poverty rate in England, higher than average in employment, lowest life expectancy, worse than average health outcomes, lowest disposable household income in England. Sometimes it feels like it’s the English region that is furthest from power, as in London, I mean, it is geographically the furthest English region from power. And, and yeah, it feels to me as though there’s a bit of a clear correlation between life outcomes, quality of life, and then the resulting mental health challenges that we experience as a region.

 

A: Oh Absolutely. If there’s poor quality of life in a region, you will have poor mental health outcomes. I mean, I wouldn’t want to say the Northeast system is the most peripheral of the regions. I guess Cumbria would probably want a word and maybe Cornwall too. They’d be saying, “Well, hang on. We’re equally excluded.” But these are very similar situations where your lack of proximity to power means that your voices are not heard, your concerns are not heard, and you are essentially forgotten about. And you know, sometimes there are marginal advantages to that. You know, if you wanted to try something really radical and different, you stand a better chance of doing it in somewhere peripheral, like the Northeast or Columbia or Cornwall, because you’re a little bit off people’s radar. [laughter] So if you really want to get something going, then these are the places to start it. But you have less access to resources, you have less access to key decision makers. It’s harder to gain that critical mass to change things.

 

W: Tell me a bit more about the, the greater flexibility to do things that are a bit more out of the box and a bit more radical.

 

A: Well, I’ll, I’ll talk about from the mental health service user and care point of view, quite a lot of pressure to do stuff under kind of national frameworks. But the further you get away from the Department of Health as it was then, but these days, I think it fits more with NHS England. The further you are from there, from the dead hand of NHS England, [laughter] then the better your life is, I would suggest!

 

So, you know, it’s really about avoiding that level of technocratic scrutiny, which always seems to mistake the wood for the trees and is keen on measuring everything but not to know the value of anything. So it’s always about, well, have you met this target? You kind of go, no, I haven’t met that target. But the purpose of that target is to improve people’s lives. We’ve improved people’s lives this way. It doesn’t swap into your narrowly defined number, but actually people’s lives are better. And it’s like, they find it hard to compute on that. So, you know, the success that we’ve had as ReCoCo has really come from going off-piste, not really fitting with whatever national guidance has been, because of usually seen it as being overly prescriptive and not well suited to frontline work, and thankfully we’ve had enough success locally and regionally to now actually be seen by some people as a different way of doing things even on a national stage.

 

W: And we’re going to hear a lot more about ReCoCo in a moment and the work that you’re doing and I think it is important isn’t it, I was talking about this with you before we pressed record, about spotting and noticing and mentioning the positives. I was saying that I wanted to be careful that we didn’t perpetuate this “it’s grim up north” kind of stereotype for the region.

 

A: No, it’s grim most places.

 

[laughter]

 

A: I’d say that glib and we’re laughing. But when you look at stuff nationally and then internationally as well, it’s a bit hard to find too much sunshine.

 

W: Yeah. And there are many things, of course, in the Northeast that we can be incredibly proud of. As a region, we have an incredibly proud, rich history, culture, and I think,  I think our present day personality as a region is really powerful as well. And talking of good stuff that’s happening in the region, tell me about ReCoCo and the work that you do.

 

A: OK, so we get placed in and are situated in the mental health field, but we define mental health broadly because it crosses over with so many other things. So, yeah, people have come to us, many odds are they will have a mental health diagnosis, but they probably have other diagnoses too. Could be long-term physical health problems, could be neurodiversity, could be drug and alcohol issues, could have benefits or ur money problems, could have housing issues, dysfunctional families, criminal justice, learning disabilities, you know, you name it, the people we serve have got a lot going on in their lives. And that’s so commonplace that it does make me wonder why the system isn’t set up to deal with this, we use a medical co- or multi-morbidities because it’s the norm certainly in our neck of the woods.

 

We are run and staffed by people with their own lived experience of using mental health services and all of those other um dimensions too. We run a whole heap of groups and courses. Some courses are four weeks or six weeks or eight weeks and they are structured. Groups are much more open-ended where there might be meet weekly, fortnightly, monthly, whatever. Big chunk of those groups and courses may deal with mental health problems, but an awful lot of activities don’t. It’s really about bringing people together. It’s a sense of community that you get. It’s giving people somewhere to go, something to do and some people to do it with. If you can provide that as a basic platform for togetherness and to enable people to build their own social support structure, then it doesn’t really matter what diagnosis they’ve got. It’s, it’s a nice foundation for people to recover.  And the stuff we have, which is specific to certain problems or certain issues that people have, it could be, you know, the unusual experiences group for people to experience psychosis. It could be stuff for people who are neurodivergent. But we, we’re not clinicians, we’re not diagnosticians. We don’t really bandy about diagnoses per se. It’s really looking at people’s functionality. How are you getting on with life? And in order really to, to progress with life whether or not the cavalry isn’t, isn’t coming. Yes, there’s been a change of government But we are repeatedly told that there’s no money. I think that’s a, slightly misleading for anybody to say because we are what’s nonetheless one of the richest countries in the world. But apparently there’s no money at least no money for improving the lots of the people that we see, so we have to encourage self-reliance and people coming together to support each other and share their own tips, experience, their own knowledge. It’s a form of knowledge exchange. I, when I say lived experience, people have got a lot of knowledge from their own journey through mental health services, but they may have an awful lot of knowledge that they’ve brought from professional background and others as well. There’s a bit of a false dichotomy between people who are mental health service providers and people who are mental health service users, you kind of go a lot of people fit in both categories and it’s about allowing people to utilize the full wealth of knowledge that they have, whether that be through academic learning, whether it be through job learning or whether it be through, you know, living life at the sharp end.

 

W: That brings us back round full circle to what you’re saying towards the beginning around the Northeast struggling when it comes to lots of socio-economic factors and I guess what ReCoCo’s doing is what it can to connect people and to improve well-being and to I guess try and act as some kind of offset to those factors that people struggle with.

 

A: Yeah ab, absolutely I mean I’m not going to deny the role there is for specialist clinical services I’m not going to cry specialist clinical services, I think they’re overwhelmed and they’re under tremendous pressure and there a lot of people are feeling let down because they can’t access those services but that’s a you know, an issue for government to address. I don’t want to in any way, put those down. I know people who working them and they’re good people and they’re usually well-intentioned. But the majority of people aren’t even able to get in their front door. So it, it sits upon the rest of us wether we’re sitting in the community or voluntary sector to try and provide something for people. I’m not saying we are the answer, but we’re better than nothing. And I think we offer a sense of camaraderie and a sense of hope for people. We’re not a replacement. In an ideal world we’d be complementary. And sometimes when the system does work, that’s how it is. We give people lots of stuff to do for all the times when they can’t see a clinician. But we’re not a replacement for other bits of the system.

 

W: This isn’t just a Northeast issue. I know this is a nationwide and probably beyond nationwide issue, is the lack of access to mental health services which is happening. And I think as well, I think it’s important as well as the socio-economic factors, I think it’s important to also recognise the intrinsic issues as well. So I have OCD and that brings about in and of itself some great challenges which need medical interventions, you know.

 

A: Yeah

 

W: And that’s fine and that’s all part of the mix. And yet on that front as well, there’s a real lack of access to those services and the waiting lists and so on, of course slightly ridiculous.

 

A: It’s a fine line to walk. I don’t want to be too critical of the NHS. Sometimes you think the NHS has been dealt a really bad hand but then again you think well that’s the hand you’ve been dealt, you’re playing it really badly. There is undoubtedly a significant role for clinical services. I think sometimes people over invest in them and believe that clinical services are capable of things which they’re not. The science is just isn’t or the, the treatment efficacy just isn’t there for some things, but equally that shouldn’t be used by some people to say, “Oh, don’t even bother.” It’s about constructing a personal jigsaw of the stuff that’s gonna work for you, and that may well include medication, may well include therapy, may well include meaningful activity, friends, hobbies, social life, et cetera. So you’ve got to build it yourself. I think the fairest way of judging the NHS is also being fair about our expectations of it

 

W: mmm

 

A: and what it can and can’t do and what we as communities can do for ourselves. I think one of the issues that underpin some of all of this is this kind of consumerist individualist mindset, which has been, you know, the political dogma for the last 50 years really, whereby everybody’s a happy little shopper and whatever want or need that they have, there will be a service that provides for it. And actually, that doesn’t map on to mental health and mental health care. Odds are there won’t be a service that absolutely hits the nail on the head for your particular needs, so you’re going to have to make adjustments.

 

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W: In recent years, England has seen increased devolution, with clusters of local councils forming combined authorities under a directly elected regional mayor, who takes over limited powers and budget decisions from central government. In 2015, Greater Manchester became the first combined authority to take control of its £6 billion health and social care budget. Internationally, subnational governments have introduced measures to improve mental health. California’s Mental Health Services Act, introduced in 2004, increased funding through a 1% tax on incomes over $1 million. In Australia, Queensland’s mental health levy is expected to raise almost $2 billion Australian dollars over five years. The extent to which any of these initiatives are effective, and target support of the people who need it most is, I am sure, up for debate. But it does point to decisions being made, powers being exercised and indeed money being raised for mental health at a subnational level. In 2024, Northeast England became the latest region to form a combined authority and I wanted to get Alistair’s take on what tools devolution could potentially give us to influence our mental health outcomes.

 

A: I mean, I’d never be averse to taxing the wealthy. Who else are you gonna get money from? You can’t get money from people who don’t have it. It’s an old saying, but it’s a true one nonetheless about equality is the best therapy, you know? and those societies which have more quality of income and do not have disparities on the scale the UK has in terms of income tend to have better health and mental health outcomes.

 

So what tools realistically, well, having said all that, I don’t think taxation is liable to be something that’s gonna be devolved. I don’t see the treasury allowing that to happen. But I think there are, there are potential opportunities. I would caveat them all with the difficulty that we have with any of the devolution in England, which is that devolution is still dominated by party politics. All of the devolved mayors belong to a major political party. And they are, um, in their respective ways, always going to be on message, which is going to provide some sort of tension with looking out for their region’s best interests. I think there is scope for getting health and social care, and for that matter education and employers and ur transport across the board looking in a more integrated fashion. I think that will be quite a struggle for any form of devolution because the current power holders are never going to give up the control that they have without some form of a struggle. So that means wrestling with, with the local health systems, it means wrestling with local authorities, it would mean encouraging parties to work together who have got a long history of being antagonistic of one another. So high degree diplomacy be needed.

 

W: I mean, I was watching a video the other day, which I’ll put a link to in the descript, show notes, that was talking about how when the London mayor was created, and London became a region into itself. And one of the challenges and one of the reasons why today the London mayor has actually so little power on that regional level is because the councils just weren’t willing to give up.

 

A: No. No

 

W: And you’re there remit.

 

A: Absolutely not.

 

W: We were talking at the very beginning about that need for even within the region, a very bespoke approach to mental health services that respects the rural nature or the urban nature of the areas and the different types of people that we might be working with. But at the same time, I think there’s also sometimes a need for stuff to happen at regional level and actually for there to be somebody at the region level who just goes, “No, actually, this is the way we’re going to do it because this does need to be something that we work together on and collaborate on”. Something that frustrates me in my day job, which is an organisation that supports disabled and neurodivergent filmmakers is if we’re working with somebody who’s got something challenging in their life happening that we can’t deal with and we want to refer them to say an advocacy service,

 

A: uh hmm

 

W: It all depends on which local authority they live in as to whether there’s even a non-statutory advocacy service in the first place and secondly, which actual organisation you refer them to.

 

A: hmmm

 

W: It’s so fragmented and so confusing and I sort of think to myself, there’s an example of something that at regional level if we could have one single advocacy service. There’s one that would just refer people to, that it was really straightforward, or even the triage, if they’re not willing to give up their advocacy services, could you just put in a triage so that we can call one number and there’s somebody who knows?

 

A: I accept that, but I suppose the counter argument is that, you know, the thinking of having a mental health triage on a regional basis, you kind of go, oh yeah, but actually what’s available to somebody in Berwick is going to be very different than what’s available to somebody in Sunderland, which is going to be different to, you know, what’s available to somebody in Bishop Auckland. And it’s just like, right, okay, that triaging person ain’t gonna know each other. So it is a tension between uniformity and very local sensibilities. And I’m not personally convinced that devolution is necessarily going to be able to manage that tension. I’ve got a feeling that it will add another layer of administration, but I don’t think, ur, we’ll see any relinquishing of power from the local authorities and other sub-regional bodies. So it could mean that we have, rather than a clearing up of things, we have an even more complicated fragmented system.

 

But in terms of the tools that would be available, I would like to see greater flexibility around welfare and benefits so that we have a less draconian benefit and sanctions scheme, because that’s one of the biggest drivers of people’s poor mental health. People have already got poor mental health, that mental health is worsened and made often calamitously bad to the point of crisis by an impersonal, inhumane sanctions regime and people being denied benefits to which  they are absolutely entitled given the state of their lives. So I’d like to see some regional control over DWP. I think there would, it would benefit from a greater integration of health and social care. I’m not merely seeing social care as an adjunct to the NHS but as something which has at least equal weight and we also need to see something of a move away from the dominance within the NHS of the big hospitals and hospital Trusts and it’s not, I would, you know if I’m in a road traffic accident tonight yeah I want to be in a hospital, I want to be in a hospital with all the the top kit and I want to be patched up as well as possible this is not to decry the work that hospitals do in hospital but actually the vast majority of people who have health problems, let alone mental health problems, aren’t in hospital. Conditions are managed and treated in the community and so there needs to be a kind of refocusing and saying that health and mental health, it’s something for the community, it’s not for some silo over there or some specialist building.

 

What I would like to say is that in our region, and I’m sure the same applies in other regions. The greatest asset that we have is our people. And we’ve got people who are their kind, their canny, their compassionate, their skilled, they’ve got resilience. We are our own best solution to the problems we face and that’s where the hope lies. I’m not sure that anything politicians deliver is really going to have the same impact as you and me looking out for each other. Everyone just, you know, covering each other’s backs.

 

W: Great note to end on. Thank you so much, Alistair.

And if you’d like to find out more about Recoco, you can find them online at recoverycoco.com.

 

Thank you for listening, and make sure you subscribe to Lively Minds wherever you get your podcasts. Tune in again next month for another episode. In the meantime, as always, you can find us on social media @LivelyMindsPod.

 

Please note that this show does not constitute medical advice and is not a replacement for seeking professional help. You can find signposting to support on our website, livelymindspod.com.

 

Take care and bye for now.

 

(whooshing)

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