Interview: The Tavistock and Portman’s new head Paul Jenkins on the challenges he faces

The cost of specialist treatments, such as the work at the Tavistock and Portman clinics, needs to be compared favourably with the cost of years of recurring acute mental health admissions and the cost of putting people in prison.

That’s the view of Paul Jenkins who has just been appointed chief executive of the world-famous Tavistock and Portman NHS Foundation Trust in Belsize Lane, Swiss Cottage – the first non-clinician to hold the post.

“But we are going to have to justify what it costs to deliver our services in terms of the outcomes we achieve, and that’s probably the most crucial challenge facing the Tavistock,” he told the Ham&High.

Mr Jenkins, 50, spent many years after taking his MBA at Manchester Business School as a civil servant in the Department of Health, where he was involved in some major initiatives. It was he who set up the NHS Direct phone and internet advice service, for which he received an OBE in 2002.

But for the last seven years Mr Jenkins has been chief executive of Rethink Mental Illness, one of the largest mental health charities in the country, where he has worked passionately to change the public’s attitude towards mental illness and remove the stigmas that sufferers face.

He played a leading role, together with the mental health charity Mind, in the Time to Change initiative, often with the help of celebrities. Most recently, he was involved in the action that forced some supermarket chains to remove “mental illness” costumes from their Halloween collections.

“One of the things I have been most proud of has been our involvement in the Time for Change campaign and the beginning of a sense that you can begin to see some attitudes shifting,” he said.

“It’s nowhere near done, but now you have celebrities coming out with their histories of mental illness, as well as politicians and sportspeople – and that’s fundamental to get better understanding and more investment in treatment and care.”

One of the most memorable advances was the day, just over a year ago, when four MPs spontaneously stood up in Parliament and spoke about their own experiences of mental illness.

“One of them was Labour MP Kevin Jones, who has been a government minister. He told me that, just before he made that speech, he really wondered whether it was the right thing to do and whether his constituents would regard him as weak and incapable.

“But he was bowled over afterwards by the number of constituents who said they now felt that someone understood what they were going through and was representing them in Parliament.”

Where does this passion to change attitudes come from? “I grew up in a family with disabilities. My older brother has been blind from birth and has other disabilities too. So I grew up in a world which shaped a lot of my values and interests. They got me into the voluntary sector, and while I hadn’t had a focus on mental illness before, I have been bowled over by that cause.”

Mr Jenkins is aware, of course, that the Tavistock and Portman clinics deal with very different kinds of mental health issues. “There are two things that resonate with me about the Tavistock’s work that I feel very excited about. One is that I have always been acutely aware that so many roots of adult mental illness lie in childhood development, childhood trauma and distress.”

The other is the expansion, in its broadest sense, of psychological approaches to treatment and care through the government’s decision to invest in improving access to psychological therapies.

He acknowledges that most of this investment is going to cognitive behavioural therapy (CBT), which is very different from the Tavistock’s more analytical approach, but he added: “I have always been a bit frustrated about the niggling and sniping from the sidelines about CBT. But there is no doubt that it isn’t the only psychological intervention that works... There need to be different approaches for different groups.”

Asked how he intended to take the trust forward at a time of unprecedented pressure on resources, he said: “We will have to be challenging about what can be done more efficiently, about what we need in the way of specialist skills and what can be done by people who may cost less. You have to ask these questions without losing sight of what it is you are trying to achieve.”

But the most crucial challenge, he said, was to justify costs against the trust’s achievements. “We have to make the case for investing in more expensive and significant specialist interventions compared with the costs of, say, 15 years of recurring acute mental health services or the cost of keeping people in prison for 15 or 20 years. That kind of evidence base and demonstration of outcomes is not easy, but it’s crucial.”

The Tavistock and Portman is one of the smallest NHS trusts in the country. Is it safe from being merged with another trust?

He replied: “I don’t think size matters as long as you are dynamic and maybe growing a bit. If you are marooned, moribund and shrinking, then you will be a target. We have to make sure that we can secure the things that we already do and also look for new opportunities.”