Each year one in four people experience a mental health problem. If you haven’t experienced a mental health problem yourself, it is likely that a close friend or family member has, although – given the on-going stigma attached to mental illness – you may not know it. Encouraging people to talk to friends and family when they are struggling with mental health problems is a great way to reduce stigma, increase understanding and to offer those with mental health problems someone to talk to. However, NHS mental health care provision remains essential and requires more funding, not less. In 2015, the Kings Fund reported that mental health problems account for 23 per cent of the total impact of ill health in the UK but get just 11 per cent of the NHS budget.”
Last week NHS England announced the implementation plan for its Five Year Forward View for Mental Health to improve mental health care by 2020/21. The strategy was recommended by a government-appointed task force led by head of Mind, Paul Farmer. Over the next five years, £1bn will be spent each year to expand services, prevent ill health and improve clinical standards. Around £72 million of this budget will be spent on more closely integrating physical and mental health services. It’s a welcome strategy: the plans would improve mental health care services and the experiences of those that use them.
However, the promise of a funding injection into the NHS’s long-neglected Cinderella service will be met with scepticism from those who have experienced the realities of the chronically underfunded and under-resourced mental health care system in the UK. And as we know, policy does not always turn into practice. In the 1988 report Community Care: Agenda for Action, Roy Griffiths argued that mental health care services had long been under-funded and required more investment, not less. Despite this assertion, mental health has consistently been one of the most underfunded parts of the NHS.
For some, mental health can be improved with self-care, such as mindfulness and adopting a healthier lifestyle, but for others, support from medical professionals or community-based services is essential to help them stay in, or return to work, and to help them avoid reaching a crisis point that could lead to hospital admission or suicide. The range of mental health conditions and varying circumstances of those experiencing mental health problems means that a one-size-fits-all approach does not work.
Being able to provide a range of entry points to services and treatment options, does not come cheap. But also costly, would be the long-term impacts. Failing to invest in mental health services now will mean long-term financial costs of the NHS, economy and society, as well as personal costs to individuals, families and communities. A report by Rethink and LSE in 2014 showed that early intervention services, which take a holistic approach to treating young people swiftly when they first experience psychosis, create savings for the NHS of £15 for every £1 spent.
The Health and Social Care Act of 2012 pledged for parity of esteem between mental and physical health. Given the long-term funding shortages in mental health care, this parity could only become truly entrenched with an increase of funding for the mental health care system. However, between 2010 and 2015 the government cut £600m from mental health care budgets.
This cut in funding has, worryingly, coincided with an increase in mental health referrals; with a 20 per cent increase in referrals to community mental health teams between 2011 and 2015. This increase is unsurprising given the success of Time to Change and other campaigns to cut mental health stigma and encourage people to open up about, and seek help for, mental health problems. It is also likely that this increase is, at least in part, a consequence of austerity measures, associated job insecurity and an ageing society where more people are living into late life, often with complex physical and mental health issues.
The plan to integrate mental and physical health services in the local community, is a step in the right direction, especially as those with mental health problems are more likely to experience physical ill health. If integrating mental and physical health care is a route to a long-overdue funding injection, it can only be a good thing. Providing physical health checks to those accessing mental health services should ensure that their physical health issues are not overlooked – and vice versa.
However, this integration risks placing more pressure on already overstretched and under-resourced community mental health services. With long waiting lists for referrals common place, it is paramount that the government ensures the infrastructure is in place on a local-level to ensure these changes can be implemented effectively. The integration of mental and physical health care should also be seen as an opportunity to truly join-up local health and social care services and ensure that service providers are sharing information effectively and efficiently between one another. This suggestion is nothing new, having been recommended by the Griffiths report in 1983.
With the prospect of the NHS not receiving the additional funding it needs under the current Conservative government, it is paramount that Labour provides a robust opposition to ensure that NHS England’s plans for increased funding to mental health care services are implemented. Indeed, last week, Jeremy Hunt’s spending review came under fire for not including adequate budget to implement NHS England’s Five Year Forward View for Mental Health.
Mental health is being talked about more openly than ever before, but this change in behaviour and attitude needs to be reflected by the government adequately resourcing the mental health services that many of us will rely on in our lifetimes.
Image: Thomas Hawk