Is mental health finally becoming a political priority?

This week has seen announcements on mental health from both the government and the opposition. With the Liberal Democrats pledging to put mental health on the front page of their election manifesto, and Andy Burnham, Shadow Secretary of State for Health, making mental health a core part of his concept of ‘whole person care’, are we starting to see mental health becoming a higher-profile political issue?

On Monday Nick Clegg announced a national initiative to reduce deaths from suicide, building on quality improvement programmes already under way in Liverpool and elsewhere. On the same day, the Labour party published the report of an independent mental health taskforce commissioned by Ed Miliband. Responding to the taskforce’s recommendations, the party has indicated that improving the mental health of the population – and of children in particular – will be a priority if they form the next government, with greater emphasis on mental health in professional education for all health professionals and school teachers.

The new legal requirement for the NHS to achieve ‘parity of esteem’ between mental and physical health care has generated significant activity at the policy level and has led to a number of specific measures being introduced. In recent months NHS England has committed to introducing the first ever waiting time targets for (some) mental health services, and in its annual planning guidance directed clinical commissioning groups to increase spending on mental health in 2015/16, at least in line with each group’s overall budget increase – ensuring that mental health receives a proportionate share of additional funding.

The attention being paid to mental health by politicians and policy-makers is to some extent part of a wider shift in public attitudes towards mental health. Speaking at our recent breakfast seminar on mental health, Paul Farmer, CEO of the mental health charity Mind, stressed that data from the Time to Change anti-stigma campaign shows that attitudes are changing for the better (although stigmatising beliefs remain stubbornly widespread in some parts of the population, notably including the NHS workforce). As the public begins to place more importance on psychological wellbeing and timely access to mental health care, this can only encourage further political attention.

The critical question, of course, is whether the rhetoric can be matched by reality. There have been some significant recent achievements, such as the large reduction in the number of people being detained in police cells during mental health crises. However, there is also no shortage of fuel for those who question how much of a difference policy commitments will make in practice.

The financial squeeze affecting many public services is creating intense pressure in some parts of the mental health system, and services such as inpatient care for mentally ill children have fallen foul of the fragmentation of commissioning across NHS England, clinical commissioning groups and local authorities. The reduction in the tariff prices paid to mental health providers in 2014/15 (which exceeded reductions for acute trusts providing physical health care) led many to conclude that institutional bias against mental health remains as strong as ever. 

The King’s Fund has supported the call for mental health services to be placed on an equal footing with physical health care, and we have included this as one of our 12 priorities for the incoming government. This will only be achieved if the priority placed on mental health at the national level is transmitted to clinical commissioning groups and other local bodies. Commissioners I have spoken to tell me that considerable importance is being placed on the new waiting times targets for mental health. However, they have also indicated that some of their peers feel ill-equipped and under-supported when it comes to ensuring those targets are met – particularly as they are being asked to do so within existing budgets.

If political parties are to make good on their commitments to give greater priority to mental health, thought will need to be given to how to support those working at the local level to turn political ambition into reality.

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Comments

#497501 gregor henderson

Thanks for Blog Chris. What about broader mental health issues? Commentators need to see mental health as not just a services issue. Need more on prevention, complimentary action outside of and alongside services. And others playing their part. Schools, employers, criminal justice, communities etc etc. Please help widen the debate

#497532 Helen Gilburt
Fellow, Health Policy
The Kings Fund

Debate around prevention, schools and criminal justice was very much part of the debate on #zerosuicide. Public mental health also featured as a key topic in our 'Transforming Mental Health report'.

#499022 Daniel Maughan
RCPsych

This is positive news. the critical issue however is to not only engage politicians, but also physical health care services as to the importance of mental health care and parity as a great deal of stigma still exists in general hospitals about the prevalence and importance of mental health

#499507 Lindy Petts
independent organisational consultant

Mental health treatment in the UK is shocking and whilst the NHS is in meltdown as a whole, there seems little chance of this clandestine, antiquated system changing. And yet change it must if we want to ever improve the overall health and wellbeing of a so called civilised society. The quantifiable and hidden costs of not treating mental health problems at an early stage are so clear, resulting in drug and alcohol abuse, self harm and self neglect leading to injury and illness, and obesity with all its resulting disease. Days and months can be lost from work or study. If investment opportunities are tight, there needs to be focus. For me, this would be on younger people, whose lives can become so blighted at an early stage; psychiatric and psychological (especially the latter) services available at walk in centres and GP practices, and quickly; far higher quality standards and training for so called home 'treatment' teams (these are often very low capability workers in my experience); government investment in good quality counselling training and grants available to encourage practitioners; refurbishment of low standard mental health units which are often bleak, frightening and boring places; compulsory retraining of psychiatrists in therapeutic processes to get away from their over reliance on the pharmaceutical industry; a professional development path which enables para professionals (eg senior nurses), rather than medical practitioners, to practise in the psychology/psychiatry overlap space; investment in more specialist units that can cope with mental disorder rather than mental illness - eg anorexia, depression, anxiety related disorders rather than lumping everyone into one type of unit with disastrous results; support for Units such as Max Glatt eg merging non profitable (but highly successful) units where treatment packages could be integrated; performance management processes for mental health workers which actually measure behaviour; integrated treatment planning (medical, mental health, social care) at an early stage with the GP as the lead care planner; commissioning panels and GPs trained in mental health - types, effects, treatments, outcomes; all GPs, mental health workers, psychiatrists having to spend a week as an inpatient in a mental health unit; a move away from the mental health profession's obsession with 'assessing' (and avoiding action) with time limits on assessment processes - I could go on. I would like to know how I could become involved in campaigning for better mental health provision?

#504009 George Coxon
Various inc specialist mental health advisor
Various

Always a keen follower of KF blogs and reports - and as an ex senior MH clinician and then MH commissioner for a time I will always hold strong views and concerns about MH service status I'm presenting at a Nursing in Practice on the 3rd Feb in Liverpool seeking to reassure as much inspire non MH nurses that they have a significant part to play in MH work and held views on the wider health and social care agenda. I will be saying how important their voices are as we approach the election. Being a non MH practitioner defending parity and integrated services has as much, if not more, influence on politicians, policy makers, and commissioners than those within services.

#509754 Rob Gough
lived experience mental health consultant and trainer

The suicide reduction collaboration was underway in the south west some months before Mr Clegg made his announcement. We are making progress, and have recently had another collective learning session, which was well attended and went well. Contact me if interested in more information.

#512257 Mr Biswas
40 Years in Mental Health Services

Interesting: but in part naïve nonsense; There was the Health of the Nation in 1994 focus on Suicide by the then Tory Govt, then in the late 1990s the Labour Govt introduced Modernising Mental Health Services, with the 12 Standards of the National Service Framework (NSF) including the funding of new services like Low Secure Services, Early Intervention Services, Home Treatment Services etc etc- many of which has been diminished or shut down . What we have now is playing politics with an election in mind rather than any form of strategic political priority; 640,000 people today would have used mental health services, many more go missing from services, need treatment but cannot get it, need a bed because they are seriously ill, but cannot get one, section rates increasing, suicides and self harm increasing, fewer staff available with skills to deal and care for people with mental illness; Campaigns has become a "celebritification" measured against how many retweets rather than focusing on the most needy, mentally ill, vulnerable and providing services and care.

#514178 Pat Hogen
United Kingdom citizen

Mr Biswas makes several good points. NHS England was already working on strengthening commitment to mental health issues before some politicians starting announcing (and reannouncing) strategies on mental health. One of the main contributors to mental ill health has been the behaviour of Jobcentre Plus and Atos in putting unfair pressure on many people unfortunate enough to need help. Their practices have in many ways passed on costs from the welfare budget to that of the National Health Service - mainly to already busy primary healthcare. Any recommitment to mental health should also include close work with the Department for Work and Pensions to help put that right. And employers should be encouraged to adhere to the Health and Safety Executive's stress management guidelines to help reduce the prevalence of stress-related illness, of which mental illness forms a huge proportion.

#514213 Mr Biswas

Excellent points Pat, supported by these figures;

Economic Impacts of mental disorder in England

• To the economy: about £105 billion annual cost of mental illness;
• To the NHS: ~£12 billion or 11% of the NHS annual budget spent on mental illness (and the biggest single item of the NHS budget when considered by disease condition);
• Proportion of the total burden of disease: nearly 23% of the total burden of disease
• To employers: £23 billion annually;
• Crime: ~ £60 billion annual cost of crime in England and Wales by adults who had conduct problems during childhood and adolescence.

No other health condition matches mental ill health in its combined extent of prevalence, persistence and breadth of impact.

#516085 Roslyn Byfield
Counsellor in private practice and mental wellbeing advocate
Roslyn Byfield Counselling

Useful blog and quite right about rhetoric needing to be matched by reality, as we have had quite a few loudly trumpeted mental health policy launches, which seem to have made little impact.
I think prevention needs much more focus and on this point what is happening with the local mental health champions?? It's hard to find out which councils actually have them.
For some years ago I've worked with NHS Maudsley colleagues (I worked there till recently) on regular anti-stigma information sharing and signposting events, supported by a wellbeing leaflet as an icebreaker. A USP is working with service users, who have lived experience of mental health difficulties. This has become higher profile and for the last 6 months we've worked with British Transport Police and Network Rail on Waterloo station, marking key dates in the mental health calendar, such as (coming up) 5 February Time to Talk Day. People are very interested, grateful for the talks and information (especially, I find, about psychological therapy) and say they didn't know where to turn as they don't get this kind of information and listening from their GP.
Anyyone is interested to hear more is welcome to contact me via my website: roslynbyfieldcounselling.co.uk.

#519764 Chris Naylor
Senior Fellow
The King's Fund

Thanks all for the comments.

Gregor and Roslyn make some important points about prevention and mental health promotion - I agree that we need to widen the debate here.

Mr Biswas and Pat Hogen have articulated very well the effects of poor mental health on the rest of the NHS, other public services and the economy more generally. The impact on the NHS in particular is significant and something we plan to do more work on.

Lindy - I would recommend contacting Mind or Rethink for advice on how you can become involved in campaigning. You could consider getting involved in your local HealthWatch too.

#544212 ritasoman

This is exactly what I was looking for.Great info, learned something new!

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