London needs action plan for mental health

London needs an action plan for mental health to address wide variations in quality of care and meet commitments to put mental health on an equal footing with physical health, says a report published today by The King's Fund.

London spends almost £7.5 billion every year addressing mental ill health, which alongside the wider social and economic impacts of mental illness adds up to an estimated annual cost of £26 billion. However, service user satisfaction is particularly low, with many needs not being met. Good practice often happens in isolation, with wide variations in availability, quality and effectiveness of specialist services. With more than 80 organisations responsible for mental health provision in London, a lack of strategic collaboration is holding London back.

Mental health is identified as a priority by the London Health Board yet there is no agreed action plan for improving provision and addressing the unique challenges of achieving this in London. The challenges include:

  • the complexity of London’s NHS structures and systems for commissioning and delivering services
  • high levels of deprivation, and a diverse and transient population 
  • high demand for services – significantly higher than the national average in more than three quarters of boroughs.

Transforming mental health: a plan of action for London, is based on engagement with key stakeholders. The authors found that while stakeholders generally agreed about the priorities for improving mental health provision in London, there was no collective view for delivering them. The report identifies a number of longstanding barriers between stakeholders that continue to hinder progress – such as:

  • different political and historical agendas
  • unconstructive communication
  • insufficient attention to collaboration in developing strategies
  • weaknesses in commissioning.

The report encourages stakeholders to recognise these barriers and unite behind a shared agenda focused on providing integrated services.  Nine key steps are identified to help to achieve the vision including: creating collective leadership around change; strengthening commissioning; and the effective use of contracting tools. 

The report highlights examples of innovative practice and some of London’s unique strengths – such as the fact that many of the world’s leading academic institutions focused on mental health research are in the capital. It suggests that academic health science networks (AHSNs) should play a greater role in disseminating the latest research and good practice, while NHS England and Public Health England also have a role to play in supporting organisations in improving practice.

While the total level of funding for mental health provision remains a contentious issue, the report argues that there is a unique opportunity to improve services through more collaborative working, so how limited resources are spent is crucial.

Helen Gilburt, Fellow at The King’s Fund and the report’s lead author, said:

‘Over the past 25 years mental health provision has undergone a dramatic transformation, with services moving from institutions to community settings. Our report shows that mental health services in London need to move away from siloed working and embark on a second phase of transformation to deliver the change needed to improve services.’

The nine key steps to support systemic implementation of a shared vision are:

  • collaborative commissioning to facilitate change
  • driving change through collective systems leadership
  • ensuring that service users, carers and clinicians are at the core of provision
  • using contracting systems to support integration
  • building a public  health approach to mental wellbeing
  • developing pan-London solutions to increase impact
  • developing data to support improvement
  • utilising London’s academic infrastructure to disseminate best practice
  • creating a new narrative for mental health.

Notes to editors: 

Following the reforms introduced by the Health and Social Care Act 2012, responsibility for the mental health and wellbeing of London’s population (as with other parts of the country) lies in the hands of organisations with varying geographical and population-specific remits. In London, this involves 32 clinical commissioning groups (CCGs), 33 local authorities, 3 local education and training boards, the London offices of NHS England and Public Health England, 10 mental health trusts, and other non-NHS providers. The London Health Board provides leadership on pan-London health issues and is currently developing its mental health priorities, while a number of pan-London mental health programmes previously led by NHS London continue within individual organisations, including UCL Partners, the Anna Freud Centre, and NHS England.

The stakeholder engagement process brought together a diverse set of agencies with a role in improving London’s mental health, along with service users and carers to develop a shared vision for the future.