Key points
Mental health problems are very common. Estimates from research studies suggest that one in four people in the UK experiences a diagnosable mental health problem at some point during their life. Depression and anxiety disorders are the most common forms of mental health problems, and evidence indicates that around a third of people with depression and half of people with anxiety disorders do not receive any support or treatment from health services.
Most people with mental health problems are supported solely by GPs and other professionals working in primary care. Around ten per cent of patients with mental health problems are referred on to specialist teams.
There has been considerable investment in mental health services in recent years. Between 2001 and 2010, real terms investment in adult mental health services increased by 58 per cent, partly as a response to historic underfunding. Over 700 new community mental health teams were created, and numbers of consultant psychiatrists and mental health nurses increased by 55 per cent and 24 per cent respectively between 1997 and 2007.
In spite of the high profile given to mental health by recent governments, certain challenges have proven difficult to address. Social outcomes for people with mental health problems remain poor, profound inequalities exist, provision of mental health support in primary care is patchy, and waiting times for psychological therapies can still be high. The latter is currently being tackled through the Improving Access to Psychological Therapies programme, launched in 2007.
The coalition government published a new mental health strategy in February 2011, ‘No Health without Mental Health’. This sets six objectives for mental health over the coming years, including promoting better mental wellbeing in the general population, helping more people with mental health problems to recover, and reducing the stigma and discrimination associated with mental illness.
For those people with severe mental illnesses such as schizophrenia, the last 25 years have witnessed a major transformation in the way services are delivered, with care shifting from large inpatient institutions to community-based teams. The NHS Plan in 2000 introduced a range of new service types designed to meet the needs of people with mental health problems living in the community.
After several years of debate, the 2007 Mental Health Act introduced a number of reforms to the laws governing when and how a person can be detained for assessment and treatment of mental health problems. The most controversial element of this is the introduction of Community Treatment Orders, under which patients can be compelled to continue taking medication after discharge from hospital.
The costs to the NHS of mental ill health are forecast to rise over the coming years. The King’s Fund report Paying the Price: The cost of mental health care in England to 2026 estimated that expenditure will reach £47 billion a year by 2026, compared with £22.5bn in 2007. This is due largely to a predicted rise in the number of people with dementia.
Dementia currently accounts for 66 per cent of all costs related to mental health care (including informal care), and is an issue of increasing concern. The King’s Fund report Paying the Price: The cost of mental health care in England in 2026 estimated that the number of people with dementia will increase by 62 per cent from 2007 to 2026. The Department of Health's National Dementia Strategy, launched in February 2009, aims to see diagnoses being made at an earlier stage of the illness, and to improve the quality of care provided.
A key challenge for mental health services over the coming years will be to deliver better value for money without sacrificing quality of care. The King's Fund's report Mental health and the productivity challenge: Improving quality and value for money highlights a number of areas where opportunities exist to do this.
