Paul Farmer - mental health: from rhetoric to reality?

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  • Posted:Friday 23 January 2015

Paul Farmer, Chief Executive of Mind, speaks at our event on moving conversations on mental health from rhetoric to reality, part of our breakfast series on the big election questions.


We have seen quite a lot of progress in the last five or six years, particularly at a policy and at a political level. We have had at least two mental health strategies. We have had the Mental Health Discrimination Act where not just two but in fact four MPs stood up and talked about their own experiences of a mental health problem. And when we have talked to all of those MPs subsequently one of the really interesting aspects of this has been that they have all said to us very clearly that they have had nothing but positive responses from their constituents. And I think that is quite an important message for us to think about as we start to open up this conversation about mental health. Because that conversation in Westminster was actually simply a rather more high-profile, more visible aspect of something that is happening up and down the country on a daily basis, where people with their own lived experience of mental health problems are beginning to feel more comfortable about talking about their experiences to their friends, their family, their work colleagues and others.

And I think in many ways that shift in public attitude and in consumer voice, if you like, or user voice is the most important shift that has happened over the last five to six years. So we see little examples of that all the time in social media, in campaigning work. We at Mind have 20,000 campaigners, a vast majority of whom have their own personal experiences. And when something happens they talk and they shout about why this is an important issue. So that might be, at one end of the spectrum, large supermarket chains stocking totally inappropriate Halloween costumes and, at the other end of the spectrum, in this context people really engaging with the policy debate and policy agenda around mental health. So that voice of people with their own lived experience and we heard that yesterday upstairs from Kerry talking about her own experience, is hugely important because that is helping to shift public attitude. And we know that the time to change campaign which tracks public attitude is showing a very distinctive, very statistically significant shift to the good in terms of public attitude.

And when public attitude starts to shift well then political interest also starts to shift too. And it isn’t any surprise to us that two parties have been pretty vocal about mental health already. We anticipate all parties being vocal on mental health in the course of the next few months. And I would certainly encourage you to look at both the publications that we saw yesterday including the Labour task force which had a focus on wider society as well.

Why should we even be worrying about this? Well your title today absolutely puts its finger on the button which is the question about the disconnect between the rhetoric and the reality. And there are two fundamental issues here. The first one is the funding gap. And the funding gap is very well documented by people who know much more about this than I do. But it is just very clear that for far too many years mental health has been under funded. And what we are trying to do really is to catch up on decades of underfunding in mental health – 13 per cent of funding in the NHS but 23 per cent of the disease burden. Lots of debate about whether the money has gone up or down over the last two to three years but I think if you ask people like Claire and her colleagues they will say that they continue to be consistently asked to cut services or cut their spend and last year we saw the institutional bias of the tariff deflator on mental health which led to further significant challenges for providers.

But that is not the only gap. The bigger gap here is the treatment gap. And in this area – and I think alone in many areas – we know from work that Richard and others have done that only a quarter of people with a mental health problem receive effective treatment. So 75 per cent of people with a mental health problem in this country don’t receive effective treatment and that is the biggest challenge of all particularly when you are thinking about what kind of service, what kind of system do you want to create for the future? Because in straightened economic times and even in un-straightened economic times there won’t be enough money to fully fund a mental health service in the way that would achieve the same level of access. So that is a really important context for what we need to do.

Our manifesto, I think, has mapped out some clear indications of what the next government can and should do. And we really welcome the contribution that the rest of the mental health community is making to a lot of these debates, many of whom are here in the room today. And I think as a community we are working incredibly effectively to provide a single voice to the rest of the system about what is needed. 

A few things on our shopping list which we think could make a big difference: first of all ensuring that everyone who needs them has access to talking therapies. As part of the We Need to Talk coalition we are very, very supportive of a lot of the progress that has been made but we know that there is still a long distance to travel bearing in mind this is a nice evidenced therapy which just should quite simply be made available to people who need it. Secondly high quality access to CRISIS care 24 hours a day seven days a week. We have seen the first steps in that with the declarations of the CRISIS care at a local level all going amber around the country. Now they need to go green with action plans and a future government has got a big job to do to really see that through. Thirdly and this is the spend point, there just can’t be any shying away from the need to put additional investment into mental health. We can do all kinds of efficiencies, we can do all kinds of things to try to make the system as good as it possibly can be but there just quite simply isn’t enough resource in the system. And we estimate that a minimum of 10 per cent increase in real terms by the end of the next parliament is what is needed. Fourthly as I said we need that investment in wider upstream work. Wellbeing and resilience is the kind of focus on this.

The mental health of children and young people which I am sure we will come along to in the discussions, the mental health of people who are both in and out of work is hugely important for our economy and our society and that requires a national strategy for wellbeing and resilience, and then two systems things that will make a big difference, better data and more accountable commissioning. I like Claire having her toes roasted by Barbara Hakin from time to time, but why is it only on one thing, IAPT? Why isn’t it on other aspects of the mental health system as well? And secondly embedding mental health in the new models of care envisaged by the five year forward view. I think we have seen some good very promising signs of leadership from Simon Stevens on this agenda. But there is always the tendency, the risk, for the NHS to go into default mode when it comes to mental health and put it on one side rather than bringing it into the middle of the system.

So maybe we should learn from all the mistakes that the acute system has made around tariff and payment by activity and other things to be again the forerunners in terms of the way in which the NHS five year forward view is delivered. After all we closed quite a lot of hospital beds quite effectively quite a long time ago. 

And then, finally for me, I suppose, the broader point that mental health has always got to go beyond mental health services. We tend to think about mental health as a cause as much as mental health as a subset of the NHS. If we just think about mental health as a subset of the NHS then we won’t get to the place that people with their own experiences of mental health problems tell us they want to be at. People want relationships, homes, jobs, quality of experience and yes good quality care and treatment. But that is to enable them to participate as equal citizens in our society.

And so to achieve that we are calling for a continuation of the Time to Change campaign to continue that improvement in public attitudes and a commitment to really transform the support offered to people who are out of work because of their mental health problems. I really think we are in the middle of an inexorable movement for change around mental health. We have seen challenges to the system as we have never seen before but I think the biggest challenge now is to the rest of the NHS and indeed the rest of society to create a mainstreamed mental health both in thinking and in delivery. Because after all we owe it to the one in four of us who experience a mental health problem to get it right first time. 

Thank you.


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