Will the government's new mental health strategy succeed?
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For all the recent investment, mental health remains an area where there is a pressing need for improvement. The government's new strategy, 'No health without mental health', sets out six objectives to improve the mental health and wellbeing of the population and to improve outcomes for people with mental health problems.
It supports the government's aim of achieving parity of esteem between physical and mental health and emphasises the interconnections between mental health, housing, employment, and the criminal justice system.
Broadly speaking, the strategy focuses on the right areas. It captures issues of long-standing concern for people with mental health problems – such as the pernicious effects of stigma – and also reflects the research evidence, for example, on the profound interconnectedness of mental and physical well-being.
In line with the government's intention to refrain from telling health professionals what to do, 'No health without mental health' contains few centrally mandated actions. Instead, it describes the destination, provides some directions for getting there, and then says how we'll know if we all get lost.
What this approach means is that if the strategy is to have any force behind it, mental health (and the six objectives in particular) needs to be fully reflected in the outcomes frameworks that will hold the NHS, public health and social care professionals to account for the results they achieve. The objectives will also need to be included in the commissioning outcomes framework to be developed for GP consortia, and any outcomes measures used to monitor contracts locally.
At present the objectives are only partially reflected in the proposed outcomes frameworks. For example, one objective – that more people with mental health problems will recover – is intended to capture not only clinical recovery but also recovery in the broader sense of having a good quality of life, however each individual defines that. However, the NHS outcomes framework will measure this exclusively in terms of employment rates for people with mental health problems.
On the absolutely crucial task of tackling stigma and discrimination, none of the outcomes frameworks contain measures relating to stigma reduction and consequently neither the NHS, nor the social care or public health sectors will be held to account at the national level for meeting this objective.
The most headline-grabbing commitment in the strategy is the announcement of £400 million over four years to expand the Improved Access to Psychological Therapies programme to three new groups of people: children and young people; people with long-term conditions; and people with severe mental illnesses. Although the money is not ring-fenced and must be found from existing budgets, commissioners should be encouraged to make good on this commitment – it would give thousands of people access to much-needed, evidence-based care. It also makes economic sense. As highlighted in a report by The King's Fund and Centre for Mental Health, Mental health and the productivity challenge: Improving quality and value for money, improving psychological support for people with long-term conditions, and dealing more effectively with childhood mental health problems, can give a return on investment which justifies the expenditure in financial terms alone.
The government should be commended for its ambitions, but as the strategy itself acknowledges, much work is needed if the vision is to become a reality. And, crucially, the objectives will not be achieved unless all relevant organisations are adequately held to account for delivering them.
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'No Health without Mental Health' is a glib slogan inherited from New Labour not a well thought out citizen as well as society focused social mental health policy that addresses some of the worst abuses and failures of the mental health system itself, systemic abuses and failures that the Government backed and massively funded and duplicated public facing anti stigma campaigns ignored even though they hugely contribute to negative perceptions of mental health and still make it extremely difficult for people to confidently acknowledge their own mental health issues or safely access services.
The arelational and abusive conditions on many mental health wards - see recent SAFH report on ward environment - are good examples of core unaddressed problems but while the Government backed and system uncritical celebritised campaigning focuses on the white middle class working well anyone who falls on wrong side of that demographic is left voiceless, struggling to get appropriate help and decent support services, including access to quality training and sustainable employment when thet help is REQUESTED rather than imposed , or worse, simply being targeted as malllingerers and scroungers because they fail to Recover to order and validate the new MH economic determinism and the negative view of people with mental health issues the public seem to have got over but the system clings to.
BrokenofBritain, an unfunded grassroots disability umbrella organisation has put the massively funded mental health charities and Think- tanks to shame in raising awareness of the latter problem. Mental health service users are not simply being 'nudged ' towards policy aims first decided by New Labour as remote policy wonks would have it they are being increasingly bullied towards policy goals in a reckless and counter-productive way .
The Kings Fund and the Centre for Mental Health have also willingly contributed to distracting from deep systemic problems and perpetuating inequalities and abuse within the mental health system and connected charity provision yet neither of these organisations which hardly act independently of the mental health system are accountable in any way that the author of this Kings article would like the Government to be.
The Kings Fund has a conference coming up next month on 'Care Pathways in Mental Health from the Service Users Perspective' but typically even Mark Brown the editor of One in Four Magazine cannot afford to book a place tocover the subject of Pathways as a feature and it doesn't look like Kings is really that interested in making sure that service users like Mark Brown and myself understand what those Pathways or recognise the service user perspective Kings seems so eager to project and share behind service users backs and often poor experience of them, a situation that brings Kings committment to 'evidence based 'practice into serious doubt as effectively Kings , many provider MH orgs and the mental health system have joined the Government and simply fallen back to a position of treating service users like laboratory fruit flies to guarantee the system can create its own impressions of evidence based outcomes we also don't get to comment upon.without ever mapping out the mental health service landscape properly so that everyone an anyone can easilly understand and navigate it as they manage to do with all other areas of health.
Factual correction from moderator: We cannot comment on the ‘Care Pathways in Mental Health from the Service Users Perspective’ conference you refer to as it is organised by another organisation who is hiring The King’s Fund as a venue for their event. This conference is not connected in any way to the work or policies of the Fund.
The King’s Fund does organise paid for conferences but where possible offers bursary places to those where price acts as a barrier to attending.
Factual response to moderator .So even though the conference is officially advertised online under bold details headline
'Care Pathways in Mental Health'
Tuesday 8 March 2011 ,
The King's Fund, London
and Chaired by the Deputy Director of NMHDU , it's apparently more important for the Kings Fund to establish just how cross-organisationally un-boundaried and unaccountable the MH sector has become in a blogpost that concludes with a call for more accountability than to address the problem that the highlighted ‘Care Pathways in Mental Health from the Service Users Perspective’ conference is closed to most service users ( 69 CD , £300 conference tickets ) who more often than not still struggle to try to figure out Care Pathways into mental health and the pitfalls involved because the system can't be bothered to address the complexity and simply map them out and resolve reoccurring and entrenched problems , an oversight/failure that costs many service users very dearly and some people their lives.
The King’s Fund we read, ' seeks to understand how the health system in England can be improved ' , so could you please as the venue hirer find out if service users can attend the Care Pathways into Mental Health conference that is putting money in your coffers please to demonstrate that Kings is also capable of addressing and changing the sectors own excluding and discriminatory behaviour as well.
Thanks for your time
Excellent points actually. Why isn't the King's Fund requiring people who book its facilities to provide some places for independent users of mental health services especially when the event claims to have "a focus on the service user perspective "?
£69 for a CD containing the conference handbook (slides etc) - are they kidding or what?
By the way King's Fund moderator, your own events listed here seem to cost from about £300 going on £500 as well and there is NO MENTION there of any bursary to help some individuals - not on the event webpages nor in the booking form.
Regarding the original post, thank you for pointing out that " one objective – that more people with mental health problems will recover – is intended to capture...recovery in the broader sense...However, the NHS outcomes framework will measure this exclusively in terms of employment rates". Hahahahahaha. Hahaha. Ha. Ahh. So the Coalition wants to index the happiness of the nation but doesn't want the mental health system to measure outcomes of happiness or distress of mental health patients. Once again mh patients get the worst most prejudiced most dehumanising treatment despite by definition being in the most need.
Has the King's Fund done any work on the return on investment for mental health promotion/illness prevention?
The King's Fund has recently published a report, with the support of the Royal College of Psychiatrists and the NHS Confederation’s Mental Health Network, to explore how mental health services could be delivered in a different and more cost-effective way.
The report is titled 'Mental health and the productivity challenge: improving quality and value for money' http://www.kingsfund.org.uk/publications/mental_health_and.html
I have been a carer for my son for 20 years and I have also been involved in 2 healthcare systems (UK & Hong Kong) in various capacities on and off for 40 years. In my view the problem is the lack of integrated care (and understanding what that entails) and also the lack of electronic integrated records for health, social and housing. My son comes under a NHS trust which is always regarded as one of the top in the country and yet, medical treatment apart, it is still very average and without my wife and I being on top of things he would very quickly regress. Housing and social care are weak links and I would like to see the NHS take over total integrated care apart from housing and local authorities revert to concentrating on education, highways, police etc. Then I would like to see the Government (the new Government has been very disappointing so far with it's changes, no real insight or understanding) think about what is the best operational size for a healthcare orgainsation, there should be no trust with a spending under £500mn as all this does is require large numbers of un-necessary management staff and consumes resources that could be spent locally and on direct patient services. The Government should also require all social housing organisations to combine their records so we have a complete housing database, at the moment MH Housing strategies are haphard and poor with totally insuffient emphasis.
I very much appreciate the commitment and support that goes into the MH service and most of the staff are excellent but there needs to be a fresh and radical approach with far more efficient structures if we are to have a world class service in the 21st century.
It would also be great if persons like myself who are not employed could be offered places at seminars/conferences at rates we can afford as carers have a huge amount to offer and often success and/or failure hinges on us.
Excellent points posted here on this post actually. I have also been involved in 2 health care systems and too aware about this. Keep updating us with more post.
As a sufferer of two different mental health conditions I am disappointed to have to state the following.
I was put into care as a young baby. I suffered mental cruelty, physical abuse and sexual abuse from the age of 2 till the age of 8, whilst in the care of the charity that was formerly known as NCH, the Queen was the patron, the government paid for our upbringing. I was then fostered at the age of 8, I was sexually abused again from the age of 8 till the age of 14. Again my care was paid for by the government.
Since adulthood I have lost a child, had 2 broken marriages' Lost 2 grand children, lost another grandchild as he was adopted, my relationship with my remaining 4 children is up and down, more negatives then positives. My last long term relationship ended last year as that broke me.
I have PTSD due to loss and abandonment. I have Emotionally Unstable Personality Disorder due to the abuse suffered.
Where is my help??? I am lucky to see my CPN once a month, there is no counselling for me as I cannot afford to pay, I see my psychiatrist once a year if I am lucky...
I am not in this mess due to something I did, it's not my fault, does the government not think that people like myself are owed a decent mental health package, the full works, every service that is available, if they have to pay for people like me to have private help, treatment etc.. I have no quality of life. It's all about children, young adults, pregnant women and young men... How does the government justify those decisions??? Sorry we have no staff, sorry we have emergency's and have to cancel your appointment, sorry ur CPN is off sick, on holiday.. Do what makes someone more important than me.. They do not understand the damage a call does to me to have to cancel an appointment, am i not important enough??? Do they not care??? Have I not suffered enough to warrent a decent level of help, support etc... It's no wonder so many adults commit suicide who were victims of historic child abuse.... So sad....
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