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Doing justice to mental health in STPs


Claire Murdoch, the national director for mental health in England, recently argued that some sustainability and transformation plans (STPs) are failing to do ‘justice’ to mental health. Following on from this, we might ask what justice would look like if we had it. For me, the answer would have to include making mental health central to work on new models of care and also part of the approach taken in STPs towards improving population health.

Ignoring the psychological aspects of health and wellbeing leads to some of the grossest inefficiencies in the health and care system. For example, we have estimated that in England, poor mental health drives up the annual cost of long-term physical health conditions by between £8 billion and £13 billion. The fact is – and it should hardly surprise us – that when people are struggling to deal with the social and emotional pressures in their lives, their physical health often deteriorates – and the impact of that is felt strongly in general practice, A&E and elsewhere. And yet all too often we act as if these issues should be of concern only to mental health professionals.

Leaders in some parts of the country are using the process of developing STPs as an opportunity to rethink the approach taken to mental health and wellbeing across their local systems, and are embedding mental health in every strand of their work. Those who haven’t yet done this risk missing a significant opportunity to use STPs to deliver better population health and better value.

So what exactly should STP leaders be focusing on in relation to mental health? To answer this, we need to return to two of the core objectives of STPs.

First, it’s clear that STPs are being seen as the main vehicle through which the new models of care currently being tested in NHS England’s vanguard sites will be rolled out across the country (particularly the multispecialty community provider and primary and acute care systems models). At the heart of these new integrated approaches is the development of community-based multidisciplinary teams, co-ordinated around clusters of GP practices and serving populations of 30,000 to 50,000 people. STP leaders should ensure that mental health is integral to these approaches from the outset. Integrated care teams need to have access to appropriate mental health expertise, and as part of their core skill-set professionals working in these teams (and the primary care teams they sit alongside) need to be able to think broadly about the physical and mental health needs of the people they support.

Our work on mental health and new models of care will provide recommendations on how this can be achieved, drawing on lessons from the vanguard sites. And building on this, later in 2017 we will be exploring the opportunities for mental health in the context of new approaches to primary care – a closely related issue which will also need to be given attention in STPs.

Second, if STPs are to be the means through which we ensure that the health and care system remains sustainable into the 2020s, they will need to improve population health and, by doing so, reducing future demand for care. Given the close relationship between poor mental health and many of the nation’s most urgent public health challenges, improving mental health and wellbeing at the population level should also be an important concern for STP leaders. And a big part of that will be to bring about a step change in how we support and promote the mental health and wellbeing of children and young people, in line with the recommendations made in Future in mind and the Foresight report before it.

The Five year forward view for mental health described specific service areas where the case for investment and improvement is particularly strong, including liaison mental health, perinatal mental health, early intervention in psychosis and crisis resolution teams. STPs will also need to support local areas in acting on these commitments – NHS England’s aide-memoire gives a summary of some of the main priorities for STP leaders.

Returning to the word ‘justice’, I wonder if in some ways it sends the wrong signal. Justice speaks to our concerns about fairness and equality – which are of course important and noble sentiments. But the message I’d like to convey is that making mental health central to STPs isn’t just noble, it makes sense clinically and financially.