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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.