The King's Fund verdict is our take on the big questions in health and social care. Here we take a look at what progress has been made following the government's pledge to put mental health on a par with physical health.
What's the issue?
A longstanding criticism of health and social care in England is that people with mental health problems often fail to receive the same access to services or quality of care as people with other forms of illness. For example, three in four people with a mental health problem in England receive little or no treatment for their condition, and there are large gaps in terms of health outcomes – people with the most severe mental illnesses die on average 15 to 20 years earlier than the general population.
Responding to these concerns, the Health and Social Care Act 2012 created a new legal responsibility for the NHS to deliver ‘parity of esteem’ between mental and physical health, and the government has pledged to achieve this by 2020. Parity of esteem involves ensuring that there is as much focus on improving mental as physical health, and that people with mental health problems receive an equal standard of care.
The government launched a new mental health strategy ‘No health without mental health’ in 2011, and subsequently has used its annual ‘mandate’ to instruct NHS England to prioritise achieving parity of esteem. A number of specific commitments and initiatives have followed.
Waiting times targets
In October 2014 the government announced waiting time standards for some mental health services – the first time such targets, used widely in other parts of the health service, have been set for mental health. From April 2015 waiting times will be measured for two types of service: psychological therapies provided through the Improved Access to Psychological Therapies programme (see below); and early intervention services for people experiencing their first episode of psychosis. The ambition is to extend targets to other forms of mental health care over time.
There has been a recent focus on improving crisis services for people experiencing an acute episode of mental distress. This is in response to a number of concerns, including reported shortages of inpatient beds in some areas, and variable practices in terms of how police forces respond to emergencies involving people with mental illnesses.
The Crisis Care Concordat, launched by the Department of Health in February 2014, has triggered joint agreements at the local level between the police, social care, mental health and ambulance services to improve how professionals work together. Some achievements have already been made, including a significant drop in the number of people being detained in police cells during mental health crises. The government also announced a national initiative aiming to reduce deaths from suicide, with three mental health providers in England already pursuing a ‘zero suicide’ ambition and others being urged to do the same.
The financial squeeze affecting many public services is creating intense pressure in some parts of the mental health system. Some have asked whether mental health receives a fair share of NHS funding. Mental health problems account for 23 per cent of the burden of disease in the United Kingdom, but spending on mental health services consumes only 11 per cent of the NHS budget.
The reduction in the prices paid to mental health providers in 2014/15 (which exceeded reductions for hospitals providing physical health care) led many to conclude that institutional bias against mental health remains as strong as ever. This criticism has been partially addressed by NHS England’s recent planning guidance, which directs clinical commissioning groups to boost spending on mental health at least in line with each group’s overall budget increase for 2015/16, ensuring that mental health receives a proportionate share of additional funding.
In terms of specific programmes, the government has also continued to invest in the Improved Access to Psychological Therapies (IAPT) programme, a primary care service aimed mainly at people with depression or anxiety disorders. The number of people treated through this programme has increased annually, and IAPT services are now being extended to include children and young people. However, the funding provided to expand the programme has not been ring-fenced, raising concerns about whether the national ambition has been reflected consistently in local spending decisions.
In March 2015, the coalition government announced that it was going to provide £1.25 billion of new funding for children's mental health services, and to support provision for pregnant women, young mothers and armed forces veterans. The extra money, spent over five years, will be predominately focused on child and adolescent mental health services with an aim to treat more than 100,000 young people by 2020. The funding will be accompanied by new waiting time standards for child mental health and a commitment to provide specialists in children’s talking therapy in every area of the country by 2018.
The King’s Fund verdict
The focus on parity of esteem is highly welcome, and some specific achievements have been made in recent years. However, the increased attention now being placed on mental health has come late in the parliament, and there remains a gap between rhetoric and reality. Given the scale of the challenges involved, improving outcomes among people with mental health problems and achieving parity will require a serious commitment from the next government.
Sufficient funding will need to be available to help local areas develop new approaches to mental health, ensuring that services are better connected with physical health care and other public services. Workforce shortages in some mental health professions must be addressed. There will also need to be investment in training and education aimed at giving GPs, nurses and other staff in all parts of the NHS the skills to help people with mental health problems to enjoy the same care and outcomes as anyone else.