Ending the neglect of mental health: can the NHS do it?
The Conservatives promise to put mental health services on a par with physical healthcare – but more austerity is a major threat, reports Andrew McConaghie.
Amid the general election's war of words, there were few themes within NHS policies which all political parties could agree on, but one of them was the urgent need to improve mental health services.
The Conservatives are now looking ahead to a five-year term up to the year 2020 (and without the compromises required of coalition), and must now fulfil their promise to 'improve access to mental health services', one of their key manifesto pledges for the NHS.
But while the NHS has been promised above-inflation increases in spending, social care services will not be protected from further swingeing cuts, and this could hamper any efforts in the field.
Even with NHS spending being protected in theory, many fear that funding won't stretch to cover all the Service's many priorities, and mental health could once again lose out. Indeed most people in the frontline say NHS mental health services have been cut back over the last five years.
In an opinion piece for pharmaphorum, Paul Farmer, chief executive of the mental health charity Mind says austerity has hit mental health services particularly hard.
"The reality of the world of mental health is that, in recent years, life has become significantly more difficult for many people with mental health problems.
"Austerity has taken its toll on the mental health of the nation, while cuts to NHS mental health services mean that people up and down the country are being failed when they are at their most unwell. People are telling us every day that it's becoming harder and harder to get the help they need."
Equal treatment for mental health problems
At the heart of the challenge in mental health are two fundamental problems. First, mental health issues are not treated or funded equally with physical health problems. Figures from NHS England in 2013 showed that mental illness causes almost a quarter of the burden of disease (22.8 per cent), yet received only 11 per cent of NHS funding. By comparison, cancer caused 15.9 per cent of that burden.
Furthermore, 92 per cent of people with diabetes receive treatment, compared to just 28 per cent of people with mental health conditions. Yet figures show that people with serious mental illness are at risk of dying up to 25 years earlier than those without such illness.
Second, mental and physical health problems are currently treated separately in the NHS, which means the link between, say, depression and diabetes is rarely properly identified or addressed.
National Clinical Director for Mental Health Dr Geraldine Strathdee, who discussed the challenges in a recent blog, commented:
"The evidence that seeing people as either just 'body' or just 'mind' parts, rather than as a whole person, results in poor outcomes for patients and poor value for commissioners is there."
She says there is a great deal of evidence to show unassessed and untreated mental ill health leads to physical ill health and long-term conditions.
"For example, people suffering untreated depression and anxiety are significantly more likely to develop heart and lung diseases, diabetes, cancer, die up to 20 years prematurely, more often use crisis services and have repeated hospital admissions."
Conservative pledges
Last week was Mental Health Awareness Week, and charities and NHS leaders were trying to push the subject up the agenda, but it must compete with many other priorities and pressures within the health service.
The Conservatives have an existing commitment to put mental health services on a par with physical health. The party has extended this promise by saying it will ensure there are therapists in every part of the country to provide treatment for those who need it.
The party's manifesto also pledged to increase funding for mental health – although how funding could be rebalanced within the NHS remains unclear. This is of particular concern as many parts of the NHS slip further into the red.
However, shortly before the election, the government made a commitment to increase funding to develop children's mental health services by £1.25 billion over the next five years.
The Conservative manifesto also pledged to enforce new access and waiting time standards for people experiencing mental ill health, including children and young people.
Yet there is clear evidence that mental health services have suffered over the last five years of the Conservative-Lib Dem coalition government, with little indication that these losses will be reversed in the next five years.
An investigation carried out jointly by the BBC and the online journal Community Care in March this year found that mental health services have been cut by eight per cent in the last five years.
At the same time, referrals to community mental health teams rose by nearly 20 per cent.
"3,300 frontline mental health nursing posts have been lost, and bed numbers have dropped by 2,100 over the past five years"
Mind says a total of 3,300 frontline mental health nursing posts have been lost, and bed numbers have dropped by 2,100 over the period.
"Meanwhile, demand is increasing and we are starting to see the scale of the unmet need and we know that around 75 per cent of people with depression and anxiety get no help at all," says Paul Farmer.
"Things cannot continue as they are; we need to see an increase in NHS funding for mental health to the tune of at least 10 per cent over the next five years if we are to begin to bring mental health services up to scratch."
On Monday Prime Minister David Cameron reiterated his pledge to increase NHS budgets by at least £8 billion a year for the next five years, an increase which NHS leaders and think tanks say is sorely needed – but also say may not be enough.
Meanwhile, the government will be making new demands on the NHS, not least its commitment to make the UK the first in the world to have a truly seven-days-a-week service.
In his speech, Cameron made sure to address the challenges in mental health directly, and promised to publish waiting times and access standards in local mental health services, in order to help drive standards up.
A Mental Health Taskforce for England was formed in March this year, and aims to develop a new five-year national strategy for mental health covering services for all ages. Led by Mind's Paul Farmer, it will investigate variations in access and quality of care, and seek the views of people with mental health problems, families, carers and health professionals.
The strategy is due to be published in autumn 2015, and will be an NHS England-led strategic approach to designing mental health services for all ages, and across the health and care system.
However if this new strategic framework is not translated into actual progress, and backed by funding, campaigners fear that the next five years could see the country's picture of mental health deteriorate, not improve.
About the author:
Andrew McConaghie is pharmaphorum's managing editor, feature media.
Contact Andrew at andrew@pharmaphorum.com and follow him on Twitter.
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