Mental health seems to have had a political promotion in the past weeks. Notably, it was one of the key social injustices - alongside poverty, gender and racial discrimination - highlighted in Theresa May's inaugural speech as Prime Minister. This prominence matters. David Cameron didn't often talk about mental health, but when he did give it his attention - most notably via the 2012 Dementia Challenge - the cogs of government sprang into action. Then shortly after Theresa May's speech, it was announced that mental health would now come within the purview of the unshuffled (and presumably unruffled) Secretary of State, rather than being the responsibility of one of his Ministers. Again, this is politically significant and a welcome move. The Ministers previously responsible for mental health made genuine improvements. It's exciting to think about what the added attention of the Secretary of State could mean.
So there's some good news. The bad news is that the good news has come at a particularly critical time for mental health. The Care Quality Commission has just completed the first round of its inspections of mental health trusts under their new framework, and the results make fairly grim reading. No trusts are 'outstanding'. One third are 'good' and the remaining two-thirds 'require improvement'. The number of patients sent out-of-area - sometimes hundreds of miles away - has more than quadrupled between 2011/12 and 2015/16. Use of the Mental Health Act - a good proxy for whether services are intervening before people reach crisis point - is at a record high. Things are certainly not all bad - many services are providing high-quality, innovative care - but the levee is at breaking point in too many places and for too many people.
The political prominence currently given to mental health is therefore vital, but prominence is meaningless without a plan. So the really good news is that a plan - a very good one - is hot off the press; NHS England has just published an implementation plan to set out how it will operationalise the independent Mental Health Taskforce's influential Five Year Forward View for Mental Health report, which was published earlier in the year. The implementation plan outlines how new funding will be made available for CCGs year on year, as well as showing how the workforce requirements will be delivered in each priority area and the way in which data, payment and other system levers will support transparency. Yes, it would have been nice to see mental health law reform mentioned, or funding being ring-fenced, but it's still fair to say that If Carlsberg made plans, they'd look pretty similar to this - costed, practical and with measurable outcomes.
However, the mental health sector is no stranger both to grand plans and broken promises. Most recently, the hearty welcome that met the announcement of the first access and waiting times standards for mental health has sharply given way to anger that they won't be fully funded, either because the funding isn't there at all or because it is being siphoned off to cover the deficits in nine out of ten of the Trusts providing physical healthcare.
In her speech, Theresa May lamented that 'if you suffer from mental health problems, there's not enough help to hand.' Hopefully political prominence will mean that the latest promises are kept - meaning the next Prime Minister will be able to list mental healthcare as a national asset in their inaugural speech. This political promotion has come at a pivotal time, and it's clear that merely paying lip service to improvement would be a further injustice for Theresa May to add to her own list. Practical action is needed on the government's part to make sure that people suffering from mental health problems do get the help they need, and which they'd take for granted for a physical illness.
So if the challenge for the Prime Minister and the Government is to keep their promises, then the challenge for the rest of us - patients, psychiatrists, psychologists, providers and even policy analysts - is to welcome these plans and promises, while keeping a wary eye on whether they are actually making the differences they are supposed to. We'll be watching.Suggest a correction