On mental health awareness week, and with a new government and Minister of State for Care and Support - Alistair Burt MP - it is important to reflect on both recent successes and future challenges for improving mental health services.
The scale of the challenge
Mental ill-health remains one of the most pressing challenges we face as a society. One third of all families include someone who is mentally ill, while at any point one in four of us is experiencing mental ill-health. What is more, prevalence rates are increasing, with more people using specialist services.
Social and cultural factors such as rates of family breakdown and an ageing population go some way to explaining this trend. As do a range of economic factors such as personal debt and cuts to welfare. With further fiscal consolidation planned in the first years of the next parliament, there is an urgent social, moral and economic need for the incoming administration to take steps to support vulnerable people and protect them against the damaging effects of mental ill-health.
There are three ways in which the new Care and Support Minister, Alistair Burt, can ensure that his legacy is a positive one. He must continue recent momentum by: diverting more funding to mental health services; ensuring that our public services are integrated and so equipped to deliver effective mental health care to those in need; and taking preventative measures to stem the tide in the number of young people becoming mentally unwell. All the while, the new Minister must be proactive in building coalitions of support with service users and carers who can lead change over the next five years.
It is no secret that mental health has historically been hugely underfunded within the NHS when compared to expenditure on physical health. This despite mental ill-health contributing to 38 per cent of all illness in under-65s, almost as much as all physical illnesses combined. The previous government's decision to enshrine 'parity of esteem' between mental and physical health in law was therefore a hugely important step. But it is vital that this is not allowed to have been merely symbolic.
Although there was a seismic increase in the profile of mental health under the last government, real terms funding to NHS Mental Health Trusts fell by over 8 per cent over the course of the parliament. Squeezed local authority budgets (which are set to continue) also saw child and adolescent mental health services (CAMHS) funding fall, meaning that only the most severe cases are now able to receive regular access to mental health professionals.
The incoming government has pledged to increase spending on mental health, but it will be the job of the new Minister to ensure that the sums are as high as possible. Significant increases in spending now will go some way to relieving pressure on the NHS in years to come, as a third of people with physical health needs are also diagnosed as having a mental health condition. This mental health comorbidity means that mental illness costs the NHS over £10 billion per year in physical illness costs.
Designing and delivering effective services
Increased spending must translate to more effective services. Recent commitments to reduce waiting times and expand access to psychological therapies are hugely important given that one in three people are still waiting longer than the recommended 28 days for treatment. But they must be accompanied by steps towards greater integration within and across systems if they are to have maximum impact.
Achieving a more joined-up approach will mean that people with both low-level and more severe and enduring conditions are better able to access services in the first instance and then transition between them as their care continues.
Mental health care is most effective when different services work together around the needs of the individual, maximising opportunities for them and those professionals working with them to gain a deeper understanding of the nature of their illness and improve the chances of self-care and recovery. Disparities in funding between health and social care are, however, are creating incentives for mental health services to become less integrated in some places. The incoming Minister must, therefore, ensure that greater local freedom over commissioning does not create a patchwork of isolated providers.
Prevention and the promotion of mental wellbeing
Three children in every classroom now have a diagnosable mental health condition, and more than half of all adults with mental health conditions were diagnosed as children. Developing mental ill-health during childhood can drastically reduce outcomes later in life. For example, a child with a conduct disorder (severe behavioural problems) is 20 times more likely to go to prison and six times more likely to die before the age of thirty.
Policies to prevent mental illness and promote wellbeing in young people are therefore hugely important. The mental wellbeing of young people is under threat from modern phenomena such as increased rates of family breakdown and cyber-bullying. Schools and other places with a duty of care towards children need to be equipped to do more to identify emerging mental health issues and consistently and effectively promote wellbeing. Rather than design systems that merely deliver care to young people in crisis, more needs to be done to ensure that young people exist within a culture that emphasises the importance of mental wellbeing alongside academic achievement.
A long to-do list
The challenges are many, and the obstacles are significant. But a focus on maximising funding, creating integrated and effective services and promoting wellbeing among young people will give the incoming Minister the greatest chance of building on the momentum of the last few years.
Mental ill-health often serves to harden pre-existing inequalities, and can severely impact our ability to work, build social relationships and contribute to our communities. If the ambition is to truly create the Big Society, then mental ill-health cannot be ignored.