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A Different Mindset Is Needed on Mental Health

The landscape of mental health services in England is bleak. Pressures in care reveal a stark dichotomy, from the human cost being unacceptable to funding being unaffordable. That gap must be closed.

The landscape of mental health services in England is bleak. Pressures in care reveal a stark dichotomy, from the human cost being unacceptable to funding being unaffordable. That gap must be closed.

There are no easy solutions. Cultural transformation is needed, with a different mind-set that puts people at the centre of care and support. More money will surely help, but not without better co-ordination, less complicated care pathways and increased capacity.

One in four adults experience at least one diagnosable mental health problem in any given year. The numbers of people taking their own lives is rising again, with three-quarters of those with psychiatric conditions not being helped and children being sent far from home to get treatment. That was the verdict of a recent damning report published by the Government's own Mental Health Task Force, Chaired by Paul Farmer of Mind.

Mental health services have been the NHS's 'poor relation', but Government now claims it is committed to putting mental health on an equal footing with physical health by implementing improvements in seven-day crisis care and increases in psychological treatments. That's why NHS England has committed to help more than a million extra people facing mental health problems and to invest in excess of £1bn annually by 2020.

Currently, round-the-clock, community-based mental health crisis care is only available across half of England. So for starters, in shaping future mental health services, NHS England must prioritise access to care seven days a week and expand community-based services for people with severe problems who need support to live safely as close to home as possible. However, it is questionable whether the pipeline of skilled doctors and nurses will be available to meet growing needs, even with imposed contracts to deliver seven-day care.

Putting additional resources into mental health services will result in cost benefits savings to both the wellbeing of patients and NHS budgets. For instance, reduced emergency hospital admissions will cause fewer traumas to families and lower per capita costs. That will help personal outcomes and assist to support more patients.

Investment works for people. For instance, the taskforce suggests a further £10m a year in services for those who are suicidal would save the lives of 400 people a year. That is a tangible deliverable that will make a difference.

Not unusually with Task Force recommendations, this latest report advocates greater co-ordination across public services. To that end, it calls for a "data revolution" to improve transparency and the appointment of an 'equalities champion' to tackle health inequalities. To truly succeed, that requires leadership across public services, not a specific Department of Health remit.

The report, for example, says cuts in local authority budgets are leading to rising pressures on important parts of mental health care, such as social care and residential housing. The consequences of decisions elsewhere in public services have knock on effects. With increasing homelessness come higher risks of acquiring mental health problems. Inadequate resources in health and social care simply push pressure to police and charities. Someone's crisis doesn't simply go away amidst such a vacuum.

We need to strengthen the varied ways of isolating the causes of mental health. For example, training for teachers would help to ensure that mental health problems are picked up early in the classroom. Talking and understanding is central, not short term response as we've seen with the increased prescription on anti-depressants to children.

All too often people with mental health problems are sidelined to life on benefits. Too often that exacerbates their troubles, as the stresses of poverty and disadvantage take hold. So the Task Force's recognition that employment provides a pathway to mental wellbeing is very welcome. Preventative action is particularly important, with more effort needed in helping people retain work.

Poor people and groups facing discrimination, such as trans people, are disproportionately affected by mental health problems. That's why co-ordinated action is needed, with employment interventions helping to improve health outcomes.

Black African and Caribbean men are on average detained five times longer in secure care than other groups, suggesting more targeted care is required. That surely has a cross over to the review being conducted by David Lammy into the disproportionate numbers of young black men in prison.

All too frequently Task Force reports proclaim that transformation is needed. With equal regularity, Ministers step forward with platitudes and then quietly place the recommendations on a shelf to gather dust. It mustn't happen with this landmark report on Mental Health, as it will only make matters worse in the long term. To ensure change with this proposition, we need a different mind-set.

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