Yesterday, Jeremy Corbyn used two out of six allocated questions at his first ever Prime Minister's Questions session to talk about mental health. The significance of this cannot be understated. It sent a clear message - along with this week's appointment of Luciana Berger as shadow minister for mental health - that Labour is going to make mental health a political priority. In turn, the Prime Minister's answers suggested that the government also increasingly sees mental health as a priority.
This political prominence is welcome, and it's fair to say that it reflects widespread and genuine public concerns; Corbyn crowd-sourced topics to raise, and received over one thousand about the problems with mental healthcare.
The most powerful question was how the Prime Minister felt about patients having to travel long distances for care because mental health beds are unavailable locally. This was an extremely well-chosen question, as the practice of having to send patients 'out-of-area' for routine inpatient care because all of the local beds are full is one of the clearest examples of how far behind mental health is when compared to physical healthcare. Having to travel for care in this way - sometimes hundreds of miles - would be unacceptable if someone needed to have their appendix removed. But it isn't just inconvenient - the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness thinks that it increases the risk of suicide. Worryingly, the figures show that this is getting worse, and that each year more people can't get the treatment they need in their local area. As the Royal College of Psychiatrists has said, this is unacceptable. It deserves the prominence it had yesterday - and it also deserves a solution.
In his answers, the Prime Minister came tantalisingly close to this. Firstly, he mentioned the introduction of waiting time standards for mental health (which are welcome, but come years after physical healthcare had them). The problem with introducing these standards is that it's not been clear how they are going to be paid for. Although the headline amount spent on the NHS increased over the last parliament, the amount spent by mental health trusts fell by 8%. These cuts were compounded by increased demand, with the number of people being treated by services rising by 10% in the one year between 2012/13 and 2013/14 alone, and the number of detentions under the Mental Health Act reaching a record high in the same year. The government has previously stated its support for the NHS receiving an extra £8bn a year by the end of the parliament. Crucially, the Prime Minister raised the possibility yesterday of some of this extra money being spent on mental health. He now needs to go on record and say that waiting and access time standards for mental health - which the Chief Executive of the NHS, Simon Stevens, wants to implement by 2020 - will be fully funded by the government (without other mental health budgets being cut).
The Prime Minister repeatedly talked about 'needing a strong economy for a strong NHS'. There's obviously some truth to this, but we'd say the opposite is in fact more appropriate. Robust economic analysis shows that mental illness costs the English economy around £105 billion each year, although cost-effective treatments are available for many conditions. So we'd turn this on its head and remind him that you can't have a strong economy without strong mental health services.
One particular claim by the Prime Minister might raise eyebrows - specifically that there is 'parity of esteem between mental and physical health' in the NHS Constitution - the document that sets out what patients should expect from the NHS. The document itself - updated this summer - now includes the wording that 'the service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard.' As we and others said while this document was being updated, although this might be a laudable ambition it simply isn't the case at the moment. Something that could go a long way towards making this a reality however is a Private Member's Bill that Rehman Chishti MP is trying to get through Parliament, and which the Royal College of Psychiatrists strongly supports. This Bill would make it a requirement for commissioners of both physical and mental health services to think about whether they are actually meeting the needs of patients with mental health problems, and to explain how they had done this each year. Transparency in this area, combined with the funded introduction of waiting time standards, could finally see mental health services - the Cinderella of the NHS - go to the ball, and we call on the Prime Minister to support Mr Chishti's Bill.
Professor Sir Simon Wessely, President of the Royal College of Psychiatrists
Mr Gregory Smith, Policy Analyst, the Royal College of Psychiatrists