Back in the autumn it felt that finally mental health was the issue whose time had come. There was a steady stream of announcements. Perhaps the most symbolic was Nick Clegg’s unveiling of the coalition government’s mental health strategy for the next five years at his own party’s political conference. This marked a significant shift – introducing the first access targets for mental health services: psychological therapies, early intervention on psychosis and standards for the provision of liaison psychiatry and the announcement of more money. This, along with the creation of a cross-government cabinet task force on mental health, a child and adolescent mental health services (Camhs) taskforce and select committee report, meant investing in and understanding this important part of health and care was in everyone’s minds. Parity of esteem was the “phrase that pays”, rightly used by politicians at every turn. What I want to see for 2015 is for us not to simply dismiss this as rhetoric. Rhetoric is actually a vital tool: in this case communicating the need to deliver parity between mental and physical health as well as the need to tackle the far-reaching stigma surrounding mental health. So let’s seize the rhetoric, identify the core intention of the announcements and make sure that our focus is on implementation, otherwise an important opportunity will be lost.
2015 is the year to reverse the chronic underfunding and structural discrimination we’ve seen in mental health over the past decade. I think we need five things to happen:
A mainstream approach to mental health
There needs to be a widespread understanding that investment in mental health provision is investment in the health and wellbeing of individuals, and a solution for mental health is a solution for the whole healthcare system. Highlighting the importance of treating mental health in every arena, setting and interaction is fundamental, as is recognition of the contribution that good mental health makes to our workforce and economy.
It is not new knowledge that mental health conditions make up 21.9% of the disease burden in the NHS but receive only 11.9% of the overall budget. If we are serious about parity, this means turning the recent investment of political capital into a financial return for these services. That’s new money. Any other approach will be robbing the Peter of other health and care services to pay the Paul of mental health, and that’s always counterproductive.
A payment system for mental health services that is fit for purpose
I’ve been working in healthcare since 2007. A tariff for mental health services was a priority then. Too little progress has been made on payment systems to support providers of mental health services that are facing the same rising costs, rising demand and financial challenges as other healthcare providers. The current block contract approach, and the lack of multi-year planning and funding frameworks, do not give mental health providers the tools and confidence they need. These factors, coupled with the new access targets for some mental health services, make this a priority. I don’t want the administration elected in May to be the third successive government to fail to bring this to fruition.
Using access targets to improve quality, not as an end in themselves
Philosophically I don’t agree with the principle “it only counts if it’s measured”. Pragmatically, however, I believe that creating these access targets puts mental health services centre stage. The nub of this is to ensure they are used to improve quality, not as an end in themselves. That means targets that are agreed by all those involved in delivering and commissioning services, sensibly constructed, and whose implementation is fully costed and funded. And we must be alert to the unintended consequences; it can be too easy for investment and service decisions to be skewed to meet national targets rather than local priorities.
Achieving structural parity
Structurally, mental health services operate at a disadvantage. There is significant variation in the quality of commissioning across the country and in the level of spend. This translates into a postcode lottery in terms of availability and sustainability of services, which needs to be addressed. The cuts in local government budgets only compound this, creating even greater demand for NHS mental health care. And we need to reinvest in good-quality research and data collection so that we can drive transparency in the quality of provision and enable accurate commissioning of comprehensive mental health care services. Here’s hoping we can tick these off the list by the end of the year.
This article first appeared The Guardian, 20 January 2015.