In the aftermath of last week’s horrific plane crash in the Alps, attitudes to mental health seem to have taken a step backwards after years of progress. We now need a more positive approach to mental illness. For the past few years, the main political parties have been trying to outdo each other when it comes to talking up what they would do to improve mental health services. They have all shown a firm commitment to NHS England’s manifesto in kind, the Five Year Forward View, which seeks to link up health and social care, shift the focus from secondary to community care, and bridge the divide between mental and physical health. So we should acknowledge that there has been progress, even if it is long overdue, in improving mental health services. Waiting times and access standards have been introduced for mental health conditions – starting with early intervention in psychosis and improving access to psychological therapies – and are set to be rolled out to cover all illnesses by 2020. Likewise, the introduction of the crisis care concordat means that in every region of England a mental health crisis is treated with the same urgency as a physical health emergency. And, beyond the world of standards and concordats, we have a parliament where the chair of the health select committee can stand up and talk about her experiences of postnatal depression which, rather than being seen as a weakness, is viewed as a testament to her character. Looking ahead, the focus on children and maternal mental health is welcome after years of neglect. This is the very essence of prevention and early intervention that we all so want to see embedded in the NHS.It is right for us, as mental health professionals, to acknowledge the courage that has recently been shown in taking genuine risks and expending so much political capital to improve mental health; it’s been an antidote to Russell Brand-style cynicism about the political classes. But having said that, permit us just a little cynicism as well.
With all the main parties emphasising the need for economic prudence if they get into power, where is the money so desperately needed to improve mental health services going to come from? Indeed, any additional investment in mental health will be against the backdrop of an 8% real terms cut to mental health trusts over the course of the last parliament, at a time when referrals to community mental health teams have risen by nearly 20%. But this isn’t just yet another plea for government funding. What we also want is some much needed accountability in the NHS in light of the 2012 Health and Social Care Act. More and more, policymakers and politicians from all sides are now belatedly acknowledging that this was unnecessary, expensive and flawed. One consequence is that, although the head of the NHS body is still functioning, other parts are not. For example, NHS England recently issued guidance for clinical commissioning groups stating that it expects them to increase their spending on mental health in real terms. In today’s NHS, “expecting” CCGs to deliver better mental health services might be the best the centre can do. That’s certainly the view of many providers. Two weeks ago, a room packed full of mental health chief executives and finance officers was asked whether they anticipated their local CCG doing the right thing and increasing mental health spending – only three raised their hands. So whoever becomes secretary of state for health, it is not enough to stand up in parliament every so often and claim “parity of esteem” for mental health has been legislated, job done. Parity of esteem must be embedded into the mindset of all health professionals, from the secretary of state for health, to local CCG commissioners, and from A&E staff to the care worker on the ground making house calls. Because ultimately, this is about ensuring that people with mental health problems are treated with the same respect and dignity as those with physical health problems. Nothing more, nothing less.
This article first appeared The Guardian, 1 April 2015.