Mental health network

Mental health: Vital next steps on the path to parity | Sean Duggan

Sean Duggan

It is not by accident that it feels as though there has been genuine and meaningful engagement with the mental health sector in the development of the long-term plan.

A dramatic step-change has occurred in recent years in how the public and politicians view mental health. The Five Year Forward View for Mental Health was a crucial step on the long journey towards parity of esteem and has implemented tangible improvements to services which have improved the lives of patients.

The quality and maturity of relationships, positive partnership-working and on-going conversations between various parts of the mental health system means that considerable consensus already exists around what the next steps should be.

The Five Year Forward View for Mental Health prioritised certain areas for improvement – it was ambitious, but it also needed to be realistic about the pace of increasing access and improving services.

The long-term plan and the related funding settlement provide an opportunity to go even further with our ambition, to focus on areas that were not prioritised in the previous five-year plan and to significantly rebalance the funding disparity that exists between physical and mental health.

The Treasury has confirmed funding for mental health “will grow as a share of the overall NHS budget over the next five years.” This is welcome news, and a vital step on the path to parity.

But we must be realistic about what we can achieve after years of financial constraints. While demand has been rising, research from the Royal College of Psychiatrists shows that when you allow for inflation, 62 per cent of NHS mental health trusts reported a lower income in 2016/17 than in 2011/12.

It might be tempting for NHS England and NHS Improvement to direct the extra funding towards reducing the acute sector deficit, yet it is also important to remember the mental health care deficit. For those people experiencing severe and enduring mental illness, the figures are stark. It is not right that, in 2018, 60 per cent of people with bipolar disorder and nearly 20 per cent of people with a psychotic disorder are not getting the treatment and help they deserve.

Mental health treatment does far more than treat mental health problems. It reduces inequalities across society. It improves people’s life chances and it increases life-expectancy. It is not acceptable that the life expectancy gap between those with severe mental illness and those without is growing.

Our members tell us that the focus in the short-to-medium term must be on strengthening core community mental health services for people with severe mental illness, as well as improving services for children and young people. We are pleased to see strong signals emerging that these priorities will be reflected in the plan.

New types of services for children and young people come with challenges around staffing, commissioning and safeguarding, while traditional services for people with severe mental illness, such as adult inpatient wards and community mental health teams are under severe and continued pressure.

We have heard of occasions where there has not been a single adult inpatient bed available in England. Behind such troubling stories are extremely ill people being denied a hospital bed due to capacity issues.

We know that “more beds” is not a silver bullet to the problems that patients face when trying to access good-quality mental health care. Adequate resources for high-quality, multi-disciplinary teams providing support is the community is also required. These services will keep people well and out of hospital.

Adequate resources for high-quality, multi-disciplinary teams providing support in the community is also required. The third sector have an important role in delivering services like crisis cafes, which help keep people well and out of hospital. 

However, improvements in services can only be delivered if you have the workforce and estates to deliver them, and if the wider societal context also supports recovery of people with mental health issues.

The mental health sector faces some of the worse vacancy rates across the whole NHS, with an estimated 20,000 positions currently vacant. Alongside the long-term plan we need a workforce strategy that is truly developed in partnership with sector, that is ambitious but realistic and opens new pathways into roles in mental health. It is time we started to capitalise on the populations’ – especially young people’s – growing interest in mental health and open more avenues into careers.

There is also a good and growing body of evidence that non-traditional roles in mental health such as peer support workers can provide more patient-centred care and help support recovery. 

We must also be aware that the financial settlement does not include spend on capital, social care or public health. Adequately resourcing these areas is necessary if we want to keep people well and improve chances of recovery. Facilitating improvement in innovative digital mental health solutions is also vital. 

The government must also look wider than the Department of Health and Social Care. Education, housing, welfare and the criminal justice systems all have a significant impact on peoples’ mental wellbeing. If we want people to stay well, access services when they need them and have the correct support in place to recover then a truly cross-governmental approach is needed.

Sean Duggan is chief executive of the Mental Health Network. Follow him on Twitter @SeanDugganMHN and the Mental Health Network @NHSConfed_MHN

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