Will the NHS long-term plan solve the decades of underinvestment and lack of services in mental health? Probably not, says Dr Phil Moore, chair of NHS Clinical Commissioners’ Mental Health Commissioners’ Network, but, he continues, it will help us move forward and step up the pace of change.
As a mental health commissioner, I am delighted that mental health features prominently in the NHS Long Term Plan (LTP). We know that mental ill health is ubiquitous in our population, with 1 in 4 adults, 1 in 8 children and young people aged 5-19 years experiencing a diagnosable mental health problem. The impact of having a mental health problem can be immense and wide-reaching. People with mental health problems often experience a range of negative outcomes such as poor housing, unemployment, stigma and discrimination, and serious inequalities with regards to accessing mental health support. Sadly, this is more evident in some groups such as BAME, LGBT+ and others. Unless we address these underlying issues, we cannot hope to reduce the need for specialist mental health services, and we are storing up problems for the future.
While many of the wider determinants of health may be outside the immediate control of clinical commission groups (CCGs), the LTP does highlight the need for prevention, which can only be achieved through joint work with local authorities and public health. This is why mental health requires a system-wide response. Numerous policy documents have set out the need for integrated care and the current move to integrated care systems could well be what the mental health system needs to make it truly effective. There is a central role for clinical commissioners to lead system change as we work in and understand the health needs of our communities.
Welcome boost for crisis services
I am particularly pleased to see a commitment to improving mental health crisis services in the LTP. Last year, NHS Clinical Commissioners’ Mental Health Commissioners’ Network, which I chair, jointly hosted an international summit with RI International, bringing together leaders in the field to find solutions to improve urgent and emergency behaviour healthcare or crisis services in both England and the USA.
The conclusions from the summit will be familiar to anyone who has been involved with mental health services – that services are not always fit for purpose and that a fragmented and siloed approach to care, inequality of access, and lack of support for ongoing needs are key issues. It was perhaps more surprising to learn that the challenges we face in England are very similar to those faced across the Atlantic. An important thread running through all the conversations was that this is a system-wide issue and isn’t just about mental health services. We need to get away from siloed thinking and work collaboratively with other parts of the system such as the emergency services, and with patients and their family and friends.
Collectively, delegates at the summit developed ten recommendations that we have been calling on NHS England to include in the LTP. I am very pleased to say that many of these featured in the plan. From specialist mental health support being available through NHS 111 and better mental health liaison services to new mental health crisis transport and an increase in alternative forms of provision such as sanctuaries.
Turning a plan into action
We are never short on good policy ideas in the NHS, but we are sometimes short on action. Often this is because we lack appropriate investment to properly implement these policies, and the LTP is no different. We welcome the additional investment and NHS England’s proposals over the past few years to ensure that all CCGs meet the Mental Health Investment Standard (MHIS), but these need to be seen in the context of the huge financial challenges that CCGs face. To invest in mental health often means money cannot be spent in some other area of need, so CCGs must make difficult decisions about the best use of the limited NHS pound. As mental health commissioners, we have a big task to continually make the case for that investment.
Clinical commissioners have a vital role in driving forward mental health care and collaborative working across the system, which is why I have been pushing for a coherent plan to develop mental health commissioners across the country, similar to the successful programme for children and young people’s commissioners, so that our skills and confidence can be increased across the whole system. Developing commissioners will result in better commissioning, which will in turn mean better services for patients.
Although the LTP is a welcome plan with much promise, it will only be realised as commissioners make the case – locally and at system level – for radical change to improve the support for those with mental health challenges.
Dr Phil Moore is the chair of NHS Clinical Commissioners’ Mental Health Commissioners’ Network, and is also deputy chair (clinical) at NHS Kingston CCG. You can follow him on Twitter @DittonPhil