Now or never : a systemic investment review of mental health care in England

A report for policy makers identifying the systemic challenges facing the mental health sector, and offering solutions and practical cost savings.
Nick O'Shea

29 July 2021

Read Now or never External link icon

This report responds to the challenge facing policy makers – how to enhance, treat and improve the nation’s mental health. The mental health consequences of the pandemic mean reflecting on this has never been more important. As with any system, there are challenges and areas for improvement. Money is not the only answer. How and where it is spent also counts. This report identifies the systemic problems, substantiates them, and describe solutions with cost savings. 

Key points

  • There is an opportunity for integrated care systems to create a simpler investment mechanism where areas can plan for population health in a new and logical way. To do this, they must integrate mental health care alongside physical healthcare.
  • The return on investment is highest for interventions which improve and enhance mental health. There are significant opportunities to fund greater preventive healthcare by reducing spend on supplementary acute care, such as delayed discharges.
  • Digital technology is one way to enable the NHS to meet rising demand, it expands choice rather than replacing in-person treatments. But it must be accompanied by practical freedoms for staff, such as being able to work for multiple NHS trusts at one time. 
  • Staff are the NHS’s biggest asset. Exhausted by the pandemic, there is a need for a well-resourced strategy for mental health which commits to providing the equivalent cost of a 1 per cent increase in absenteeism for clinical treatment to help them to recover.
  • Information governance presents a golden opportunity to understand how patients use healthcare and would be an efficient alternative to paper-based records. Being able to identify groups of patients with high treatment costs and poor outcomes would enable alternatives to be offered. 
  • The absence of an outcomes framework across the mental healthcare system means government cannot measure value for money, return on investment or compare different treatments. Many frameworks have been designed but none have been adopted at scale.