The world of mental health is changing. National policy is that there should be parity of esteem between mental and physical health meaning, at its simplest, that someone seriously mentally ill should be treated as rapidly and effectively as someone having a heart attack or stroke. The government has promised an extra £2.3bn and published a five-year implementation plan for England. Celebrities are talking about their own experiences, leading employers are taking action, and the Wellcome Trust is funding new research.
But does all this change mean services and mental health are benefiting? There have undoubtedly been improvements, but we have a long way to go and there are obstacles to be overcome.
There are now perinatal mental health services everywhere in England, fewer patients are being placed in units far from their homes and the Mind Workforce Wellbeing Index is showing clear improvement. There is progress being made. But looking ahead there are big risks inside and outside the NHS. There is an inevitable time-lag between the announcement of new funds and widespread and visible impacts. Staffing is the biggest risk, with the NHS needing to train and recruit 27,500 more health workers to deliver on the plan. Brexit brings the additional risk of staff shortages across the health service. All of this means there is a chance that raised expectations will not be met.
The NHS can’t do all this by itself. Local authorities and the voluntary and private sectors are involved in the plan and there is renewed political commitment to social care, which will help. However, there are other deep-seated problems in other services. Five years ago, I led a review of adult admissions to mental health institutions, and found that a fifth of inpatients were admitted because there was no alternative in the community or, having been admitted, no provision for them on discharge. The lack of suitable housing was one of the biggest problems.
Cuts in community services and changes in welfare benefits have made it harder for people with long-term mental health problems to live independently and, the evidence shows, damaged mental and physical health. Moreover, the widespread use of permanent exclusion from school leaves many children very vulnerable. These major problems will undermine progress if they are not tackled firmly.
"Staffing is the biggest risk—the NHS needs to train and recruit 27,500 health workers to deliver the government’s plan”There are other underlying issues to be resolved. There is a new and positive narrative developing, although some experts fear it is still only skin deep. Language itself is an issue: with terms like mental health, wellbeing and mental illness being used in different ways, sometimes confusing sadness and unhappiness with clinical depression and anxiety. There is also a need for more research evidence on what has the greatest impact, along with the continuing development of best practice.
Success will require passionate advocacy and sustained political will over many years. But, importantly, there is a plan shared by leaders across the whole field and a truly impressive build-up of momentum and energy. That is a good position from which to implement change.
Now read Tom Clark—we've faced it, now let's fix it
