Consultation document April 2016: Please put your comments on the Health and Care Policy Commission page by 8 June 2016 if you want them to be considered by the Labour Party Commission.  Put them below if you want them to be considered by the SHA.

The Labour leadership has made a firm commitment to making mental health a priority and ensuring that parity of esteem between mental and physical health becomes a reality. The creation of a dedicated Shadow Cabinet Minister for Mental Health in September 2015 ensures that the Government is being held to account for its actions, and also signals that mental health will be a key priority for a future Labour Government.

The Challenge

One in four of us will experience a mental health problem each year and mental health problems represent the largest single cause of disability in the UK. The economic and social cost of poor mental health is estimated at £105 billion a year – roughly the cost of the entire NHS.

Mental health affects people of all ages, from all walks of life. In 2014/15 nearly two million adults were in contact with specialist mental health and learning disability services; one in ten children and young people suffer from a diagnosable mental health condition and there has been an increase in the number of employees reporting mental health problems. Those from under-represented groups in society such as those from the Black and Minority Ethnic  and Lesbian, Gay, Bi-sexual and Transgender communities, disabled people, veterans, older people and those who have had contact with the criminal justice system are also at greater risk of suffering from mental illness.

The challenges facing mental health are immense and have been exacerbated by this Government’s failures over the last five years.

The Government committed to spend £250 million on Child and Adolescent Mental Health Services  in 2015/2016. However, we now know that it will fail to spend the full amount this year. Making sure the Government honours the mental health funding commitments they have made is a constant challenge.

Transparency in spending has been made even more difficult following the Government’s decision in 2012 to discontinue the annual National Survey of Investment in Mental Health Services, which provided information on national investment in mental health services and monitored expenditure for 11 years. Without the important measures contained in this survey, it is almost impossible to make an accurate assessment of the level of spending on mental health services. Since 2010 the situation for mental health patients has deteriorated across the board. In 2013 the rates of male suicide were at their highest since 2001; the number of people becoming so ill they have been detained under the Mental Health Act increased by almost 10 per cent between 2012/13 and 2014/15; and the number of people being forced to travel hundreds of miles for a bed has increased year on year between 2011-12 and 2013-14.

The state of affairs for children and young people is particularly poor with insufficient investment in services. Despite the fact that 75 per cent of people who have mental health problems in working life first experienced symptoms in childhood or adolescence, just six per cent of the mental health budget is spent on Child and Adolescent Mental Health Services. The failure to invest in services has meant that there are now double the amount of children turning up to A&E with mental health problems compared to 2010/11.

The number of people under the age of 18 being admitted to hospital as a result of self-harm has increased and there has also been an increase in the number of children being treated on adult wards.

The mental health of new mothers and fathers is also a real cause for concern and something which, despite commitments from the Government, we have seen little progress on. Since 2010 the number of specialist perinatal mental health units and beds has fallen, and the Government has failed to spend the full amount set aside for perinatal mental health in 2015/16, spending only a third of it.

Our mental health system is struggling due to a lack of appropriate workforce and our current workforce is under increasing pressure. We are seeing high vacancy rates for psychiatry consultant posts and for mental health nurses. According to the Royal College of Psychiatrists, more than 18 per cent of core training posts in psychiatry are currently vacant, and psychiatry has the slowest rate of growth and the highest drop-out rate of any clinical specialty. In addition, figures show that there has been a 10 per cent reduction in the number of nurses working in mental health since 2010–nearly 5,000 nurses. Staffing shortages have also meant that children are not getting access to Child and Adolescent Mental Health Services appointments, and that patients are not getting appropriate continuity of care.

Under this Government, patients are being failed. The current system is chronically underfunded and understaffed, skewed towards dealing with crises, rather than prevention and early intervention in mental health. If these trends continue, the system will be under extreme pressure by 2020. Put simply, it will be impossible to meet the needs of a growing number of people who need support from our mental health services.

The Issues

Ensuring that mental health policies work for all parts of society If we want to improve the lives of people suffering from mental illness it is vital that we ensure the system works for everybody. Mental health affects people of all ages, from all parts of society.

Making sure that our schools, colleges and universities are equipped to promote good mental health; ensuring our criminal justice system protects the 9 out of 10 people in our prisons who have a mental health or substance misuse problem; and understanding the impact that supportive workplaces, stable employment, poverty, isolation and housing can have on people’s mental health is crucial if we are to improve the lives of the millions affected by mental health problems. We do not solve the challenges facing our nation’s mental health solely from the Department of Health. In order to address mental health issues we need to think about what effect policies in all key areas can have on improving people’s mental health. Underpinning this must be a wider shift in our society’s attitudes and behaviour towards mental health, so that no-one with a mental health problem has to face stigma, prejudice or discrimination.

Prevention and early intervention in mental health

If we want to move away from a culture of dealing with mental health issues as crises, we must promote prevention and early intervention. Too often we hear of people in desperate need being turned away from services. This has been a particular problem for children and young people, many of whom have been unable to access help when they need it due to failure to meet high thresholds needed in order to qualify for support.

We need to consider how employers should be best equipped to support their employees to cope with work related stress.

Ensuring people have access to help early on, including through adequate funding to public health, is critical to preventing people from becoming more ill. Many people suffering from mental health problems are not getting the help they need at an early stage and it often means that help will only be offered when the situation has reached crisis point (for example, a suicide attempt).

If we are to ensure our services are sustainable into the future, we must do so much more to prevent people from becoming ill in the first place and here we must look to our places of learning, our workplaces and our communities.

Guaranteeing parity of esteem in mental health services

If we want to achieve parity of esteem between physical and mental health, we need to ensure that mental health receives sustainable, long term investment.

According to NHS England’s mental health taskforce report, The Five Year Forward View for Mental Health, just £34 billion is spent on mental health support and services each year, across all Government departments. Poor physical and mental health are often connected, yet are more often than not dealt with independently of one another. Despite the fact that mental health problems account for 23 per cent of the burden of disease in the United Kingdom, spending on mental health services account for only 11 per cent of the NHS budget.

In 2011/2012 investment in mental health fell by £150m. This was the first fall in investment since 2001. Analysis by the King’s Fund also shows that 40 per cent of mental health trusts experienced reductions in income in 2013/14 and research by Community Care and the BBC last year showed that funding for mental health fell by eight per cent in real terms over the course of the last parliament. These figures show that the Government is failing to ensure mental health is placed on an equal footing with physical health.

Furthermore, if we want to achieve real parity of esteem between mental and physical health we need to make sure we have a mental health workforce that is ready to cope with the challenges it is presented with. Adequate staffing levels, awareness and training across the health service are key.

Questions

  • In your view which Health and Care policies and key messages in the last manifesto most resonated with voters? Which policies did not resonate so well? Was there anything missing from our policy offer to voters on this issue?
  • Given that half of all mental health problems begin by the age of 14, what steps should be taken to improve early intervention in mental health? What other measures can be taken to transform our current mental health system from one driven by crisis to one focussed on prevention?
  • How can we ensure that parity of esteem between mental and physical health is achieved? How do we guarantee that mental health receives its fair share of funding?
  • How can we best identify and address the root causes of mental distress in our society? What measures can we take to promote awareness of mental health in our society and ensure it works alongside policies in other areas? What action should be taken to ensure that those groups which are at greater risk from suffering from mental health problems in our society are given the help they need?
  • How can we share best practice across local/ devolved authorities in policy development?
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11 Comments

  1. Graham Brack says:

    For brevity, I’ll just make statements but happy to expand on them if necessary.

    1. Mental health is a long term condition like diabetes, asthma and arthritis and should be treated as such, not as a succession of unconnected crises. If we can get mental health accepted as a long term condition it will change how commissioners look at it.
    2. The block contract is a system that curtails innovation, because you’re only paid for what you’ve already been doing, not to widen or deepen services, but it’s far too prevalent in mental health commissioning.
    3. We mustn’t let the dialogue contrast mental and physical health because they’re not separate. Mental health impacts on physical health, but the physical health of mental health patients is generally very poorly cared for. Some mental health teams have no staff with recent physical healthcare experience.

    1. Stephen Musk says:

      Mental health is often not just a long term condition but a lifelong condition. As such the pernicious “Recovery Model” troubles me greatly. It is a bogus model aimed at ‘recovering’ service users out of case-loads, out of sickness benefits and into shelf-stacking, regardless of their actual state of health.

      1. Martin Rathfelder says:

        Is that not at least partly because of the way it was treated. If we are going to have real parity of esteem then we should be looking to cure mental illnesses as we do with physical illnesses, or at least helping to live with their illness. Having a job is not the answer to every problem, but it helps with quite a lot.

        1. Stephen Musk says:

          Parity of esteem (and funding!) are worthy goals but there is an ‘elephant in the room’. Whilst there is general agreement amongst care professionals when it comes to the diagnoses and treatment of physical illnesses, there is no such thing when it comes to mental problems. The believers in the biomedical model are at loggerheads with those who support the psychosocial model whilst the critical psychiatrists are a throwback to the antipsychiatrists of the sixties. Speaking personally, each model has some relevance to my illness but there appears to be little co-operative working between followers of the different theories. As usual, I despair, longing for the day when psychiatrists and psychologists work together rather than waste my life in taking pot shots at each other.

      2. “Recovery” is a contested concept: I prefer to think of it as making each day a little bit better than the last, rather than it being seen as ‘shelf stacking’. That could be construed as quite a stigmatising (or self-stigmatising?) view. The reality is that after the first episode, roughly one third of people with a long term mental health problem will return to full time employment with no major issues; roughly a third will be in and out of employment; and roughly a third will remain unemployed for the rest of their lives. The important idea about the recovery model is it seeks to understand why some of these people have a more successful recovery than others. I would have thought that finding out what works is preferable to the sort of laissez faire crisis management we are used to?

  2. When I was first diagnosed I was told that I had a lifelong condition, then a few years later it all changed when we (mental health service users) were told that we would recover.
    I may have misunderstood the comment above, but surely many physical illnesses are also lifelong eg diabetes and asthma.
    Regarding having a job the last 3 times I was employed I lost the jobs because of my mental illness, that has not given me the confidence to keep trying. I have a couple of friends with serious mental health diagnoses who have spent years looking for work with no luck. They are looking for things like shelf-filling or washing up at a burger joint. On the odd occasions they have been taken on, the jobs don’t last more than one day.

  3. Karen Newbigging says:

    Poor mental health is strongly linked to socio-economic inequalities and framing it in a biomedical discourse and linking to improving access to services is a limited approach. Whilst lobbying for additional investment in mental health is important, there needs to be a much stronger focus on addressing inequalities and the risks (particularly violence and abuse), on the early years, which provide the foundation for mental health, and on the role of peers and the voluntary sector and community organisations. There needs to be concerted action to promote people’s rights and to co-design a system that does not provide treatment under compulsion.

  4. More effort needs to be given to prevention, particularly in the early years and at schools. There is some evidence to suggest delays in school readiness are getting worse. Abilities in e.g.language, toilet training etc are likely to reflect broader parental investment with subsequent implications for emotional/behavioural/cognitive health.

    At secondary school level, bullying seems to have become endemic, particularly among girls, with associated rises in depression and anxiety. There seems to be huge variation between schools and LAs in their responses to preventing, intervening and managing bullying (perhaps because of a reluctance to label behaviour that really hurts – e.g. collectively not ‘liking’ a girl’s facebook status – as problematic. And yes, it seems really trivial but when you are 14-15 years old, you are desperate for friendship and validation).

    So, I agree with the statements made about promoting better mental health in schools etc. Where I start to worry is in the idea of ‘parity’ between mental and physical health in the NHS. The statement that we ‘only’ spend £34 billion on mental health rather skates over the fact that £34 billion is a lot of money! Mental health is the BIGGEST programme budget category in our health service. We spend more on this (though, given the parlous state of our mental health services, I can’t really understand why) than on cancer and cardiovascular disease.

    If parity is taken to mean parity in funding, we are going to have to divert resources away from these kinds of areas. Is that what we really want to do? As well as medicalising problems that perhaps merit social and economic interventions, we would be totally abandoning the idea of a health care system that is fit to deal with the range of chronic, degenerative diseases that inevitably come with ageing. This would set us apart from virtually every other health care system in the world!

    I think we need to start thinking outside the NHS box but the many references to parity keep on bringing us back into it. I worry that ‘deep end’ GP practices are deemed to need more and more funding when a better use of money would perhaps ensure that the people who are taking up a lot of time in deprived practices (and who have multiple social, emotional, economic, relationship, substance misuse problems etc) are given support by financial advisors, social workers, educators; people who are help them to develop their capabilities (I really like Sen’s understanding of what poverty means). Similarly, we need to start taking dementia seriously – but while that does mean early diagnosis, prescribing for mild-moderate dementia, ensuring that other illness are not overlooked, the area where support is really lacking is in the community.

    Sorry for the long rant. However, this parity issue does seem like a red herring to me.

  5. Mohammed says:

    Mental Health is a long term condition, NHS medicines should be exempt (as it is for people for diabetes).

  6. In your view which Health and Care policies and key messages in the last manifesto most resonated with voters? Which policies did not resonate so well? Was there anything missing from our policy offer to voters on this issue?

    UKIP had a strong message on the NHS “If you want to save the NHS we musy get out of the EU”. The people who needed to know soon found out that the EU wants/ed to end the NHS’s monopoly on healthcare (provision rather than regulation I think) in the UK. The UK Labour Party had/has a strong “Remain in the EU” agenda; this contradicts/ed their “Repeal the Health and Social Care Act” agenda. Therefore, although the polling on the NHS was good for Labour, the detailed arguments had very little resonance with those who needed to know. What is missing from the Remain in the EU agenda is a vision of the EU as a redistributive system, and the construction of an EU-wide welfare state. This is the only tangible answer to the ‘economic migrants taking all our benefits’ and ‘no more refugees’ rhetoric. It would also opem the door for welfare funding to follow migrant workers across national borders and be used to fund refugee camps on the EU borders with troubled states. In addition, voters real problems are mainly with access to and quality of GP consultations and A&E waiting times. The whole primary care system should be redesigned to be more like CMHTs with GP’s becoming more like ‘Community Consultants’ and District Nurses, Social Workers, OT’s, Physios, etc. leading on two different sorts of teams, crisis teams and recovery teams, both with more of an emphasis on visiting people in their own homes and doing one-stop-shop holistic assessments and referrals. Both of these new teams would require different sorts of ‘virtual ward’ systems but this sort of technology is becoming more and more available.

    Given that half of all mental health problems begin by the age of 14, what steps should be taken to improve early intervention in mental health? What other measures can be taken to transform our current mental health system from one driven by crisis to one focussed on prevention?

    Many of the more serious mental health problems have higher genetic loads. It should be mandatory to collect genetic specimens of anyone who is being put on a psychiatric drug so that a database can be compiled for future scientific analysis of their therapuetic effects and dangerous side effects. This would transport psychiatry into the modern age. As knowledge of the interaction between genetic inheritence and social environments builds up over time it should be possible to disentangle the behavioural aspects of psychiatric illnesses, e.g. alcohol related violence, from their genetic predispositions, e.g. the predisposition to engage in risky and sensation seeking acts, as they are passed down across the generations. This knowledge could then also be used in the prevention and detection of crimes such as domestic violence, child abuse, substance misuse, and/or tackle social problems like long term unemployment in deprived communities.

    How can we ensure that parity of esteem between mental and physical health is achieved? How do we guarantee that mental health receives its fair share of funding?

    Poor mental health in the workplace costs our economy billions of pounds; the health and safety executive have suggested to me privately that most sources of unnecessary interpersonal stress that they are reported in the workplace can be classed as ‘bullying’; therefore, the laws against bullying should be tightened and people who are responsible for bullying should be shamed in the national press as part of a campaign to improve our attitudes towards mental health. The money that is retrieved from successful prosecutions should be used to pay for the recovery of those who have been made ill by it.

    How can we best identify and address the root causes of mental distress in our society? What measures can we take to promote awareness of mental health in our society and ensure it works alongside policies in other areas? What action should be taken to ensure that those groups which are at greater risk from suffering from mental health problems in our society are given the help they need?

    I believe that mental health care should be about collaboration between patients and staff; this should be as true on the inpatient wards as it is in the academic research labs. Much more funding of the social sciences is needed in our UK universities to support the great work that is being in/through the Recovery Colleges. Recovery should be about knowledge generation that can be recycled back into the system to improve outcomes. Care should not just be about Consultants prescribing medications that patients refuse to take as soon as they are beyond the reach of the authorities. Section 117 rights should be invoked far more often; and the link between mental illness and crime in our communities and probation/prison systems needs to be understood in more detail.

    How can we share best practice across local/ devolved authorities in policy development?

    New Labour did a lot to make public services more democratic in the board room but the reforms did not go far enough. The advent of Health Watch has opened the door to more public representation in the community health sector but this has not helped the integration of marginalised groups. More ‘Communities of Practice’ should be formed where expert opinion and support can be sourced for anyone in need. Long term conditions require long term solutions, like expert patient groups, recovery colleges, respite centres and informal drop-in groups. This could happen through the local charity networks (as they are mostly categorised by the long term conditions they champion) with the support from academic and healthcare institutions where required/if possible (most charities already have connections to these sorts of organisations as part of their campaigning arms).

  7. Ian Gourlay says:

    Mental Health is Long Term . Drugs tend to aim at a Balance . In our experience they leave the user in a a Depressed Mood not able to enjoy or cope with life.

    This causes problems with family who do not understand and immediate family who have to cope with problem and often find themselves also cut off from normal Social Life.
    Because of Pressure Mental Health Professional discharge patient from their care as far as they are concerned they can stay on the same old useless drugs forever.
    Blame shift to family often takes place

    We do not need need protocols different theories we just need a Mental Health Service that continues to try and resolve the problem its that simple

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