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?