This is a discussion document not agreed policy.

Mental Health services are “overwhelmed” by soaring demand according to a report by the body representing community, ambulance and hospital service providers, NHS Providers (July 2017, ref 1). Demand has increased by 5-10% over the last 3-4 years, but by 30-40% for children and young people. Patients are facing long delays to access mental health care, and people too often receive inadequate treatment. The numbers of people in need of specialist post-trauma mental health services has escalated dramatically following recent terrorist and civilian disasters. These intractable problems are the result of the Conservative Government’s unremitting policy of economic austerity, the prolonged real terms reduction of NHS funding over the past 7 years, and worsening shortages of key mental health staff such as nurses and psychiatrists.

The Socialist Health Association is committed to ensuring fulfilment of repeated high level commitments to ‘parity of esteem’ for mental health, and urgent implementation of proposals set out in the cross-agency Five Year Forward View for Mental Health (February 2016, ref 2) and Five Year Forward View for Mental Health: one year on’ (February 2017, ref 3). This must be combined with the future freedom from political interference of NHS policy making and delivery.

mental health

The origins of mental wellbeing and good mental health

The SHA policy on mental wellbeing is founded on the recognition that societal factors impact significantly on the whole spectrum of mental wellbeing to mental ill-health. The effects on individuals and families of social deprivation impacting on income, debt, access to appropriate accommodation, rewarding employment and security of tenure, community and family support networks, the availability and content of education, and other factors all play their part. The physiological reactions to stress of an expectant mother with pressing social difficulties affect the developing brain of her child. Experiencing or witnessing abuse and violence in the domestic setting at an early age can have severe lifelong effects on mental wellbeing and health.

In addition to the effects of absolute deprivation, living with extreme socio-economic inequalities has an independent impact: the experience of being judged socially inferior is a chronic cause of stress with negative effects on physical and mental health. Even severe mental illnesses with a genetic component are influenced by such social factors.

‘’.. . although genetic vulnerability may underlie some mental illness, this can’t by itself explain the huge rises in illness in recent decades – our genes can’t change that fast.’ Richard Wilkinson and Kate Pickett – The Spirit Level.

Virtually every aspect of policy – economic, housing, education and training, environment, equalities, health and social care – impacts on mental wellbeing, and should be seen clearly and addressed collaboratively to serve the promotion of good mental health, personal autonomy, and full access to civil society. At the same time, responsibility for determining and delivering health and social care must be freed from the highly disruptive cycle of repeated organisational change and political interference in NHS management.

Promoting knowledge, support, and care

A general understanding of the promotion of mental wellbeing, and the way mental health problems are manifest should be promoted at all levels in society through ante-natal care, children’s centres, school and further / higher education, to places of employment, and this should be a central facet of a National Strategy for Public Health.

The vast majority of people with mental health problems, including those who need highly specialised inputs to their management, will rely on primary and community care for diagnosis and ongoing care and support. For the large number of people who have both physical health and mental health problems these are managed together in primary care. Access to social support and integrated resources can best be managed by community based mental wellbeing collaboratives bringing together service users and carers, community groups including ‘Being Well’ projects (Plunkett Foundation: https://www.plunkett.co.uk/community-controlled-care ) commissioners, voluntary sector organisations, local authority services, and primary and secondary health services.

To make these effective,

  1. The severe reduction in funding for primary care, and in particular general practice, must be reversed urgently
  2. Community based mental wellbeing collaboratives (see above) should be established in all areas, with appropriate public health support.
  3. The progressive and continuing erosion of funding for mental health services, itself the product in part of continuing real-terms reduction in funding for the NHS more widely, must also be reversed urgently and in line with ongoing rhetoric about ‘parity of esteem’ for mental health. Parity should not mean a race to the bottom for mental, physical and social health funding.

Specific SHA policy recommendations include:

  1. Parity of funding for the prevention of, treatment services and related social care for, and research into mental ill-health; and for treatments including psychological alternatives to medication; and funding to ensure research findings are applied in clinical practice more quickly. To reflect the accepted burden of disease, 23% of NHS spend should be committed to secondary mental health service provision rather than the present 13%. Funding must be ring-fenced.
  2. An integrated cross-party, cross-government National Strategy for Mental Health including public education, universal support, and clear policies for tackling the societal determinants of poor mental health, ie poverty, debt, housing need, low educational attainment, low employment aspiration and community disintegration.
  3. A new National Service Framework for Mental Health drawing on the ‘Five Year Forward View for Mental Health’ and linked to the National Strategy for Mental Health, incorporating urgent review and reinstatement of national standards for mental health service provision, including for illness prevention and improved access to services.
  4. Establishment of an Independent National Health and Social Care Service Commission to oversee the rapid integration of health and social care, and to govern a new National Health and Social Care Service in future free from party political interference.
  5. Confrontation and breaking down of stigma should be a fundamental part of mental health strategy – this requires more public information and education about mental illness, the building of community cohesion, how to help oneself, and about the principles of early intervention.
  1. Improved and better resources including mental health services in Primary Care / General Practice, funded in addition to and not at the expense of more specialised secondary mental health services
  2. Continued development of integrated services which jointly and holistically address mental, physical and social needs, especially for children, women in the perinatal period, people with learning disabilities and associated mental ill-health, people with serious mental illness, people suffering comorbid physical and mental illness, and older people with multiple physical and mental conditions and related social needs.
  3. Review and possible reversal of the ill-considered and austerity-driven dismantling of specialist mental health teams (eg for people in crisis, people with complex needs and personality disorders, assertive outreach for people with psychotic illnesses), or greatly enhanced resourcing of integrated Community Mental Health Teams.
  4. Further extension of psychological therapy services to provide more alternatives to medication, including increased provision of longer term psychotherapies for those with more complex and enduring mental health problems.
  5. Greatly enhanced services for children and young people with mental health problems (anxiety, depression, self-harm and eating disorders are increasingly prevalent), including collaborative mental health & wellbeing provision in schools and colleges, increased numbers of health visitors and school nurses, ready access to specialised mental health services (CAMHS), an increase in inpatient provision to avoid children and young people being admitted to hospital far from family and home, and specialist provision for eating disorders, post sexual abuse and other post-traumatic disorders, autistic spectrum disorders, Attention Deficit Hyperactivity Disorder, and drug abuse.
  6. Service development and further research for the identification and treatment of ill-health, and provision of integrated social care for older people with mental disorders or dementias, in domestic, community and residential (care and nursing home) settings.
  7. Substantial additional funding and improvement in health and social care services for children and adults with learning disabilities, including for autistic spectrum disorders.
  8. Urgent research and clinical intervention to reduce mortality rates for people with serious mental illness who still die 15-20 years before those without SMI.
  9. Urgent review of the escalating incidence of suicide and attempted suicide, urgent updating of suicide prevention strategies, and resources for rapid intervention and inter-agency collaboration following suicide attempts.
  10. Greatly improved cross-agency provision for people with acute mental health emergencies, including mental health / police interface services and crisis intervention services – including helping friends and families to cope. We should treat mental health crises with the same urgency and import as other medical crises.
  11. Reduction in the number of patients who are subject to Compulsory Treatment Orders, which have not been shown to benefit patients. This will require increased and improved in-patient treatment provision.
  12. Reversal of austerity-driven and counter-productive reductions in psychiatric in-patient bed numbers, including for children and young people.
  13. Comprehensive provision of integrated health and social care services for adults and children who have been exposed to significant traumatic experiences recently or in the past, including specialised psychological treatment services for those suffering from post-traumatic and related disorders.
  14. Urgent and rapid enhancement of mental illness diagnostic and treatment provision in the criminal justice system, especially in prisons for both adults and young people.
  15. Provision of comprehensive, country-wide mental health facilities with essential translation services for refugees and migrants, both in mainstream community services and in detention / removal centres.
  16. More research and sensitive provision for people who experience mental health problems as a result of exposure to stress in the workplace.
  17. Research on and more systematic approaches to evaluating the outcomes of treatments for the full range of mental health problems, including both common, episodic ill-health (eg anxiety and depressive disorders) and severe, enduring mental illnesses (eg schizophrenia, bipolar disorder).
  18. Resources for mental health services have been stretched to the point of dangerousness, so substantial additional funding, imaginative development of more integrated services, and persistent determination will be required to bring about the improvements and changes that are so urgently needed. Only a robust policy framework, freedom from repeated political interference, and ruthless commitment to delivery will achieve true ‘parity’ of esteem and funding for mental health.

References:

  1. NHS Providers (2017) ‘The State of the NHS Provider Sector’

  2. NHS England (2016) ‘The Five Year Forward View for Mental Health’

  3. NHS England (2017) ‘Five Year Forward View for Mental Health: one year on’

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5 Comments

  1. Eric Alan Leach says:

    An excellent piece.

    Some points to add:

    + There is much evidence to suggest we have an almost epidemic of mental health problems amongst teenage girls and young women

    + My direct experience is that a substantial number of GPs do not want to have to deal with the mentally ill and probably no level of financial incentive will persuade them otherwise

    + A national, continuous effort must be made to move sufferers off drug linked psychiatric programmes and onto non drug psychological programmes. More exposure of Lord Layard’s economic justifications for this is essential for this as we need 1,000s more psychiatrists

    + We have all got to imagine an NHS in which its primary role and absorber of cash is mental healthcare services and physical healthcare services are a bolt-on. No point in waking up physically well if all you want to do is self harm or killi yourself

    + NHS funds must be found/diverted to locating, training and supporting carers and carer suppurt groups. NHS CCGs and Trusts seem here in west London to be especially poor in even recognising the role or carers and signposting carer support groups.

  2. As a carer I totally agree with the reply that Eric Alan Leach has written
    in particular where he states: + My direct experience is that a substantial number of GPs do not want to have to deal with the mentally ill and probably no level of financial incentive will persuade them otherwise.

    For those patients that like my son whom have been misunderstood from birth and
    consequently they including the families never receive support and get mistreated by the NHS, because of ignorance of his condition
    (autistic/learning disability/challenging behavior) and the lack of understanding has delivered the dropping off/pushed around from one GP practice to the next this is the way General Practitioner’s work as the General Practices do not want these patients or their families, needs and expectations is created around the needs of the masses and not the few
    and General Practices work staff are not encouraged /educated differently
    because the patient is seen as a work problem

  3. dinah morley says:

    I would like to see perinatal mental health care given a stronger emphasis. At present there is a real postcode lottery in availability and accessibility of these crucial services.
    The importance of a good parent/child attachment which is the bedrock of good mental health in the child, needs to be in there.

    I would support wholeheartedly the enhanced finding of integrated patch-based M.H. teams, workjng across both in and out patient services.
    I would also like a mention of the need for research to establish why, after all the years we have known this, here is still a disproportionate number of BAME people being sectioned.

  4. Cllr Maggie Mansell says:

    I would like to see specific mention of the importance of NHS working with Local Government at local level. Councils in the shape of Public Health, Education, community engagement and Social services have a role in reducing stigma and promoting understanding of Mental Health/ Wellbeing. Councils through Planning can create environments, housing, jobs and community development to support or reduce mental wellbeing. Collaboration at strategic and personal level can make a difference for a community.

  5. Chris Mckenzie says:

    This is a great contribution, but under the section on “more investment in preventative services” I would include the role of Holistic, non medicalised Mental Health Day Services, as part of the NHS funded and integrated services, but not under it’s medical model. Instead, these services focus on non stigmatising, ‘psycho social models’, safe, creative spaces, with attention to integrated practical support, housing and welfare as well as ‘recovery’ models and therapeutic approaches. They must be non time limited but based on individual need. The closure of Day Services under the Tories and the introduction of personal budgets has restricted access and control for clients, they have not improved access and control. This model of “customer” marketisation, is a failure because it means providers compete with each other, causing friction when they could be working together, wasting valuable staff time on funding, PB bureaucracy instead of focusing on patient care and growth.

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