This month has seen the publication of an influential new report on mental health services from the Care Quality Commission; Right Here, Right Now, describes people’s experiences of help and care during a crisis. In light of this new report, Martin Hodgson examines the state of the England and the UK’s provision of care for those in urgent need and looks at the Government’s plan of action to address some pressing issues.
Within the Right Here, Right Now report, CQC describe many examples of people in need being given strong mental health care in urgent circumstances, but conclude that far too many people in crisis have “poor experiences” due to services failing to meet their needs and lacking “basic respect, warmth and compassion”.
They state that this is unsafe, unfair and “completely unacceptable”.
Before the general election there was much talk from politicians about the urgent need to improve mental health services in England. The need for action was agreed across the political spectrum with poor mental health being identified as the largest cause of disability in the UK, and as a significant factor in associated problems such as poor physical health and problems in relationships, education and work.
Now that a new government is in place, we can take a look at the pledges made, the action taken following the election, and consider what areas mental health experts and campaigners see as priorities for action.
The state of the NHS in general, and mental health services in particular, were hotly debated in the recent election campaign as politicians responded to media reports of a crisis in mental health provision, and in child and adolescent mental health services in particular.
Perhaps most vocal before the election was Nick Clegg of the Liberal Democrats who, while still part of the previous coalition government, secured £1.25 billion of new funding within the March budget to help children and new mothers with mental health issues. The initial plan was for the money to be used over a five-year period to help treat 110,000 more children and provide rapid access to mental health treatment for new mothers.
The Liberal Democrat manifesto included allocating £3.5 billion more to mental health services and a guarantee of “equal care” for mental and physical health.
The eventual winners of the election, the Conservatives, were criticised for being vague about mental health. However, they did promise an increase in mental health spending, new waiting time standards to ensure that mental health was taken as seriously as physical ill-health, and improved access to “talking therapies” in every part of the country. They also made a commitment to ensuring that women have access to mental health support during and after pregnancy and discussed “significant” new support for people with mental health problems to secure employment.
The view of mental health organisations
The view of the UK's mental health professions and leading mental health charities on what needs to be done is set out in Improving England’s Mental Health: The First 100 Days and Beyond, published by the Mental Health Policy Group just before the election.
The Mental Health Policy Group consists of six national organisations working together to improve mental health. The document is signed by chief executives from the Mental Health Network, the Centre for Mental Health, the Mental Health Foundation, Mind, the Royal College of Psychiatrists and Rethink Mental Illness.
The organisations state that, in its view, the new government has a “historic opportunity” to make a genuine difference to the lives of millions of people with mental health problems. However, they warn that it must “turn rhetoric about improving into reality”.
The paper states that, for too long, mental health services have been “massively underfunded” and that too few people are able to access the help and support they need.
The policy group warn that the scale of the problem is considerable. It reports that:
referrals to community mental health teams rose nearly 20 per cent during the last Parliament — but that funding was cut in real terms by £600 million
by 2030 there will be approximately two million more adults in the UK with mental health problems than there are today
poor mental health carries an economic and social cost of £105 billion a year in England
the cost of mental ill-health among the UK workforce is thought to total £26 billion
people with severe mental illness experience some of the starkest health inequalities - dying, on average, between 10 and 25 years earlier than the rest of the population.
Despite public attitudes changing for the better, the expert group state that too many people still experience “stigma and discrimination” and that access and outcomes need to be improved generally, but especially for certain demographics, such as those from black and minority ethnic communities.
The policy group identify five key areas of urgent action needed.
Ensuring fair funding for mental health services.
Addressing child and adolescent mental health issues and giving children a good start in life.
Improving physical health care for people with mental health problems.
Improving the lives of people with mental health problems.
Enabling better access to mental health services.
The 100 day plan
The Mental Health Policy Group include a “to do” list in their report for the Government during its first 100 days to address these five areas. They include suggestions that the Government should take the following steps.
Make a commitment to increase levels of investment in mental health services in real terms over the lifetime of the Parliament.
Reinstate annual surveys of mental health services for adults and children and young people, reporting on national and Clinical Commissioning Group levels of investment to improve transparency.
Make perinatal and maternal mental health care an identified ministerial responsibility.
Commit to raising awareness of mental health among young people by ensuring mental health education forms an enhanced part of the school curriculum and part of training for teachers and school nurses.
Restate the commitment made in the March 2015 budget to increase investment in mental health services for children and new mothers.
Publicly state that all existing and future targets for smoking reduction apply equally to people with mental health problems.
Commit to invest in a national smoking cessation programme for people with mental health problems.
Commit to a continuation of government funding for the Time to Change mental health public education programme over the 2015–20 period.
Commit to offer integrated health and employment support to people with mental health conditions who are out of work and seeking employment.
Enable better access to mental health services by committing to a clear, transparent programme for introducing maximum waiting times for mental health services, and amending the NHS Constitution to embed these.
Commit to work with national partners to complete the local roll out of the Crisis Care Concordat — an agreement made last year between all crisis care providers — including ensuring comprehensive liaison psychiatry services are on hand around the clock in every hospital.
Beyond the first 100 days, the suggestions of the expert group include.
Ensuring all women have access to mental health support during, and after, pregnancy by committing to include measurable objectives in the first NHS Mandate following the General Election, building on the work of the Maternal Mental Health Alliance.
Taking practical steps to support schools in improving the mental health and wellbeing of primary and secondary pupils.
Developing tailored public health programmes for people with mental health problems, with a particular focus on Public Health England’s priorities of obesity, smoking, and harmful drinking.
Reviewing the curriculum for health professionals to ensure that they receive mental health training as part of their continuous professional development.
Boosting the uptake of the Access to Work scheme for people with mental health issues by publicising the scheme’s benefits among employers, Jobcentre Plus, General Practitioners and the wider public.
Addressing inequalities in access to mental health services, experience and outcomes — particularly for people from black and minority ethnic communities, homeless people, survivors of violence and abuse, lesbian, gay, transgender or bisexual groups and people with disabilities.
In addition, the group demand that the full range of recommendations made in the mental health taskforce report – due in the Autumn – are acted upon, including any recommendations the taskforce makes around investment in mental health services and research. The taskforce was commissioned by NHS England and is chaired by Mind’s Chief Executive, Paul Farmer.
The need for better crisis care
The latest CQC report on crisis care, Right Here, Right Now, published in June 2015, states that too often people in a mental health crisis have “poor experiences” of care.
The CQC describe service users’ responses on provisions that “fail to meet their needs and lack basic respect, warmth and compassion”. They describe clear variations in response times and quality and reflect that, where response times from specialist mental health services are slow or the care provided inadequate, this often puts pressure back on GP services and A&E services.
The CQC called on local providers and commissioners to ask serious questions about whether the services they provide are safe and to take urgent action to improve.
The Government has not yet completed its first 100 days, but it has responded by pointing to the range of work that is currently being done to improve services, including:
making better access to mental health services and shorter waiting times a priority
setting up a national liaison and diversion service to help identify criminal offenders’ mental health problems earlier and make sure they are getting the right treatment
improving access to services by giving local health and wellbeing boards a duty to reduce health inequalities in their area, including in mental health
making mental health part of the “national measure of wellbeing” so it must be taken into account during policy setting.
It is likely that campaigners and mental health experts will be unconvinced until they see tangible evidence of improvement. It is also likely that the consensus across political parties about mental health will see the Government pressed on honouring its pledges and seeing improvements through, including those requested in the upcoming taskforce report.
Last reviewed 8 July 2015