Action to implement the government’s No Health Without Mental Health strategy is long overdue, says Sean Duggan
As the nation got through “Blue Monday”, the deputy prime minister set out a 25 point action plan to improve mental health support and get us closer to “parity of esteem” in the NHS. The plan, entitled Closing the Gap, brought together existing commitments and new proposals for actions the government, the NHS, local authorities and others need to take over the next two years to implement the strategy No Health Without Mental Health.
‘How can CCGs be held to account for how much they invest in mental health care if we do not even know what they’re spending?’
Recent weeks have also given us plenty of reminders of why action to implement the three-year-old strategy is so important and overdue. Just days before the action plan was published, HSJ revealed that Monitor has asked mental health and community services to make savings 20 per cent in excess of those expected of acute hospital trusts. This decision risks exacerbating, rather than rectifying, the “institutional bias” against mental health that the minister for care services rightly identifies in the NHS today.
Lack of accountability
This situation is not helped by the decommissioning of the national survey of investment in mental health services for adults and the continued absence of any reliable indicator of spending on children’s mental health care.
How can clinical commissioning groups be held to account for how much they invest in mental healthcare if we do not even know what they’re spending and how it is distributed between different types of support for different groups of people?
The importance of investing in children’s mental health has been underlined especially strongly this week. An important new YoungMinds campaign, for example, highlights the pressures young people report, from pressures at school to relationships and body image.
A new report from the Centre for Mental Health reminds us once again of the significance of behavioural problems to a child’s life chances and the importance of parenting programmes to help put this right.
Rebalance the NHS
There is much in Closing the Gap to welcome and support. The pledge to introduce waiting time standards for mental health services, for example, could help to improve people’s experiences of getting help when they need it. If we can learn from the experiences of other health services in introducing access standards we can ensure that new entitlements help people get the care they need more quickly and efficiently.
‘Achieving parity of esteem between physical and mental health will be the work of a generation’
Action to improve crisis care and treatment on acute inpatient wards is also vital. Wherever a person seeks help in a mental health crisis they need to know that respectful and effective care will be offered quickly. From liaison psychiatry teams in general hospitals to peer support workers in psychiatric wards, there is growing evidence of how best to offer good crisis care that supports mental and physical health recovery from the start. The challenge now is to enable commissioners and providers to work together to put in place the interventions that work in every part of the country.
Achieving parity of esteem between physical and mental health will be the work of a generation. It will take concerted action from politicians, campaigners, commissioners and providers of services for many years to rebalance the NHS alone.
Closing the Gap must be a staging post on the way to parity, and not a rear-guard effort to prevent existing disparities from getting even bigger.
Sean Duggan is chief executive at the Centre for Mental Health