Mental Health Matters: Out of sight, out of mind

The nation’s mental health is getting worse, but the government would rather not worry about it, or so the 10-Year Health Plan would suggest.

According to NHS England’s recently published Adult Psychiatric Morbidity Survey, poor mental health has become more prevalent since the pandemic, with one in four people now reporting anxiety or depression, and people in deprived communities or with physical health problems are much more likely to also suffer with their mental health.

Signs have been gathering for some time that the Labour government does not see mental health – or learning disabilities – as a priority. The signs were there in its general election manifesto, the stark removal of planning guidance targets, and the battle over the mental health investment standard.

Now the absence of any substantial mental health proposals in the 10-Year Health Plan makes the deprioritisation even clearer.

It leaves the sector without any vision or focus for improvement efforts, and without the dedicated national resourcing of the past few years.

Especially within integrated care boards, as they work out how they can get by with half as many staff, attention is being turned elsewhere. There is much concern that the progress of recent years will be lost. 

The policy proposals for mental health in the plan are all sensible. But much like the rest of it, delivery detail is lacking.

Some are a continuation of current work, like expanding mental health teams in schools and colleges. But unlike 2019’s NHS long-term plan, there was no mental health chapter, and no sense of how it dovetails with other services.

A diagram of the 10YHP’s operating model, from page 77 (see the image at the end of the piece), is telling about how government now sees the NHS landscape: There are no mental health providers (nor other specialists) – only “neighbourhood health services and acute health services”.

Yet the plan does not explain how the myriad dedicated mental health services are meant to evolve into this simple neighbourhood/acute split.

A significant pledge, and for some the most controversial proposal for mental health in the 10YP, had already been announced in the government’s urgent care strategy: the rollout of “mental health A&Es”, or mental health crisis assessment centres. It was also the only one with money attached.

The UEC plan confirmed around £600,000 per system (£26m total) would be available to “support systems that can demonstrate they can invest in crisis assessment centres in the year ahead of this winter”. The 10YHP said there will be around 85 “meaning there will be one co-located [with] (or very close to) 50 per cent of existing type 1 A&E units”.

With accident and emergency waits often running into several days for mental health crisis patients, and a number of warnings from coroners, something undoubtedly needs to be done. But there are concerns about separating mental and physical health, when often patients present with complex problems across both.

For some, a therapeutic space away from the noise and bright lights of A&E will be much better, but others will still need support in the standard A&E, which means proper mental health staffing will be needed across both.

It also does not tackle the need for the crisis and long waits – often a lack of community care, a lack of beds due to poor flow, which itself is worsened by a range of factors, especially housing (something largely outside the gift of the NHS).

Hopeful pilots

There was, at least, a clear recognition in the plan of the need for a better 24/7 mental health offering for people in crisis, with a promise to “transform mental health services into 24/7 neighbourhood care models”.

There were no specifics, but this likely refers to six NHSE-funded pilots, launched at the end of last year and running for two years. They will offer clinical care and support as well as expertise to help with other issues such as housing.

As pilots, there is the fear that the money will stop, the good work may be lost. Speaking at HSJ’s Care Closer to Home Forum event last month, James Duncan, CEO of Cumbria, Northumberland, Tyne and Wear Foundation Trust, described how it is refurbishing an old Halifax branch in Whitehaven, to host a “Hope Haven” pilot. It has been purchased by the NHS and given to charity Whitehaven Community Trust.

Mr Duncan said he hoped this would future-proof its role in the community, and that the trust wanted to continue to fund the work, acknowledging it wasn’t expecting national money beyond the two years.

The plan also says it wants to ensure “100 per cent national coverage” of assertive outreach services “in the next decade” – a drive prompted by the catastrophic events in Nottingham in summer 2023.

Assertive outreach coverage is distinctly patchy, as shown by examples like Surrey and Borders Partnership Trust, which says it is unable to roll out the service due to lack of money.

Trust medical director Emma Whicher said despite the lack of a dedicated team, it was still working to identify individuals who “would benefit from this level of outreach”, and plans to support them with existing teams.

Its situation is certainly not unique. NHSE has carried out an audit, but not released the findings.

Andy Bell, CEO of the Centre of Mental Health, stressed assertive outreach services must be fully resourced and well connected with other local services. “This cannot be done without adequate investment and the necessary workforce,” he said.

On top of the 10YHP, there remain real concerns in the sector that the mental health investment standard is still hanging by a thread. Wes Streeting is said to still be keen to scrap it for the future, despite his U-turn for 2025-26.

When asked by HSJ, the Department of Health and Social Care said it expected all ICBs to meet the MHIS for financial year 2025-26, but refused to comment on speculation about future funding decisions.

It seems something of a contradiction that a new mental health plan is reportedly in the works. Without investment and clear thinking on delivery, there are fears it will be the same as the 10YHP: commendable ideas, but toothless.