The asylums have long since closed - we need to maintain the pressure for better care so people with mental health problems can lead productive, positive lives
Mental health has come a long way since the old asylums, and that momentum must continue to enable more people with mental health problems to lead the lives they want. The advent of New Horizons, the mental health strategy launched this week, has been an opportunity to consider the achievements built on the national service framework for mental health. It has been a time to celebrate developments barely envisaged in 1999 and to look forward to the next decade’s challenges.
Aspiration and talent is being wasted and surely no economy can afford that level of lost contribution
As I retire from full time work, I have been prompted to think back over 35 or so years in the mental health world.
As a keen community health council member in the 1970s, I saw the old asylums in their last phase. Many things shocked me: the lack of privacy, with beds divided by a curtain that did not touch the floor, great distress, isolation and a desperate lack of hope or expectation for an ordinary life. This kind of experience prompted many of us to work for good local mental health services.
Closing the large asylums was a movement to create better mental healthcare in people’s own communities, avoiding the dreadful effects of institutionalisation. It was also a way of spending money differently - some said it was doing it more cheaply.
Another movement began in earnest in the 1970s - the service user or survivor movement. While some professionals and health activists supported it, it was the authentic voice of user experience that gave strength to their call for change. That voice has continued to advocate strongly for improvement and continues to grow in strength.
Many believed that closing the large hospitals and creating better community services signalled the beginning of a system that would meet people’s needs. How did this work out?
Community services were patchy; some lacked focus and were of poor quality. Acute inpatient wards in district general hospitals were not always designed to promote good quality - some wards occupied premises that had barely changed since the days of the workhouse.
Everyone leaving the asylums was found a place to live, but those places did not seem like home, especially to people who had never lived outside the old institutions. Employment opportunities were very limited.
Campaigns were mounted for improvement but, sadly, public indignation is more easily roused by very rare homicides than by the poor conditions commonly experienced by our fellow citizens.
It is against this background that the national service framework provided focus and a way forward. We now have some very good community services. The Improving Access to Psychological Therapies programme offers the chance of change to many people who otherwise could not get talking therapies. There is increasingly helpful guidance from the National Institute for Health and Clinical Excellence, although this is still honoured more in its breach by some commissioners and providers. Overall, the movement to improve services has been more successful than many believed possible.
Yet discrimination, exclusion and lack of opportunity are being tackled very slowly indeed.
The Time to Change programme is beginning to combat discrimination and stigma. But the government should fund this work. Charitable funding cannot replace commitment - and money - from the top.
Many people with mental health problems live in a degree of poverty that reduces their chances of having their own home. Public service agreement 16 is intended to help housing, but work on this has barely started. Nine out of 10 people with long term mental health problems would like to get a job, but only one in five can.
It cannot be right that more than half of the people claiming long term sickness benefits have been diagnosed with mental ill health. Aspiration and talent is being wasted and surely no economy can afford that level of lost contribution.
As we begin to tackle these challenges, the recession might destroy progress. Recession is also likely to increase the demand for services. We have heard talk of NHS efficiency savings of £15bn-£20bn from 2011-2014. The threat to mental health services is real.
What increasing numbers of clients want is more support to lead the lives they want, as well as good treatment. They want to manage their own recovery.
Creating services that support people in achieving their potential and meeting their aspirations is the big challenge for the next decade. It could fulfil the process that began with closing the asylums. If we stop now, society will continue to fail many people, just when we can see the chance for change.