Devolution and metro mayors can redraw the mental health landscape

Devolution has been a defining feature of UK politics for two decades. The specific powers held differ from region to region, but health and social care policy has played a core role in many devolution settlements – and rightly so.

‘Devo Manc’ will see the new mayor for Greater Manchester handed full control over a £6bn health and social care budget in 2016/17, and while the mayor for East Anglia will not have any standalone health powers, they will be expected to work with the government to form its National Work and Health Programme.

While this negotiated approach provides opportunities for devolved powers, its inherent inconsistency delivers fresh challenges to all NHS trusts as the traditional landscape of health and social care is re-drawn.

Two million Londoners experience some form of mental ill-health every year and this is why our mayor’s focus on mental health early on in his tenure must be extremely positive

While London is often considered the model to be emulated when it comes to city-level devolution, it is questionable whether this is the case with health and social care; the Greater London Authority has not acquired a similar level of power in health services as it has in transport, planning and emergency services.

However, while only around 200 days in, the new mayoral regime has already started the job of improving the mental health of nearly nine million Londoners by establishing a working group to develop the kind of ‘Thrive’ model that was so effectively applied in New York.

Two million Londoners experience some form of mental ill-health every year and this is why our mayor’s focus on mental health early on in his tenure must be extremely positive for everyone involved in providing related services and developing ways to meet the capital’s unique challenges in this area.

Just as these challenges are unique, so is the mayor’s profile and the tools at his disposal. With or without statutory powers, he has the ability to advance positive social policy. Mr Khan has the clout to bring together leaders from across London – from the NHS and the emergency services, to councils, business and charities – to advance a set of mental health-relevant policies which cut across many areas of life, and the weight to get issues firmly on the agenda of London’s diverse media.

Clinical expertise

Furthermore, London is home to 15.5 per cent of the total population of England so has an opportunity to positively impact on a huge number of people – including the 10,000 children and young people who come into contact with existing mental health services in London each year.

He can also benefit from the vast clinical expertise that London’s mental health service providers have to offer. As the city is a world leader in mental healthcare research and training, the mayor can learn from an array of mental health professionals at all levels to understand London’s needs and identify the best solutions.

In February, the Mental Health Taskforce, a group brought together to develop a new five year national strategy for mental health, published the Forward View, which sets out the current state of mental health service provision in England and made recommendations in all service areas.

The Forward View made 58 recommendations – for the NHS, government and system partners. We aren’t going to list all of these recommendations here, but each of them will make a difference to the NHS, Londoners, and London as a whole.

Mental health, and the implications of poor mental health, resonates with transport, business, the environment, planning, education, leisure and the criminal justice system

For example, the report called for 30,000 more women each year to have access to evidence-based specialist mental healthcare during the perinatal period, every hospital to have all-age mental health liaison services in emergency departments and inpatient wards, a doubling of employment support advisers and, perhaps most importantly of all, 70,000 more children and young people to receive specialist mental healthcare and, if they need inpatient care, to receive it close to home.

These recommendations were accepted in full and endorsed by the government. We now need to see action.

Simply put, having well-designed mental health policy is essential to social policy – indeed, to policy across the board. Mental health, and the implications of poor mental health, resonates with transport, business, the environment, planning, education, leisure and the criminal justice system. All policy has a role to play in improving the health of our communities. Conversely, mental health has much to contribute to every aspect of London life.

We want the mayor to push for these changes in this great city as well as all the other excellent initiatives he will support. A world-class city must have these evidence-based modern treatments available to its citizens. They will build resilience, reduce days lost at work, relieve suffering and promote happier, healthier lives. We call upon the mayor to give these plans his full backing.

Paul Jenkins is vice-chair of the Cavendish Square Group and chief executive of the Tavistock and Portman Foundation Trust.