A comprehensive, cross-government strategy is also needed to complement the NHS plan to tackle issues which have an enormous impact on the day-to-day experiences of people with mental health problems, writes Paul Farmer.
The last few years have been a rollercoaster for mental health. I have found myself welcoming, wholeheartedly, an endless stream of promises and pots of money, and I have worked with colleagues and people with experience of mental health problems on any number of concordats, pathways and pilot programmes.
No one can deny that mental health is on the agenda like never before and its profile within the recent long-term plan for the NHS is tangible evidence that both the NHS and government are committed to doing better by the 1 in 4 of us who will experience a mental health problem this year.
But the uncomfortable truth is that we have yet to see sufficient meaningful improvement in the experiences of people trying to access services. Mental health was deprived of NHS attention for so long that we are still feeling the effects of that every day. Much of the time, access to support is inadequate and people only get help once they reach crisis point. In total, only a third of people with a mental health problem get any kind of support at all.
Urgent investment
The NHS faces huge challenges but the message that urgent investment is needed in mental health is now being heard. The NHS long-term plan includes a funding increase of at least £2.3bn a year for mental health services and if delivered, has the potential to make a difference to thousands of people.
The plan is ambitious, including promises to support pregnant women and new mums, improve community care and increase people’s access to treatment like counselling and cognitive behavioural therapy. Importantly, it recognises the necessity of improving mental health services for children; many problems begin before the age of 18 and if younger people get the support they need, it can help to prevent more complex problems from developing later on.
It doesn’t have all the answers though and there has rightly been several questions about how any of the plan can be delivered by the current workforce. Mental health services in particular rely hugely on people, so the right workforce in place is crucial to improving services.
We need to see the detail of how the NHS will do this, including how to make the most of the energy of young people who want to work in mental health, and the experience of the voluntary sector before we can feel truly confident about the future.
When we developed the Five-Year Forward View for Mental Health in 2016, we did it with an understanding that new plans take time to get going, which made 2019 a critical year for delivery
Now that the NHS has set the direction of travel, responsibility lies with local decision makers to develop and deliver their own long-term plans that reflect their communities’ needs. The plan is clear that this must be done by involving local people. Charities like Mind will be keeping a close eye on this and supporting people with experience of mental health problems and experts like our local Minds are fully involved in this process.
Above all, though, the NHS both nationally and locally must not lose sight of the fact that we are already in the middle of an existing five-year plan for mental health services. When we developed the Five-Year Forward View for Mental Health in 2016, we did it with an understanding that new plans take time to get going, which made 2019 a critical year for delivery.
The NHS in England has some huge commitments to meet this year to improve services and its own accountability measure for clinical commissioning groups – the Improvement and Assessment Framework – shows that although there has been some progress in access and recovery rates, there is still a long way to go in areas like early intervention.
And beyond both the five-year and longer term plans, there is growing recognition that the NHS is only one piece of the puzzle. We are still waiting to hear what the government’s plans are for social care and public health, which are vital to help people with mental health problems and to relieve pressure on the NHS.
A comprehensive, cross-government strategy is also needed to complement the NHS plan – tackling issues like benefits and housing which have an enormous impact on the day-to-day experiences of people with mental health problems.
We have been waiting a long, long time for better support and have heard a lot of promises made in recent years. We are starting to see results, but the challenge is huge.
People with mental health problems deserve better and only when we start to hear that people can get the support they need, when they need it, will we feel that we are making sufficient progress. Change is possible, but only with the full commitment and participation of the NHS and its partners from top to bottom.
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