Mental Health Matters: Kicking the can down the road (again)

Last month’s announcement of a national review into inpatient services was welcomed by campaigners last month, but it seems to have come at the cost of the 10-year plan for mental health.

Not a fan of strategy, health and social care secretary Steve Barclay folded the promised long-term mental health plan into a major conditions policy covering five areas: cancer, cardiovascular disease, chronic respiratory disease, dementia and mental health.

This effectively means government will not have a long-term strategy specifically targeting mental health: prompting sector leaders to warn that patients may suffer as a result.

It does not bode well for achieving parity; many leaders, who were asked to be ambitious in their responses to the 10-year plan consultation, fear condensing five areas into one may limit investment and resources.

Mr Barclay said the workforce model needs to adapt to reflect increasingly complex needs and multiple long-term conditions, but leaders would argue it actually needs to expand.

He cited the promised upcoming workforce plan, adding the strategy will set standards patients can expect over the short term and over five years, though timescales for detail remain a mystery.

Mr Barclay stressed a need for whole-person care, and it is widely known that people with long-term physical illnesses are more likely to have a mental illness.

This aspect of the strategy is welcomed. What it could do, by examining the mental health of the nation alongside other conditions, is address life expectancy, particularly in those with a severe mental illness who face a 20-year gap due to higher risk of physical illness. Another positive is that the 10-year suicide prevention plan will be taken forward.

CAMHS in ‘dire state’

However, a major concern is that not enough focus will be placed on mental health as part of the wider strategy, given the escalating crisis.

Sean Duggan, chief executive of NHS Confederation’s mental health network, is lobbying the Department of Health and Social Care to ensure mental health is explored within the other areas.

For instance, medically unexplained symptoms – where people present to accident and emergency with severe physical issues and are later found to have underlying depression and anxiety – could be explored within cardiovascular and respiratory disease.

“With the other conditions – respiratory, cardiovascular and cancer – we know a lot of those will have an underlying mental health problem,” he told MHM.

“What we need to do is to influence the government and say mental health has to be streamed through all the other areas, to give it the right focus it deserves. You can’t have good physical health without good mental health.”

Perhaps the most significant fear among leaders is that escalating demand they are battling each day from rising mental illness among children, and complexity, may not be addressed effectively without sufficient research, resource, and cross-sector working with education.

The original strategy outlined the importance of education, early intervention, and support in schools – mental health leaders stressed to MHM this appears to be missing from the new policy.

It is a huge priority: according to a recent NHS Providers survey, 88 per cent of mental health and learning disability trust leaders, and 97 per cent of combined mental health and community trust leaders, said they were worried or very worried about their capacity to meet demand over the next year.

A stark report by Look Ahead, a housing association, last month revealed rising numbers of children are attempting suicide before receiving help from NHS services.

One trust leader said children’s mental health and autism services locally and nationally are in a “dire state”, which adds to previous coverage by HSJ on huge backlogs in broader children’s community and autism services.

Now, 18 per cent of children aged seven to 16 years and 22 per cent of young people aged 17 to 24 have a probable mental illness. Those children will grow up into adults with a higher chance of having an enduring mental illness. Without sufficient focus on earlier years, leaders fear the policy will be redundant.

Regional gaps

Royal College of Psychiatrists president Adrian James warned significant regional variation in access to high-quality mental health support will not be tackled in the strategy. For instance, some areas of the country have a much higher use of out of area beds.

It is also unclear if the new strategy will allow for major differences across the broad spectrum of mental illnesses. For instance, eating disorder treatment will be vastly different from anxiety. The devil will be in the detail, if and when it emerges.

Mr Barclay said the strategy will set out “interventions” the centre can make to ensure integrated care systems, and organisations within them, can maximise opportunities to tackle clusters of disadvantage, informed by the Hewitt review.

The inclusion of Patricia Hewitt could be a positive move. MHM understands she has taken an active interest in mental health and the role ICSs can play.

A final issue to address is timing. The delay in responding to the 10-year plan consultation was widely seen as kicking the can down the road: it now seems that an interim report on the new strategy will arrive “in the summer”. A long-term strategy to dismantle inequalities and improve national health will take years to implement and even longer to become effective.

Delaying its introduction kicks it even further. Clarity on resource, budgets and specific areas tackled would help to assuage concerns, and the earlier that arrives, the better.