This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector. Feedback and comments are welcome - email me in confidence.

Trolls under bridges

There is one question which festers beneath any article or discussion of the mental health sector, like the troll under the bridge waiting to ambush the unwary crosser: are things getting better?

I have not spoken to a single leader who would answer this question negatively, although many caveat their answers.

It is impossible to deny the amount of interest and investment in mental health has increased dramatically in recent years. From the royals to the prime minister, the great and the good are talking about mental health and it is being taken seriously by policy makers.

Spend by clinical commissioning groups and NHS England has risen from £10.9bn in 2015-16 to £11.9bn in 2017-18.

The recovery rate for talking therapies has finally risen to regularly over the 50 per cent mark nationally. New perinatal, liaison and community forensic services are being set up and more than 130 new child and adolescent mental health beds have been confirmed.

But time and again the troll raises its ugly head.

Battling the hydra

Last week HSJ revealed that one in 10 clinical commissioning groups had cut their mental health spending. The analysis of NHS England data showed that 24 of the 207 CCGs had reduced their spending on the sector between 2016-17 and 2017-18.

The latest workforce data for the first quarter of 2018-19 show that mental health nursing vacancies rose by 18 per cent – the second highest sector behind ambulance nurses.

Freedom of Information requests submitted by HSJ also found hundreds of children were waiting more than a year to access treatment and thousands of staff and patients had reported being sexually assaulted.

And this week the BBC revealed a leaked letter showing that in some areas access to CAMHS is being rationed to only the most seriously ill children and young people.

Whether the positives balance out the negatives often depends on your philosophy on whether a glass is full or not.

But what is clear is that for all the investment, all the interest and all the scrutiny, the same problems raise their ugly heads again and again. Every time the sector cuts off one head of the hydra two grow back.

Easy wins or a long, hard slog

While the centre keeps a positive spin on its implementation of the Mental Health Forward View, and NHS England is right that many of the statistics are moving in the right direction. But more CCGs than last year are cutting spending, even if total spending is increasing.

NHS Improvement can point to the number of doctors and nurses rising and say growing the workforce requires more vacancies. But the rising vacancies still points to problems with recruitment and retention – despite the regulator launching a retention programme which includes all mental health trusts.

But there is only so long you can pat yourself on the back while frontline staff, patients and families raise concerns about accessing services and getting treatment. 

There are fears within the sector that the long term plan will offer new cash to easy wins rather than address some of the biggest issues in the sector.

Tackling these will be difficult and expensive. There needs to be significant new investment and the sector needs to find thousands of new staff.

There are no easy wins to these problems, only a long, hard slog.