Successive governments have left mental health in the shadows. At the Liberal Democrat conference leader Nick Clegg will outline his plans to turn the sector around and make it truly patient centred
Over the last 10 years we have missed a great opportunity for achieving radical improvements in provision of care and support for people with mental health problems.
First to blame must be politicians. I am sure if you asked people to name a mental health policy most would opt for Mrs Thatcher's "care in the community" drive, which led to an increase in homelessness and visible neglect of people with mental health problems.
Ask people to tell you what Labour has done to mental health services over the last decade and most will probably say they don't know. At best someone might mention something about psychiatric ASBOs or, rather, the long, drawn out introduction of community treatment orders via the Mental Health Act.
Mental health services have received more money, but not at the rate of other aspects of healthcare. Perhaps it is because there is no obvious political or electoral gain that the government has left the real issues surrounding mental health in the shadows and a whole section of society lost and unmentionable.
We know that mental health problems are widespread, with one in six experiencing anything from mild depression to severe psychosis at any one time. We also know the vast majority of people receive no treatment or help at all. Even for those who do, the help comes after months if not years of waiting. For people who have mild or moderate depression, too often the help is a prescription.
Child medication
Over the last decade we have seen the number of antidepressants prescribed to children quadruple. Prescriptions for adults are rising too. We risk slipping into the default position of prescribing more and more antidepressants but this cannot be the solution. If all we do is rely on pills to mask the problem and make us feel that we are doing something we miss the opportunity to tackle the wider issues in our society that cause and exacerbate mental health problems. We also miss the opportunity to help people arrive at a better understanding of themselves and how best to manage their problems.
We cannot shrug at the explosion in antidepressant use as if it were of no consequence when we know that in most cases antidepressants are of no more benefit than a placebo.
The vast majority of GPs say they prescribe antidepressants because there is no other option. Despite the National Institute for Health and Clinical Excellence telling the NHS four years ago to use psychological therapies, in practice you would be lucky in some areas to get on a waiting list. Even where people are referred the wait can be as long a couple of years. And if you are elderly you are unlikely to get any access at all.
At least, to their credit, the government has started the process of increasing access to psychological therapies, but it is only the first step and a very belated one at that. Over the last 10 years, most attention and incentives have been focused on acute general medical care and the big increases in funding have also tended to be drawn to these high profile areas and away from community mental health services.
What is clear is that we have a long way to go before we have built sufficient capacity in psychological therapies. The current level of commitment gets us about a third of the way towards the sort of service necessary to meet most people's needs. When the next spending round is launched in a year or two it is vital access to psychological therapies does not slip off the plan.
Care guarantee
At our party conference next week, we will be debating a motion on mental health that I hope will receive widespread support.
If passed, the motion will commit us to a guarantee that people suffering from mental health problems get faster access to treatment. We want to see this guarantee set at 13 weeks by 2012 and if the NHS could not meet this entitlement people should be able to get treatment from the private sector paid for by the NHS. This guarantee is earlier than the 18-week maximum wait for other health services because early assessment and the provision of appropriate therapies are vital to reducing prescription rates and combating mental health problems before they have the chance to grow and become entrenched.
This guarantee would be one part of a patient's contract, a binding agreement between the patient and the NHS, setting out new minimum standards of care to be applied throughout every level of the health service. Personal entitlements would cover not only maximum waiting times but access to information, rights to patient advocacy, availability of treatments and core services and options for redress.
A truly people centred NHS must empower patients so they have a real say in their own treatment. But it is hard to start empowering patients if they cannot be kept safe when they are most vulnerable.
Safer wards
At the most basic level, we need to make wards safer, with an end to mixed-sex wards in mental health units and an absolute prohibition on placing those aged under 18 on adult wards. I completely agree with the recent assessment of the Mental Health Act Commission which said it is a "truly scandalous and tragic situation" when women are forced to stay in places where they fear for their safety. Under our plans, every service user will be entitled to safe and secure accommodation that meets their needs.
I also want to reverse the feeling of powerlessness too many people feel when they seek help. There is no reason why mental health service users should not have more choice over the options available to them and greater say in their care. Only when it is clearly not in an individual's best interest should this right be overridden, not simply for convenience.
Where people need help in making choices and negotiating with the system we would introduce more advocacy. All the evidence suggests advocates can build trusting relationships with patients and give them the advice they need to make good, informed decisions for themselves. The government has plans for statutory advocates for those with mental health problems to be introduced next year. I want patient advocates to be independent of the health service in order to build up as much trust as possible between them and the patient. Such a network, dedicated to providing information, guidance and support to both mental health patients and carers, should be piloted as soon as possible.
Individual budgets
I see the expansion of direct payments as another way of giving people more control over their treatment and helping them rebuild confidence in themselves and their trust in other people. Social services have used direct payments and individual budgets to empower people to decide how their care is administered. The same principle should apply to mental health service users.
I want to see care budgets granted to those patients who are able to make informed choices. These will present a menu of care options. Under our plans and with guidance from clinicians, many patients will be able to decide on the therapies and therapists that they want.
I believe that more personalised, patient centred care and experimentation with ideas cannot be delivered from Whitehall. Commissioners must shape healthcare around the specific needs of local people. And they must be accountable to local people for the services they commission and those they refuse to fund.
To achieve this fundamental shift in accountability, we would replace primary care trusts with directly elected local health boards. Local people will be empowered to imprint their priorities on their health services and standards will improve.
Finally, in the same way that too many people are being sent away with pills, too many are being dumped on benefits. We have more than a million people claiming incapacity benefits because of mental ill health. Mental health has been estimated to cost the UK economy£48bn every year in loss of output and cost of treatment. It is vital for our economy and for individual well-being that we do more to improve employment prospects for those with mental health problems. For example, the Department for Work and Pensions could pay money to the NHS when someone is helped back to work through access to therapies.
All the changes I want to see stem from the fundamental conviction that as a society we must treat people equally by constantly ensuring that services are meeting need, we must be fair in the distribution of services and we must empower people to take back control over their own lives as far as possible. l
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