Dan Parton cutWhile the government may talk up parity of esteem between mental health and physical health services, and promote integration of both, the reality on the ground for service users and frontline workers is often different, and this pattern is set to continue.

For several years now, health ministers and other politicians have talked about the goal of mental health services having ‘parity of esteem’ with physical health. It is a laudable aim, although mental health should never have been allowed to fall so far behind physical health – and that’s a failing in health policy by successive governments.

But as we head into 2014, parity of esteem for mental health still seems like a distant dream. The government may talk a good game, but the statistics say that, in at least some respects, things are getting worse rather than better. For instance, recent research found that spending on mental health has dropped by 2.3% in real terms in the past two years, despite demand for services – acute and community-based – increasing by more than 10% over that period. And, this is a time when the NHS budget is meant to be protected, remember.

This is deeply concerning, although nothing new. It has led to cuts to mental health inpatient beds and community services, meaning that more people are not getting the help they need when they need it, with obvious adverse consequences. 

One hesitates to use the word ‘crisis’ to describe the state of mental health services – although others already have – but continued cuts can only have a negative effect and you wonder how much more can be taken out. The salami can only be sliced so thinly before the possibility of services failing emerges. 

But more cuts there will be. For instance, local authorities again have to trim their budgets and, as usual, social care, as one of the largest areas of spend, is being scrutinised. History tells us that mental health is often at the front of the queue of services to be cut.

Meanwhile, service integration continues to be a slow process, which is to be expected when dealing with large services. Examples are emerging of how it can work, but these need to be replicated much more widely.  Mental and physical health are closely intertwined and having properly joined-up services can only be a good thing.

Elsewhere this year, the concerns of service users will largely be the same as they were in 2013. Worries over welfare benefits will continue, if not increase, as more people are reassessed for their eligibility to claim employment and support allowance via the much-hated work capability assessment (WCA).

Despite three High Court judges ruling that the WCA did disadvantage people with mental ill health last year, the test remains largely as it was. While Dr Paul Litchfield – taking over from Professor Malcolm Harrington – reviewed the WCA and recommended changes to help those with mental ill health, the general feeling was that they did not go far enough.

But while times remain tough, there is still much cause for optimism. There are many examples of individual and organisational best practice out there – some of which have appeared in the pages of Mental Health Today – and they are making a difference to the lives of service users, regardless of cuts. Whatever the pressures, I’m sure that will continue in 2014.