Writing for NSUN, Mark Brown (@markoneinfour) explores what Prime Minister David Cameron’s recent surprise Life Chances speech tells us about the immediate future of mental health in England.
On January 11, Prime Minister David Cameron gave a surprise speech announcing the imminent arrival of his government’s Life Chances Strategy in the spring. In an unexpected twist, the speech announced £1 billion of spending commitments for mental health services tied into a broader vision for the country.
Forming a vision of the Prime Minister’s intended legacy, the overall drive of the speech was security: security for the economy; security for families; security for communities. The speech reiterated Cameron’s view that the welfare state can trap people rather than giving them what they need to ‘get on’ and reasserted his belief in the free market as the best tool for achieving progress for the many in society.
In the speech he raised the twin spectres of poverty and family breakdown, reiterating his view that a job is the best way out of poverty. However, he did acknowledge that some people “get ‘left behind’” and that “they haven’t been equipped to make the most of opportunities presented to them”; and that “a chasm exists between them, and those who have been able to take advantage.”
Mental health care and support formed a sizable part of the speech, linked by the PM to what he called ‘four vital social insights’. The first of these insights was that “neuroscience shows us the pivotal importance of the first few years of life”, the second was the importance of “developing character and resilience”, the third that “social connections and experiences are vitally important in helping people get on” and the fourth that “when we know that so many of those in poverty have specific, treatable problems such as alcoholism, drug addiction, poor mental health we’ve got to offer the right support, including to those in crisis.”
In the speech, of mental health Cameron said: “I want us to be able to say to anyone who is struggling, “talk to someone, ask your doctor for help and we will always be there to support you.” But that support has to be there. And that poses a big challenge for government in terms of services and treatment.”
The Prime Minister announced £290 million up to 2020 to be invested in perinatal mental health care; nearly £250 million to further liaison psychiatry in Accident and Emergency Departments; and £400 million to improve and further extend Home Treatment Crisis Teams, “a safe and effective alternative to hospitals”. He also underlined the government’s commitment to the introduction of waiting times standards for mental health care, focusing on a two-week standard for people experiencing psychosis and the “first ever” waiting times standard for “teenagers suffering from eating disorders like anorexia.”
Those with long memories of previous announcements of new money for mental health wondered if there wasn’t something a little fishy. On the day of the announcement Health Service Journal's Shaun Lintern received confirmation from the Department of Health that the £1 billion was not new money but a confirmation of “which areas and services would receive funding, in line with expected recommendations from NHS England’s mental health taskforce.”
The Taskforce, formed in March 2015 and chaired by Mind’s chief executive, Paul Farmer, was tasked with drawing up the first ever independent five-year mental health strategy for England. It overshot its expected publication date of autumn 2015 and had been widely expected over previous weeks that the Taskforce would publish its recommendations on January 11, the day of the Prime Minister’s surprise speech.
Until the publication of the Mental Health Taskforce report it’s impossible to see whether Cameron’s speech is a trailer or a spoiler for its recommendations. On January 17, The Sunday Times published an article based upon a version of the Mental Health Taskforce report that had been leaked to the newspaper. According to the paper: “The report says ministers need to find an extra £1.2 billion a year for mental health services by 2020." The paper also claimed the leaked document: “concludes that the government’s reforms, introduced in 2012, have made mental health services worse by complicating the way some treatment is delivered.”
There was nothing in Cameron’s speech about mental health that isn’t already there in the NHS Mandate 2016-2017, one of the huge number of government documents dumped out on December 17, 2015, the final day of Parliament before the winter holidays. It makes sense that a Prime Minister might want to claim the headlines for some mental health measures that have already been announced quietly in a document only read by NHS management folks and health nerds. The more sceptical might say that it will take more than being more prescriptive about the uses to which an ever-dwindling pot of money is put to bring about a “revolution in mental health treatment.”
The Prime Minister’s speech offers little for people who have long-term mental health difficulties, those people who would be considered to be ‘already in the system’ and who have been so for decades. There is perhaps some comfort in the expansion of Crisis Resolution Home Treatment Teams and the extension of liaison psychiatry within Accident and Emergency departments.
Despite the Prime Minister’s vision for society as a whole, his vision for mental health is limited to the NHS with little or no mention of services provided by charities or paid for by local authorities. Both have taken a hammering during the past five years of austerity.
The focus upon early treatment and intervention and the idea of the welfare state as a trap will provide scant comfort to people who have relied for decades upon social protections such as in and out-of-work benefits and social care and support. Similarly, the focus upon work will sound alarm bells for those living with the effects of such policies as the Work Capability Assessment, the Spare Room Subsidy and other attempts to cap benefits and reduce social security spending.
In a country where the overall spending on public services and social protections is dropping, it’ll take more than a few spending announcements to convince people with mental health difficulties living at the hard end of social policy that no one will be left behind.
About the author
Mark Brown is development director at Social Spider CIC. Mark supports, researches and writes about mental health, social innovation and social media.
NSUN is the National Survivor User Network