A report out this week warns that mental health services must not “sleepwalk” into the future and plans need to be made to ensure they are fit-for-purpose for the next 20-30 years. For me, to achieve this will require both proper investment and strong direction from government.
For anyone involved in mental health services, the findings of the Mental Health Foundation’s (MHF) latest report, Starting Today, will have made for unsurprising reading.
It details how mental health services are straining at the seams, but adds that pressure is going to increase in the coming years because demand is set to grow, and grow markedly, if current prevalence trends continue. As a result, the report says plans need to be put in place now to ensure that mental health services are fit for purpose for the next 20-30 years.
Nothing there that hasn’t been said before. Of course, that the MHF has to say it again means that not enough progress has been made in addressing these issues. It also means that it has to be said again because the need becomes more pressing, by the day.
The report makes some sensible recommendations on such things as greater personalisation of services, better integrated working and more effective workforce development.
It also emphasises the importance of preventative work to avoid people developing mental illness in the first place. I’ve said before that this is a no-brainer: mental health services – especially acute services – cost a lot, so investment to stop people reaching crisis-point will bring savings in the longer run.
This leads me to the elephant in the room: funding, or the lack of it. Reform and development of mental health services necessarily require additional investment. But, as Mind’s chief executive Paul Farmer noted, government figures show investment in mental health services has fallen for the first time in 10 years, despite rising demand. And cuts to local authority budgets have seen social care services squeezed, with mental health provision often being a casualty.
While much of the rhetoric in recent years has been around ‘efficiency savings’ and ‘doing more with less’ – and there are examples of local authorities and providers that have done this effectively – the salami can only be sliced so thinly. New money is needed if services are to be expanded to meet the expected increase in demand.
Strong government direction is also needed to ensure necessary change. If the government makes mental health a priority for the NHS – and sets targets that local authorities have to hit – it tends to focus minds. Without that commitment, commissioners and others in the NHS and in local authorities may prioritise other areas of healthcare (not that they aren’t important as well), with mental health left to “muddle along with no clear sense of what is required”, as professor Dinesh Bhugra, co-chair of the Inquiry Advisory Panel for the report, said.
The combination of better funding and government direction could give much-needed impetus to the drive for change in mental health services and ensure that they can cope with the increasing needs of the population.
But, without these elements, progress will only be limited, and despite the best efforts of commissioners and professionals, that will mean that some people with mental ill health will be failed, yet again – heaping only more pressure on the system, as a whole.