London needs an action plan for mental health to address wide variations in quality of care and meet commitments to put mental health on an equal footing with physical health, according to a new report.
Currently, London spends almost £7.5 billion per year addressing mental ill health, which alongside the wider social and economic impacts of mental illness adds up to an estimated annual cost of £26 billion. Yet service user satisfaction is particularly low, with many needs not being met. Good practice often happens in isolation, with wide variations in availability, quality and effectiveness of specialist services. With more than 80 organisations – including clinical commissioning groups and local authorities – responsible for mental health provision in London, a lack of strategic collaboration is holding London back, says a report by health and social care charity The King’s Fund.
Mental health is identified as a priority by the London Health Board yet there is no agreed action plan for improving provision and addressing the challenges of achieving this. Challenges include the complexity of London’s NHS structures and systems for commissioning and delivering services, high levels of deprivation, a diverse and transient population and demand for services being significantly higher than the national average in more than 75% of boroughs.
Transforming mental health: a plan of action for London, found that while stakeholders generally agreed about the priorities for improving mental health provision in London, there was no collective view for delivering them. The report identifies a number of longstanding barriers between stakeholders that continue to hinder progress – such as:
• Different political and historical agendas
• Unconstructive communication
• Insufficient attention to collaboration in developing strategies
• Weaknesses in commissioning.
Helen Gilburt, fellow at The King’s Fund and the report’s lead author, said: “Over the past 25 years mental health provision has undergone a dramatic transformation, with services moving from institutions to community settings. Our report shows that mental health services in London need to move away from siloed working and embark on a second phase of transformation to deliver the change needed to improve services.”
The report encourages stakeholders to recognise these barriers and unite behind a shared agenda focused on providing integrated services. Nine key steps are identified to help to achieve the vision:
• Collaborative commissioning to facilitate change
• Driving change through collective systems leadership
• Ensuring that service users, carers and clinicians are at the core of provision
• Using contracting systems to support integration
• Building a public health approach to mental wellbeing
• Developing pan-London solutions to increase impact
• Developing data to support improvement
• Utilising London’s academic infrastructure to disseminate best practice
• Creating a new narrative for mental health.
The report suggests that academic health science networks should play a greater role in disseminating the latest research and good practice, while NHS England and Public Health England also have a role to play in supporting organisations in improving practice.
While the level of funding for mental health provision remains a contentious issue, the report argues that there is a unique opportunity to improve services through more collaborative working, so how limited resources are spent is crucial.
Paul Farmer, chief executive of mental health charity Mind, welcomed the report and its recommendations. “Our own work with the We Need to Talk coalition has found that 1 in 5 people in London wait longer than 6 months to access talking therapies, and reports of bed shortages in some London trusts show the pressure on secondary services. Meanwhile public health programmes designed to prevent mental ill health lag far behind those for obesity and smoking that we now take for granted.
“We need a collective approach to improving mental health in London. The London Health Commission is due to publish its plans for health in London next month – this report shows that mental health needs really to be at the heart of its thinking.”