LSE's report on the national priority of - and need for investment in - mental health services pulls no punches. In this guest blog, CareKnowledge editor Jim Kennedy's looks at some of its key conclusions.
LSE's report on how Mental Illness Loses out in the NHS,frankly, says it all in its title. But to emphasise the pointfurther its introduction to the report is titled: "Shockingdiscrimination against mental illness within the NHS". Thisall raises an enormously important series of debates, not onlyabout levels of investment in the NHS and its various specialities- particularly at a time of acute financial pressure - but alsoabout a much wider set of attitudes towards mental health problemsand the services we need to meet demand.
At one level, the timing of the report couldn't be worse. TheNHS is undergoing major structural change and is experiencing itsfirst significant period of financial constraint in years. A hardtime to plead for investment in mental health services. But therenever is a good time - under-investment in mental health has been along-term problem in the NHS - ever since the original communitycare changes led to the closure of the large institutions and aredistribution of their funding across the wider NHS.
And, it's arguably the case that the levels of investmentachieved in the years since the closure programme reflectssomething deep-seated in our own attitudes, and in the thinking ofthe NHS. As we all know, much of the NHS's energy is devoted toensuring that the rationing decisions it takes are the right ones.Since public attitudes to mental health and the need for associatedservices have often been, at best, ambivalent, priority decisionsto invest - and deflect resources away from other services - havealways presented the system with acute difficulties.
Here, the LSE report points to the burgeoning evidence, that,like it or not, the NHS is, in one way or another, going to have torecognise just how much ill health is directly or indirectlyattributable to mental health problems. And it argues that much ofwhat is currently spent could be better invested in proven servicesthat are cheaper to deliver at the outset, rather than in servicesthat pick up the pieces later.
Leaving aside the fundamental problem with all broadlypreventative arguments for new services (you have to re-directinvestment, at least for a period, before you gain the promisedsavings elsewhere), the LSE report:
- Notes that mental illness now constitutes nearly half of allill health suffered by people under 65
- Argues that the failure to treat mental health problemsadequately is the biggest national health inequality
- Argues that effective therapies are available, but are notsufficiently used
- Suggests that therapies such as cognitive behavioural therapylead to rapid recovery from depression or anxiety disorders in over40% of cases
- And argues that, If they were more widely available, therewould be little additional cost to the NHS, who already respond tothe physical health problems caused by the failure to deal withmental ill health
- Further argues that wider additional costs would be covered bysavings on incapacity benefits and increases in tax income
- Commends the already announced programme to increase access tothe full range of psychological therapies, and seeks to ensure itscompletion - and urgent further follow-up (the current programme,LSE says, is only expected to address 15% of need by 2014)
So, the argument is strongly made. What will be theresponse…?
Jim Kennedy is editor of CareKnowledge, an online informationresource for social workers and social care professionals. For moreinformation go to: www.careknowledge.com