Theresa May’s outlined reforms to the mental health care system are welcome and could make a real difference to people’s lives – but they will founder unless they are properly funded, says Mental Health Today editor Dan Parton.
Prime Minister Theresa May used her first policy statement of the New Year to unveil plans to tackle what she called the “hidden injustice” of mental illness, and put reform of the system centre-stage and top of the news agenda.
The initiative is long overdue, but welcome to see. In a speech to the Charity Commission, May outlined a range of proposed measures that are eminently sensible and, if enacted properly, would make a positive difference to many people’s lives.
For instance, offering mental health first aid training to all secondary schools could be a boon – many have complained about the lack of training for teachers in aspects of mental health, when they can often be a first port of call for a young person who is experiencing mental ill health. Having teachers confident in how they can help young people to access support at an earlier point could potentially avoid their situation escalating to a crisis – a step which would be beneficial to the young person and speed their recovery, but also avoid costlier interventions later.
The expansion of new models of community–based care such as crisis cafes and community clinics is also welcome. Providing mental health care in settings such as this has been shown to have a positive impact on service users.
Increasing access to digital therapies for people with stress, anxiety or more serious issues is again a sensible decision. The evidence base for the effectiveness of online therapies is growing, and many people, especially those in work, prefer the flexible nature of using the internet to access information and treatment.
Of course, May also announced more reviews, including a Green Paper on children and young people’s mental health which will set out plans to transform services in schools, universities and for families later this year. There will also be a review on how best to ensure employees with mental health problems are supported in the workplace.
Hoswever, I’m not sure these reviews/papers will reveal anything that isn’t already widely known within the sector and from previous research.
My worry is that reviews are good for looking like you are doing something to address a problem, but all they may do is ensure that nothing on the ground changes for longer. Reviews and Green Papers tend not to be quick to produce – and then there may be things like consultations and government responses before we even get close to changes on the ground.
But there is also an elephant in the room: funding. Or, rather, the lack of it. Mental health funding – especially through local authorities – has been slashed in the past 6 years, thanks to the austerity agenda pursued by former Chancellor George Osborne. Child and adolescent mental health services (CAMHS) budgets have been particularly hard hit in some areas.
While the government may point to increased funding for mental health in the past couple of years, evidence from several sources says that it isn’t all getting to the frontline. For instance, an NHS Providers survey of mental health trust leaders found that 63% thought that the Mental Health Investment Standard – which stipulates that commissioners are required to boost funding for mental health in line with their own budget increases – would be missed as clinical commissioning groups (CCGs) were prioritising acute care.
Meanwhile, research by Youngminds found that only 36% of CCGs that responded to its Freedom of Information request increased their CAMHS spend to reflect their additional government funds in 2015/16. The remaining 64% used some, or all, of the extra money to backfill cuts or to spend on other priorities.
While in 2016-17, 50% of CCGs that responded increased their CAMHS spend to reflect their additional government funds, the other half still used some or all of the extra money for other priorities.
May’s announcement contained little information on new funding for these measures – especially on providing mental health first aid training to schools. On Radio 5Live, Health Secretary Jeremy Hunt said that the £15 million to provide and promote new models of community–based care such as crisis cafes and community clinics was new.
This is where the major problem lies. Without adequate funding, even the best plans for change will founder. The current increases in funding for mental health should have been ring-fenced, as many commentators said when they were announced, because they, correctly, feared the money would be diverted to prop up other areas of the health and social care system.
However, the increases already pledged – even if all of them did get to where they were supposed to – will not be enough to solve the problems facing mental health care. Additional funding is needed to ensure that not only are the reforms put in place, but that existing services are maintained. Without it, more people will fail to receive the services they need and could end up requiring more intensive treatment later. This, of course, has a serious impact on individuals and their families, but it also has a financial impact, as those concerned will often come to require costlier treatment, at a later stage.
But there is hope for change happening soon, as something that may have got lost in the hoopla surrounding the Prime Minister’s announcement – but is just as significant – was the publication by the government of its response to the Five Year Forward View for Mental Health. In the response, government accepted the Taskforce’s report in full – all 58 recommendations – which will help to drive forward change in mental health.
Implementation is the crucial thing here. While mental health has commanded more attention in politics in recent years, and has had its fair share of high-profile figures making well-publicised speeches about how services would be reformed – parity of esteem with physical health springs to mind – commitments often seem to have been quietly forgotten, and little has changed.
This cannot happen this time – the Prime Minister’s initiative and the positive response to the Five Year Forward View have to be backed up by action. More reviews and Green Papers are not needed: action and implementation plans are. ‘Implementing the Five Year Forward View for Mental Health’ was published in July 2016, so we are already on the way to things changing, which is great, and the government’s response will hopefully quicken the pace of reform. Where May’s announcements will fit in to this, we assume will be worked out at a later date – but pressure must be kept up to ensure that improvement is delivered and doesn’t get lost among other priorities, such as dealing with Brexit.