Figures on council spending last week show that the government’s aim of achieving parity of esteem for mental and physical health is still very far from being a reality. This has to change, but will it?
For some time now, the government has been talking a good game on mental health, with various ministers stating their goal for mental health to achieve parity with physical health. But this doesn’t seem to have percolated down to local authority level, as research by mental health charity Mind laid bare last week.
The charity’s research found that local authorities in England spend an average of less than 1.36% of their public health budget on mental health, with some spending nothing on preventing mental health problems this year, and many areas having no clear plan for tackling poor mental health. Shockingly, a number of local authorities had no idea mental health was even among their public health responsibilities.
Mind reckons that local authorities spend less than £40 million per year on preventing mental health problems, whereas spending on things like smoking cessation, sexual health initiatives and increasing physical activity all receive significantly more.
While I’m not denying the importance of these public health issues, nor saying that the money should not be spent on them, surely mental health should have a greater priority? After all, mental ill health accounts for 23% of the UK’s disease burden.
These figures show that for many local authorities, mental health is still very much an afterthought – some even file it under ‘miscellaneous’ – exposing the huge gap between central government rhetoric and local government reality.
In fairness, the government has made some progress towards parity in the NHS, such as the commitment to introduce waiting time standards from April next year. This will mean that most patients needing talking therapies will be guaranteed the treatment they need in as little as 6 weeks, with a maximum wait of 18 weeks. For many patients experiencing their first episode of psychosis, the NHS will start to provide treatment within two weeks of referral – bringing it into line with consultations for cancer.
However, if we are to have any chance of mental health getting even close to parity with physical health, then relevant local authority public health spending has to be reformed and increased.
Mind has called on the next government to introduce a national strategy for prevention to ensure local authorities and public health teams use their budgets to prevent mental health problems developing and reduce the numbers of people becoming unwell.
It is a good call. If change within local authorities is to happen, it has to come from the top downwards, and a national strategy would give the necessary push to local authority commissioners to change their policies.
But that alone won’t be enough. Local authorities are under tremendous pressure to make budget cuts and the indications are that this will continue well into the next parliament – whichever party is in power. Could commissioners find more money for mental health services, even if they wanted to? Maybe, but it would probably mean taking money from other services, unless the government were to provide a serious injection of cash – and given the commitment to austerity, the chances of that appear between slim, and none.
With that in mind, achieving genuine parity for mental health is likely still to be a distant dream. Only when people with mental ill health get the care and treatment they need when they need it – including through preventative services – will we be anywhere close to achieving the parity goal.