thumbs upThe 2011 national mental health strategy has not delivered all that was promised, but there are some positives says Edward Davie.

February marked the third anniversary of the No Health Without Mental Health strategy so it is a good time to take look at what has been achieved.

In the strategy’s foreword the then health ministers Andrew Lansley and Paul Burstow said it would “mainstream mental health” and create “parity of esteem”. Sadly the evidence shows that the gap has grown with BBC Freedom of Information requests revealing that mental health trusts in England have had their funding cut by 2.3% in real terms over the past two years – a larger proportion than for physical health services. This coincides with a 16% rise in referrals to crisis and community mental health teams leading the Royal College of Psychiatrists to warn that “mental health services are near breaking point”.

There are other worrying statistics coming out of the sector. The Samaritans reports that suicides are at a 10-year high and rising; the Health and Social Care Information Centre found the number of compulsory treatment orders is increasing by 10% a year and that more psychiatric medicines than ever are being dispensed.

Meanwhile, polling shows that 95% of NSUN members say the mental health strategy is failing, 80% believe mental health services are getting worse and 93% reported that the government’s changes to the welfare system have had a detrimental impact on their wellbeing.

So what has gone wrong? Let’s start at the beginning. Lansley and Burstow wrote: “By promoting good mental health and intervening early, particularly in the crucial childhood and teenage years, we can help to prevent mental illness from developing and mitigate its effects when it does.”

Unfortunately, this message did not seem to get through to the Department for Education (DfE) with then schools minister Nick Gibb describing social and emotional education as “ghastly” and “peripheral”.
The DfE then removed ‘wellbeing’ from the Ofsted inspection regime leading to the wholesale closure of school counselling services and the dropping of resilience training for children. Although the strategy clearly links mental and physical health, the DfE also scrapped minimum nutrition standards for academies and ‘free’ schools leading to 90% of them feeding their pupils junk food. This fact was revealed by the Schools Food Trust annual survey, which itself was then axed.

Widening inequality gap
The strategy said “empowering local organisations” was key to success but as councils’ budgets shrink by an average of 40% many have fallen by the wayside. Audit Commission research says the local authorities with the most deprived populations, and therefore the greatest mental health needs, have carried a greater cuts burden than more affluent areas. This disparity is reflected in funding settlements that gave the City of London, Westminster and Kensington and Chelsea more public health money per head than anywhere else in the country.

If NHS England’s plan to redistribute clinical commissioning group money by a new formula reflecting age rather than deprivation goes ahead then this gap will widen further. Research from the University of Durham says the new formula to allocate money for health services could promote “substantial” inequality – Camden for example will lose more than a quarter of its funds while parts of Hampshire gain 14%.

On the positive side efforts to tackle stigma have been well-resourced, high profile and do seem to be shifting perceptions. At a national level mental health charities have worked brilliantly together to do their bit to implement the strategy’s laudable aims. Together we have produced: the No Decision About Us Without Us service user guide to the strategy that is so popular it is being reprinted, the Mental Healthwatch scheme, the local authority mental health challenge and piloted some innovative work.

These positives, however sparse, may point the way to a brighter future. Results have been achieved when resources have been made available nationally and locally to people and charities with experience of mental health conditions. If we are serious about implementing No Health Without Mental Health then we need to fairly distribute the resources we have and give real power to the people and communities who are being so ill-served by diminishing services.

This article first appeared as the ‘Network’ column in the January/February 2014 issue of Mental Health Today. For more information on the magazine, and how to subscribe visit:  

Audit Commission (2013) Tough Times 2013: Councils’ responses to financial challenges from 2010/11 to 2013/14. London: Audit Commission.
Department of Health (2011) No Health Without Mental Health. London: DH.
Health and Social Care Information Centre (2013) Inpatients Formally Detained in Hospitals Under the Mental Health Act 1983 and Patients Subject to Supervised Community Treatment, England 2012–2013, Annual figures. London: HSCIC.
Mental Health Foundation (2012) No Decision About Us Without Us. London: MHF.
University of Durham (2013) New health funding proposal is “misguided” (press release) [online]. Durham: University of Durham. Available at:  

About the author
Edward Davie is communications and public affairs manager at NSUN network for mental health.