pauljenkinsIn this guest blog, Paul Jenkins, CEO of Rethink Mental Illness, look ahead the Comprehensive Spending Review, and what it could mean for people with mental ill health.

We live in challenging times. The upcoming Comprehensive Spending Review is unlikely to make cheery reading for any group in society. However, even in these tough economic times, there are some important decisions that have the potential to make a huge difference to people with mental illness and their families.

The right choices could, despite the constraints of austerity, help us get closer to the aspiration of putting mental and physical healthcare on an equal footing. The wrong ones could further widen the gap.

The four key areas I will be watching out for on Wednesday are:

Health - There is a general expectation that the NHS budget will be “protected”. Whether or not this represents real terms protection is doubtful, but the fact remains that the NHS will face much lower pressures than other public services. For this we should be grateful. 

However within this overall position much more needs to be done to protect the resources available for mental health. Mental health budgets have already seen two years of reductions that have exacerbated the already massive gap between the level of demand on the NHS which mental health represents (23%) and the proportion of the NHS budget it gets (13%). 

There is no doubt that cuts are beginning to bite into frontline services and parts of the system are beginning to creak. The 9,000 people with mental health problems in crisis inappropriately being held in police stations are a clear example of that pressure.

Ministers must also make sure resources are found to deliver their own commitment to improve access to psychological therapies. This is not a ‘nice to have’. The gap in access to talking therapies is the equivalent of saying to a cancer patient that they can have chemotherapy but there is a two-year waiting list for radiotherapy.

Social care and housing - These areas have taken some of the heaviest cuts over the past couple of years and there are major gaps opening up which are putting vulnerable people at risk. Disproportionate cuts here are short-sighted. In the long-term, they are only likely to lead to more people entering crisis and needing the most expensive kinds of care further down the line.

Welfare and employment – People with mental illness have been particularly penalised by the double whammy of being put through a new benefits test, which discriminates against them and being let down by the blatant failure of the Work Programme to help those who can work, find employment. 

Much of the cost of mental illness to society is due to unemployment, so it would not only benefit people with mental illness, but also wider society to give them the support they need to find work. Current approaches need a serious rethink and it is crucial that good public policy is not compromised by cheap political rhetoric or short-term financial pressures.

Criminal justice – I had hoped that the need to save money in the criminal justice system would drive a more rational approach to policy in this area. This would mean a much greater focus on effective community sentences rather than short spells in prison, which are expensive and ineffective. It would also make sense to put greater resources into addressing underlying issues such as mental illness and substance misuse, which can stand in the way of breaking the cycle of offending. 

The political messages have been mixed in this area and it will be crucial that the Spending Review provides support for practical initiatives such as the roll out of diversion and liaison teams, which help reduce the need for expensive prison places.

I don’t look forward to Wednesday with the greatest optimism, but there are choices which can be made which will make a huge difference to the lives of people affected by mental illness. I hope Mr Osborne and colleagues will make at least some of them.