Mental health under pressure – King’s Fund appraisal

Introduction

Mental health services in England have a history of transformation – replacing long-stay
institutions with care in the community, diversifying services to focus support on people
with specific needs, and extending access to evidence-based mental health treatment to
those in primary care. In recent years, a new wave of transformation programmes has
emerged that aims to shift provision from a ‘medicalised’ system of delivering care and
treatment to one that focuses on the principles of recovery, with services and the
workforce redesigned to reflect that focus.

NHS England commissions mental health services at a national level, ensuring the
provision of specialised care for the small groups of individuals who require it. Clinical
commissioning groups (CCGs) and local authorities commission local provision for people
in the community, who constitute the majority of those with mental health conditions; this
also allows for the provision of support beyond that of health services.

King's Fund

The last population survey of mental health found that 17.6 per cent of the English
population aged between 16 and 64 meet the criteria for one or more common mental
health disorders, while 0.4 per cent experienced a psychotic disorder (McManus et al
2009. In 2014/15 1,835,996 people were in contact with mental health services – an
increase of 4.9 per cent from 2013/14 (Health and Social Care Information Centre 2015b).
Approximately 1 adult in 28 was in contact with secondary mental health services.
Ministerial support for mental health, from Norman Lamb among others, has resulted in a
renewed focus on mental health policy. A government mandate for parity of esteem
between physical and mental health (Department of Health 2013) has been followed by
the identification of priority areas for improvement, and the subsequent introduction of
access standards in line with those in the acute sector (Department of Health 2014). Each
has sought to put mental health on an equal footing with physical health. However, voices
from across the mental health sector are warning of a crisis.

Funding has been put at the heart of those concerns. There is a marked disparity between
the level of funding for mental health services and the impact that mental health problems
have at a population level, and there has been a notable reduction in funding to NHS mental health providers since 2010/11. On the surface, however, the finances of NHS
mental health providers are relatively healthy compared with those of acute providers.

Another area of concern is the quality of care. Stories highlighting examples of poor care and poor outcomes have dominated media coverage on mental health in recent years: patients waiting months for talking therapies, patients in crisis being told that there are no beds available, and patients receiving little or no support for physical health care conditions. These stories span all types of provision, and their frequency suggests that quality of care is a systemic issue.

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