Mental health under pressure – King’s Fund appraisal
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.
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.
“To be safe in the UK these days, don’t be ill or become ill”