Yesterday’s debate in Parliament on mental health was a welcome reminder of the positive impact that our elected representatives can have on issues that matter to people’s day-to-day lives. A number of MPs, notably Kevan Jones, spoke candidly, and at times emotionally, about their own experiences of mental health issues including depression and OCD, reminding us that in some respects, as individuals they are not so different to the constituents that they serve. As Nicky Morgan MP said yesterday: “mental ill health is no respecter of age or background”. The debate was far removed from arguing over breaches of the Ministerial Code, who’s been texting who or which country supper party the Prime Minister may or may not have attended. The cross-party group of MPs who took part yesterday should be commended.
The challenges of mental health facing the UK were well documented in last year’s mental health outcomes strategy No Health Without Mental Health. Given the scale of the challenges, however, it’s worth restating them. At least one in four of us will experience a mental health problem at some point in our lives and one in 100 live with serious mental illness. Mental ill health represents up to 23% of the total burden of ill health in the UK. A recent report from The King’s Fund and the Centre for Mental Health found that in terms of NHS spending, at least £1 in every £8 spent on long-term conditions is linked to poor mental health and well-being – between £8 billion and £13 billion in England each year. And beyond the immediate health impacts, the Centre for Mental Health has estimated the costs of mental health to the whole UK economy at £105.2billion.
Although the scale of the impact of mental ill health is well known, for many people the stigma caused by attitudes towards mental health is a barrier to seeking assistance or treatment. Yesterday’s debate played an important part in raising awareness and should help to address that challenge. The Time to Change campaign has played a vital role in this area as have a series of contributions from people in the public eye – from Alastair Campbell’s blog to cricketer Andrew Flintoff’s documentary The Hidden Side of Sport to Stephen Fry.
If stigma is being (slowly) addressed then it’s important to consider how well equipped the health and care system is to meet the challenges. In the current NHS reform process, it is difficult to argue that mental health has been neglected. Mechanisms are being put, or already are, in place to ensure high quality care for people with mental ill health. A quality standard for depression in adults was one of the very first to be launched. Mental health indicators are included in the interlinked NHS, adult social care and public health outcomes frameworks (in recognition of the broader care interventions required to address mental health) and in the draft commissioning outcomes framework. In many ways, the ‘system‘ is being put in place to work – although how success will be measured and performance addresses in practice remains to be seen. But will this be enough to deliver better care?
Some will suggest that it’s all very well having ‘levers’ in place but what about the money to make change happen? Given current economic pressures, there have been reports of service cuts and funding pressures in some areas but this has proved very hard to quantify – as Rethink’s recent Lost in Localism report demonstrates. However, MHP Health Mandate’s own report An Atlas of Variations in Social Care found that just 4% of the additional £648 million allocated by the Government for social care in 2011/12 was spent on mental health services.
Addressing the mental health challenge requires several things to work together: money will play a part; training will be important; and performance management across the NHS, social care and public health systems will be vital to ensure that care is directed towards achieving better outcomes.
Clear leadership and direction will also be critical and the imminent publication of the implementation plan for No health without mental health will be an important stage in clarifying the roles of NHS commissioners, providers, frontline staff, public bodies and employers in delivering better mental health across all care settings. However, what will be more important are clearer metrics to measure the success of the strategy – and work on those is underway.
The biggest factor to effect meaningful change however is still one of attitudes. One of the late amendments to the Health and Social Care Act was the inclusion of parity in promoting improved physical and mental health. This was an important political (as well as legal) signal and yesterday’s debate helps support these aims of parity. I’d like to say well done to Nicky Morgan, Kevan Jones, Charles Walker and the other MPs who played their part yesterday and acted on something meaningful which affects many people across the country.