Last month on this blog I wrote that addressing the challenge of mental ill health over the coming years would require different systems and organisations to work together in a more cohesive way. In practice, this needs to include linked performance management across the NHS, social care and public health using clear and achievable measurements, access to local support, continued efforts to fight stigma and better training for a broad range of professionals, among others.
I also suggested that clear leadership and direction were needed to ensure that the overall aims set out almost 18 months ago in No health without mental health stood a better chance of being achieved. Today’s publication of the mental health strategy’simplementation framework marks the next stage of development of this work – although more detail is still to come.
Measurement of success is of course crucial in showing commissioners and providers whether they are on the right track. Notably, the framework also announces a new mental health dashboard, which will provide a picture of overall progress towards implementing the mental health strategy. This is due to be launched this autumn and will bring together the most relevant measures from the NHS, Public Health and Adult Social Care Outcomes Frameworks, together with additional indicators. How the overall success of No health without mental health will be measured still remains therefore a little opaque. In addition, it is not clear how the NHS Commissioning Board will be held to account on the basis of the recently published mandate which includes the ambition of making mental health on a par with physical health.
One of the criticisms of No health without mental health has been how aspiration will be translated in to action at local level. In response to this, one of the themes which emerges today is that of local leadership. Clinical commissioning groups and local authorities are encouraged to appoint individuals to take the leader for local mental health. The preparedness of local authorities is an area that we looked at last year in our report Ready for Health which found a varied picture. In addition, our Atlas of variations in social care shows that funding flows from the NHS to social care suggested a relative under-prioritisation of mental health in some areas. It will therefore be interesting to see how the role of elected ‘mental health champion’ makes a positive impact at local level. The answer may be that pioneers in some areas will lead the way.
An important role for health and wellbeing boards is also identified in terms of forging local partnerships, identifying local needs and in ensuring parity between mental health and physical health in approach. During the Government’s NHS reform process, health and wellbeing boards have been regularly cited as one of the many answers to improving integration and make local services more responsive to local needs. For example, as my colleague Stephanie Bell wrote previously on this blog “Hopes are pinned on local authorities and Health and Wellbeing Boards to identify local needs and to stimulate an integrated commissioning response that satisfies the needs of people with, or at risk of, mental health illness.”
Although active in many areas in shadow forms, it may however take time before the transformative impact of health and wellbeing boards will be seen in terms of mental health being fully reflected in local needs assessments and commissioning plans. It is positive, however, that mental health has been recognised as one of the eight priority commissioning areas in the CCG authorisation process. In turn, it may take many years to be able to clearly identify their impact through improved local services and better experiences for people accessing services locally. The framework recognises these challenges. Employers, schools, businesses, local authorities, housing organisations, voluntary groups and health and care organisations are all identified as having a role to promote good mental health at local level.
Although actions are identified for different organisations, the implementation framework perhaps could have benefited from spelling out more clearly what practical tools each could use to help them play their part. Each organisation has much to do in order to prepare itself for new responsibilities. And as the new health and care system takes shape, for many individuals, it will still be a case of trying to navigate their own way to secure access to the best possible (and available) mental health care.