Analysis

Levelling Up Mental Health

Sophie Heywood

Mental health has grown on the agenda in recent years, with inclusion in the NHS Long Term plan, the Government’s Levelling up initiative and we are now seeing reforms to the Mental Health Act. However, with systemic pressures on the health system worsening from the pandemic, will these moves to extend service provision be implemented?

We have seen the broadening of mental health strategies across Government in recent years. Mental health is now gaining in prominence within key Government policy thinking and NHS planning. Greater media commentary and public discussion of emotional welfare has been highlighted within this year’s Mental Health Awareness Week, 9-15 May.

Mental health has become an integral part of Government’s strategic thinking, intersecting other non-health priorities. The announcement of the Government’s Levelling up agenda this year demonstrated the breadth of coverage, from housing to transport for instance. Specifically for health, it aims to reduce disparities and ensure that no matter where you live, you can access appropriate healthcare. However, the white paper says very little about mental health directly. Whilst one of the 12 ‘missions’ the document hopes to achieve by 2030 is an improvement in ‘wellbeing’ across every area in the UK, it provides no detail about the actions to be taken in addressing this. Crucially, little recognition was given to the influence of poverty and wealth inequality, with no policy pledges to improve social security.

Nonetheless, we know that achieving good mental health is directly linked to Government decisions. Decisions about the economy, education, the built environment and justice all have a substantial impact.

This drive to reduce variation and health disparity between local areas has been seen within recent policy strategies to improve health outcomes across England. The 2019 NHS Long Term Plan, which set out key commitments to tackle health inequalities, emphasised the inclusion and enabling of equal access to services for a wide range of health conditions. The commitment to extend access to mental health support for more children, young people and young adults up to age 25 is promising, especially for people with most serious and long-term conditions. However, the plan must invest in public health, social care, early years and youth services, since it is limited by its applicability to only the NHS.

Good mental health support relies on effective social care working in an equal partnership with the NHS in every local area in England. To improve mental health services alongside cardiovascular disease, cancer, respiratory and maternity, NHS England is driving the Core20PLUS5 initiative to level up healthcare for the poorest 20 per cent of the population. A consultation was opened in April to aid the delivery of the new cross-Government 10-year plan for mental health and wellbeing in England. It has been framed within its wider strategy to reduce health inequalities and level up services across the country.

March 2021 marked the initiation of the Mental Health Recovery Plan, backed by £500 million. This is part of the wider Government agenda to ‘build back better’ from the pandemic, ensuring patient access to care by accelerating the expansion of community mental health services. Its aim is to promote cohesion between primary and secondary care, including specialist mental health staff embedded in primary care, offering greater access to psychological therapies as well as disability diagnostics for example. £3 million was set to support the Mental Health Act Reform to increase capacity in the workforce and revise methods used to test the quality of care and provide appropriate advocacy. The Queen’s Speech last week referenced measures that will be introduced to facilitate changes to the mental health agenda of the nation. This builds on the White Paper, published in January, which was set to reform the Mental Health Act from 1983. The reworking of the Mental Health Act is an opportunity to input the significant research and more common understanding of mental health conditions, which has drastically changed over the last 40 years.

Whilst these moves to amend previous mental health policies and structures over recent decades shows the progress in acceptance and understanding of the breadth of mental health conditions, it still remains to be seen if a stretched NHS workforce is able to follow through the implementation of reforms. Public health funding to local councils having been cut by 24 per cent since 2013, facing below-inflation settlements for the coming three years, which will hinder actions taken at the scale necessary to increase life expectancy or reduce health inequalities. Only 61 per cent of urgent cases were treated within the one week target, and just 67 per cent of routine cases were treated within the four week target between April 2021 to March 2022. These are the lowest annual percentages since records began in 2016/17.

The patient pathway is impeded, diagnostics and specialist treatment have been cut across many conditions. But the question that still stands is, will the NHS have the ability to deliver on these ambitions in a capacity and resource constrained environment?