Rising to the scale of the challenge: time for new thinking on tackling mental health

Isabel Lawicka

As Mental Health Awareness week draws to a close, this blog questions whether ‘parity of esteem’ is an outdated policy ambition and whether we should be looking at mental health through a different lens altogether.

There has been much discussion in recent years about achieving ‘parity of esteem’ for mental health – in other words, ensuring that it receives the same attention, investment and ‘status’ as physical health in policy and frontline decision-making.

Experts and commentators have rightly started to challenge whether looking through the lens of ‘parity of esteem’ is still helpful. Poppy Jaman OBE, Chief Executive of City Mental Health Alliance, speaking on a recent King’s Fund’s podcast, has argued that we instead need to be talking about “making progress towards equality for mental health”. But is there a more fundamental problem with drawing a comparison with physical health?

It seems right in the current context that we should be asking difficult questions about how, as a society, we can best improve and manage the nation’s mental health. Debates over funding levels continue but no one can deny that the issue has achieved greater status on the UK’s policy agenda in recent years. A series of high-level commitments, including from the Prime Minister, have set out a vision of targeted investment and new policies, several focused on children and young people.

And yet, only a quarter of this age group who require mental health support are able to access the help they need. This is at the same time as the government reports it is spending record amounts of taxpayers’ money on mental health services. A recent National Audit Office report found that even if current Government initiatives are delivered as intended, there would remain significant unmet need amongst young people. This is a topic Ibrahim Zafar has explored on our blog recently.

It is clear that a new approach is needed, and not one that simply ensures mental health is able to ‘catch up’ with physical health in terms of how we treat and prioritise it. This is of course important but a greater ambition is surely necessary. The forthcoming prevention green paper and initiatives like the prevention concordat for better mental health seem to be a step in the right direction, with the expectation that these will lead to greater cross-sector working. But effective prevention – at both primary and secondary level – inevitably takes time, investment and parallel accountability across different public bodies.

I was interested in the progress of mental health initiatives being driven outside their traditional home of the health sector and whether these pointed to a positive future for cross-sector prevention and management of mental health. I therefore canvassed opinion from a small group of teachers and their insights were fascinating.

Those I spoke to returned a resounding ‘yes’ when asked about whether recent stats on rising mental health referrals and prevalence in young people was a trend they recognised. They also spoke about challenges and significant variation in the availability of mental health training for teachers, even for those in pastoral roles. Interestingly, some mentioned that teachers’ roles in this area aren’t clearly delineated and voiced concern about being seen as a ‘frontline’ service. This quote struck me as particularly pertinent to the prevention agenda:

“The government must find a way of better funding support services for young people regardless of their background otherwise they will live with mental health concerns later on in life and be reliant upon the NHS, which is under enough strain as it is.” (From a head of year at a London secondary school.)

As part of a new government initiative, 25 trailblazers will launch a total of 59 mental health support teams in schools and colleges across England this year. This aims to establish early intervention models and provide the right support to staff, to transform children and young people’s wellbeing.

Initiatives like this may help to address some of the concerns raised by the teachers I spoke to.  And, if successful, should pave the way for tackling mental health in a way that goes beyond parity of esteem. A true cross-sector approach is clearly required but this will only be achievable if more individuals and organisations, across both the public and private sectors see mental health as falling firmly within their remit and that they are equipped to do something about it.