Ruth Patrick has identified some encouraging signs with more positive attitudes and perception of mental health, but under-funding and ongoing cuts to services shed a less positive light.
For years, describing mental health as the ‘Cinderella’ of NHS provision was commonplace, an easy shorthand for the chronic under-funding and poor levels of mental health care. Fast forward to 2015 and at Westminster we have the first ever appointment of a Shadow Minister for Mental Health, with Luciana Berger taking up this role in Jeremy Corbyn’s new shadow cabinet. Each of the major political parties’ manifestos for the year’s General Election included specific commitments on mental health, an important sign that mental health is having its day in the limelight.
While it would be churlish not to welcome the increased profile and attention that mental health is currently attracting, it sits alongside ongoing issues of poor and inadequate provision and support for those living with mental health challenges. The capacity to access appropriate treatment for one’s mental health has been dealt a serious blow by a series of cuts to provision, such that Paul Farmer, Chief Executive of Mind, describes mental health services as “veering towards crisis”.
Mental health services in crisis
Bed numbers have been cut by 2,100 (nearly 10%) since 2010, with over 3,300 specialist nurses losing their jobs over the same period. A recent BBC Panorama investigation noted that cuts to mental health services are far bigger than cuts to other acute services, a challenge to politicians who promise to secure ‘parity’ between physical and mental health care. Those accessing services report being sent hundreds of miles away for treatment, with knock-on effects for their capacity to draw upon vital support from family and friends. There are reports of very ill and vulnerable adults and young people being held temporarily in police cells when a bed on a mental health ward cannot be found, a damning indictment of the level of care (un)available in one of the richest countries in the world.
At the same time as those living with mental health challenges have to navigate persistently under-funded forms of health support, they are also having to cope with and respond to the ongoing welfare reforms that seek to ‘encourage’ (I might say compel) all but the most disabled back into the paid labour market. Describing his priorities as Minister for Disabled People to Disability Now, Justin Tomlinson MP explained:
“Almost a quarter of people claiming Jobseekers Allowance have a mental health condition. Whether mental health is a cause of joblessness, or the result, we want to support these people…We’re investing £40m to introduce a range of pilots to identify how best we can support people with mental health conditions in looking for work. We know that the vast majority of people with mental health conditions want to succeed in work, so we are giving them all the support we can.”
While the aspiration to support those with mental health conditions into work makes sense, there are real questions about whether appropriate and effective support is being provided. It is particularly difficult to see how cutting people’s Employment and Support Allowance (ESA) by £30 a week (for those in the Work-Related Activity Group) will do anything other than harm affected individuals.
The welcome policy focus on mental health seems to fit at best poorly, at worst not at all, with the day-to-day realities for those living with mental health issues in the UK today. Here, the example of waiting times for mental health care is pertinent.
Speaking in 2014, Nick Clegg committed the Coalition government to introducing waiting times for mental health care and support. This commitment has been inherited and taken forward by the Conservatives, who will introduce waiting times targets from next year. This move must of course be welcomed, but look at the detail and it is a modest and insufficient measure. The targets are unambitious, particularly for those with the most serious mental health issues. For example, there is a target that more than 50% of those experiencing a first episode of psychosis should receive treatment within two weeks. As someone who has been unlucky enough to experience psychosis this target is almost laughable. If you are psychotic, urgent help is needed, not within 14 days, as you could be at immediate risk to yourself and others. Further, what is to happen to the 49% experiencing psychosis who do not receive treatment within two weeks? Not good enough, politicians. Not good enough by a long shot.
Mental health services in Scotland
While the appointment of Luciana Berger was hailed south of the border, up in Scotland they have had a minister for Mental Health (albeit with a portfolio which includes Sport and Health Improvement) for over a year. Jamie Hepburn MSP holds this brief, and mental health is a devolved area of policy, meaning the Scottish Government has complete discretion over its policy approach and focus. Talking to Disability Now about his role, Jamie explained:
“I’m proud to be the first Scottish minister with mental health in my job title. However, while this is a sign of how seriously we take this issue, I want us to be judged on actions and not words. Mental health has deservedly moved up the agenda and that’s something we can all welcome.”
Speaking from Scotland where he works for ACUMEN, a service user and carer network, David Wright reflected on the advantages of mental health having a higher profile:
“The difference mental health as a higher priority is having, at least psychologically, is a very positive thing. There is a perception change in the public profile, and I suspect an impact on the dignity and self-esteem of volunteers and people with lived experiences. It’s not uniform but it’s there.”
While the Scottish Ministerial appointment is a positive one, although I still find the mental health – sport link up a bit baffling, it is interesting to note that Scotland actually spends a smaller proportion of its NHS budget on mental health than the rest of the UK (8.6% compared to 11.9%). But the Scottish Government have announced a new £100m five-year fund, and declare a commitment to further investment in this area.
Jamie Hepburn again:
“Yes, there are challenges, but we have also made great progress. Waiting times have decreased significantly, we have better data to drive improvement, and the number of deaths by suicide are their lowest level since 1977. This doesn’t mean we’re complacent. More progress is needed and we continue to work with health boards to attract more staff and bring waiting times down further. That’s one of the reasons why we’ve committed to invest an extra £100 million in mental health over the next five years. This funding will also be used to promote wellbeing, improve patient rights and develop better responses to mental illness in primary care… Mental health has deservedly moved up the agenda and that’s something we can all welcome. As treatment improves and the stigma of mental illness decreases, we will see more people coming forward to ask for help. I’m determined that we are able to meet that challenge.”
Arguably, mental health’s rise up the political agenda, and the Shadow and Scottish Ministerial appointments are to be welcomed, given that they demonstrate a growing recognition of both the scale of the issue and its central importance to the health and wellbeing of the British population. They also represent a campaigning win for charities, campaigners and service users who have long argued for more attention to be paid to this area of health.
As new Shadow Minister Luciana Berger put it when commenting on her appointment to Disability Now,
“Making mental health a dedicated and shadow cabinet level responsibility sends a powerful signal that mental health is not just a challenge for our health service. It a cross-cutting issue and it needs a cross-cutting response. This is a vital move and one that has much public support. In the first few weeks that I have been in post, I have been inundated with thousands of messages from people up and down the country. They are desperate to see a change in how our society approaches mental health.”
Reflecting on Berger’s appointment, Mark Brown, the former editor of One in Four magazine and director of Social Spider CIC is cautiously optimistic:
“There’s something strong to be said for a minister (or in Luciana Berger’s case Shadow Minister) for mental health. It’s a victory for the raised profile of mental health that there is political capital to be gained by addressing it. Even a shadow minister for mental health can help to bring texture and context to policy debates about mental health which, without an anchor in the real world of people’s lives, tend to fly off into rhetoric and abstraction.”
However, as Chris Young a campaigner who has lived experiences of mental ill health put it to me; “My home town, Corby, has a motto ‘Deeds, not words’ which I think applies rather well here.’ Until politicians do more to match their (sometimes) fine words with actions, there is every risk that mental health will remain the Cinderella of the NHS, in reality if no longer in rhetoric.”
Further, a problem will remain so long as the politicians do not do more to make sure that their own policy priorities are shared by the real experts on mental health; those who are living with, and have lived with, mental health challenges. Simon Bradstreet of the Scottish Recovery Network wants to see a braver and more ambitious mental health strategy:
“The increased political profile is welcome but it has to be aligned to an openness to consider new and alternative approaches to supporting people in distress. This means being open to stopping doing some things, to money and changing roles. That takes political bravery, and leadership and not just new job titles.