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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee

 
 

Press Comment Mental health services are still like having ambulances for only half the country

2020health welcomes the emphasis on parity of esteem, practical whole-life support and reducing inequalities at the centre of the Mental Health Taskforce’s report, out last week. The report contains 58 recommendations, and we welcome the government’s commitment to an extra £1bn investment in services, in the workforce and in data collection for informed decision making.

Julia Manning, Chief Executive of 2020health said:
“Real progress is being made on reducing the stigma and increasing the understanding of mental health. Anyone with experience of mental illness, either through their work family or friends, knows that there is a dual investment problem: inadequate prevention and early intervention, and insufficient provision for those with established mental illness."

“The recent figures showing a 21% increase in suicides amongst mental health patients in England over the last 3 years¹  is a heart-breaking reminder that demand for support and treatment is not being met. There is massive variation in services across the country, and the only time you find out whether you are in an area that actually has a service is when you or someone close to you needs help. This is a scandalous situation which if it were the case for ambulances, would be causing national outrage."

“The report calls for a fully-costed workforce review to be undertaken, but nowhere in the report do they estimate the actual cost of providing a quality service across the country, so that as when you call for help from the GP and ambulance service, you know there will be the appropriate person to assist you."

“An extra £1bn sounds a lot but budgets over the past few years have been cut² so this could simply be a return to previous levels of spending. Budgets are so fragmented between  CCGs, Local Authorities, NHS England and Innovation funds it is difficult to know what the true figures are. What we do know is that up to 13% of the NHS budget went on mental illness, when it constitutes 23% of the burden of disease. A £1bn increase is less than a one per cent increase in spending on mental illness (total NHS Budget £113bn)."

On reducing inequalities:
“We understand that this is a five year plan and that the authors have wanted to keep their demands realistic, but they have missed the opportunity to alert the public to the massive gulf in provision of services for people with mental illness. Even if everything this document ask for is delivered by the government, we would still have 40% of people not getting support when they first experienced psychosis (Recommendation 16), and we wouldn’t know whether there was enough provision for women with post-natal depression or men with anxiety or those living with severe mental illness  (Recommendations 14, 15 & 19). As the Report says itself, we simply don’t have the data in many cases to know what the level of need is."

“What we do know is that there aren’t enough doctors³, especially for children, and stricter criteria for giving help to young people means that fewer children are getting the help that they desperately need. However there are evolving, effective digital interventions and we are glad that promoting these have been supported (Recommendation 28)."

On practical whole-life support:

“In 2020health’s 2015 Head of Wellbeing report(4), we described the concept of a senior, strategic, full-time coordinator of whole-school wellbeing who would prioritise prevention and early intervention. A named mental health lead is not enough. We think especially that there is a real opportunity for using new digital technologies such as apps for anxiety and online support forums that are second nature to young people. We remain convinced that a Head of Wellbeing position could bring about game-changing improvement in the mental and emotional experience of young people, and their teachers."

On parity of esteem:
“In our Whole in One report on depression (2015), we also called for more community based therapy, better collation of evidence and data and support in the workplace, so we are pleased to see this reflected by the Mental Health Taskforce. However if they were serious about parity of esteem, they would have asked as we did for NICE guidelines (purely advisory) to become recommendations (which carry legal weight). At present, only advisory guidelines appear to apply to all treatments (including medicines) for depression, as well as service access and treatment pathways (see NICE guidelines [CG90]) (5)."

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Our Key points:
•    £1bn sounds a lot but it could simply be returning us back to previous spending levels
•    Criteria for referral to CAMHS is not mentioned at all; access to CAMHS is severely restricted as the workforce is so overstretched – what improvement can parents and schools expect to see?
•    We need to know what all agencies with budgets for mental illness are spending on mental health, year on year, not just CCGs
•    Prevalence surveys once every seven years on mental illness not frequent enough – we haven’t done a survey on children since 2004
•    Government should calculate the national need and budget for tier 2, 3 and 4 mental health services so the public understand the level of need and cost

Report References:
Costs
Page 3
•    Mental health problems represent the largest single cause of disability in the UK. The cost to the economy is estimated at £105 billion a year – roughly the cost of the entire NHS.
Page 4
•    For example, in the case of Type 2 diabetes, £1.8 billion of additional costs can be attributed to poor mental health. Yet fewer than 15 per cent of people with diabetes have access to psychological support. Pilot schemes show providing such support improves health and cuts costs by 25 per cent.
Inadequate provision
Page 4
•    Fewer than 15per cent of localities provide effective specialist community perinatal services for women with severe or complex conditions, and more than 40 per cent provide no service at all.
Page 7
Mental health accounts for 23 per cent of NHS activity but NHS spending on secondary mental health services is equivalent to just half of this.
Page 9
•    The Care Quality Commission (CQC) found that just half of Community Mental Health Teams (CMHTs) are able to offer a 24/7 crisis service today.
•    Only a minority of A&E departments have 24/7 liaison mental health services that reach minimum quality standards, even though peak hours for people presenting to A&E with mental health crises are 11pm-7am.
•    There has been no improvement in race inequalities relating to mental health care since the end of the 5-year Delivering Race Equality programme in 2010.
Page 11
•    The provision of psychological therapies for people with common mental health problems has expanded hugely in recent years. But it is still meeting only 15 per cent of need for adults.
Page 24
•    Comprehensive liaison mental health services are currently available in only one in six (16 per cent) of England’s 179 acute hospitals. The situation is better for paediatric mental health liaison, with 79 per cent of hospitals reporting cover, but these frequently do not operate out of hours.

Comment * on Recommendation 14:
NHS England should invest to increase access to integrated evidence-based psychological therapies for an additional 600,000* adults with anxiety and depression each year by 2020/21 (resulting in at least 350,000 completing treatment), with a focus on people living with long-term physical health conditions and supporting 20 000 people into employment. There must also be investment to increase access to psychological therapies for people with psychosis, bipolar disorder and personality disorder.

*In 2013/14 just over 700,000 individuals were treated by IAPT services; 319,904 individuals who were initially recognised as ‘clinical cases’ finished a course of treatment; 143,833 (45%) were diagnosed as recovered (HSCIC, 2014a) (6)

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¹Mental health deaths in NHS up by more than a fifth over three years, new figures show- http://www.independent.co.uk/life-style/health-and-families/health-news/mental-health-deaths-in-nhs-up-by-more-than-a-fifth-new-figures-show-a6834196.html
²http://blogs.channel4.com/factcheck/factcheck-mental-health-budget-cut/20617 e.g. 43 out of 56 mental health trusts in England surveyed found there had been a real terms cut of 8 per cent in funding between 2010/11 and 2014/15, worth around £600m
³MHT Page 35: Health Education England indicate a 6.3 per cent vacancy rate for NHS consultant psychiatrist posts, and over 18 per cent of core training posts in psychiatry are currently vacant. Psychiatry has the slowest rate of growth and the highest drop-out rate of any clinical specialty. Between 2013/14 and 2014/15, referral rates increased five times faster than the Child and Adolescent Mental Health Services (CAMHS) workforce
(4) Manning J and Paxman J: Head of Wellbeing – an essential post for secondary schools? 2015
(5) 2020health: Paxman J and Manning J: Whole in One: Achieving equality of status, access and resources for people with depression 2015 - page 34 
(6) 2020health: Jon Paxman and Julia Manning: Whole in One: Achieving equality of status, access and resources for people with depression 2015 Page 15

2020health Report Whole in One: Achieving equality of status, access and resources for people with depression

Whole in One: Achieving equality of status, access and resources for people with depression

This report focuses on depression in adults, with particular emphasis on access to NHS services and treatment, the funding of services, depression in the workplace, and the role of the National Institute for Health and Care Excellence (NICE). read on Whole in One: Achieving equality of status, access and resources for people with depression