Prioritising mental health commissioning is brave, but it’s also sensible

Sean's blogOriginally posted in the HSJ blog Leadership in Mental Health, 15 March, 2011

HSJ recently told us that “brave” GPs in Brighton had chosen mental health as their first priority for commissioning.

The decision to focus on mental health care is indeed a brave one. But it is also one that makes a lot of business sense for any GP consortium, big or small, urban or rural, anywhere in England.

Mental health issues account for 23 per cent of all GP consultations and will figure in many more. Mental health services account for one pound in every eight the NHS spends, making it by far the biggest single programme budget.

Commissioning of mental health services has been widely criticised, not always fairly, but with some justification. Some primary care trusts in the past cut mental health care budgets to balance their books, most notoriously when many acute trusts overspent following the arrival of the tariff system in 2005. There is doubtless a risk they will do the same again in the absence, for now, of a tariff for mental health care.

So why not focus on mental health first? What other area could be considered more deserving of GPs’ attentions nor more important in terms of the overall health and wellbeing of the people they serve?

There are, of course, a lot of concerns about the ability of GPs to commission for mental health. A Rethink survey last year found that few GPs feel confident in their ability to commission mental health services.

Mental health services come with added complexities: they cannot all be parceled up into short, discrete ‘episodes of care’. Specialist services are provided jointly by health and social services, often with the involvement of voluntary and community organisations, especially to reach those for whom mainstream services are not enough.

Many people with mental health difficulties have a range of other needs, for drug and alcohol misuse for example, for help into employment or with welfare benefits. And children and young people’s mental health services are often run separately, on quite different lines with different partners such as schools and child protection services.

These are some of the factors that make commissioning mental health care a complex task. But there are plenty of opportunities to do it better and in so doing improve the mental health of the community as a whole while raising the life chances of those with mental health problems.

The government’s mental health strategy set out some of those opportunities: to invest for the first time in public mental health activities such as parenting support for vulnerable families; to build up a full range of evidence-based psychological therapies for all who need them; and to give everyone who uses mental health services the right support to get into paid work.

Brighton has its advantages in this regard, of course. It has a unitary council and if the GP consortium is coterminous with the local authority it makes a lot of the new arrangements easier to manage: a director of public health for the one area, a single Health and Wellbeing Board, many more opportunities for pooled and place-based budgets.

So are Brighton’s family doctors brave to take on mental health so soon? Maybe. But maybe the truth is they are just doing the right thing and in doing so, setting an example for many others.

HSJ Blog

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