Mental health services and their partners face a challenging year in 2012. The introduction of payment by results in adult mental health care in England and the organisational changes taking place in the wider NHS are likely to create large-scale upheaval this year. Growing pressures on NHS budgets will also continue to affect mental health services, though hopefully not disproportionately. Alongside those pressures will be the increasing impact of cuts in local authority budgets, affecting not just social care but also housing and other key supports for people experiencing mental ill health.
Against this backdrop, it can be challenging to focus on improving the quality of care we provide or on the evident need to focus more effort on intervening early and integrating services across many different planes. While the Government’s mental health strategy has sent out a clear message in support of these objectives, there are too many competing priorities on the attentions on NHS leaders for that strategy yet to have taken effect on day-to-day decision-making.
With the new year inevitably comes talk of resolutions and new starts. Yet for mental health services in England new starts need to be accompanied by an awareness of what we do well already and are in danger of losing.
Early intervention in psychosis teams, for example, were developed under the National Service Framework for Mental Health and evaluations have shown the best of them to be highly cost-effective. Yet many of these teams are now being merged into generic community mental health teams and risk losing the distinctive approach that makes them so effective.
Likewise some assertive outreach teams are being cut at the very time that the creation of new and expanded diversion services for people in courts and police custody with mental health problems should be giving assertive outreach a vital role in sustaining support for people that other services find it hardest to reach.
We know that this year, and more likely than not the next few years too, mental health services have to do their part to achieve savings in the NHS budget and make the whole system more efficient. Yet in doing this it is vital we follow the evidence of what will achieve sustainable savings alongside improvements in the service people experience.
The NHS has the comparative luxury of a longer timescale to make these changes than say local government. Unlike most councils, it can reinvest money from less effective interventions to those that have the potential to offer better value long-term. This may include the creation of new and expanded liaison psychiatry services in general hospitals and the development of improved employment support in mental health services. But alongside these necessary changes we should at the very least be maintaining what works already, supporting staff who are working well in effective services and offering what stability we can in the midst of the maelstrom we know is to come.