The Health and Social Care Act earlier this year included a new requirement on the secretary of state for health to give equal prominence to physical and mental health. This week, a report published by the LSE has reminded us of quite how big a task this is.
The report, How mental illness loses out in the NHS, notes that mental ill health accounts for 23 per cent of the ‘burden of disease’ in the UK yet it receives just 13 per cent of NHS funding. At a total of £14bn a year, spending on mental health care is of course a major cost to the health service. Yet to put that in context mental ill health represents almost half of the total amount of illness among working age adults, three quarters of whom never receive any treatment for it.
The cost of failing to deal with mental ill health vastly outweighs what we currently spend on mental health care. The NHS alone spends some £8bn extra treating long-term physical conditions among people with co-occurring mental health problems and another £3bn on treating people with ‘medically unexplained symptoms’, many of whom may have an underlying psychological need. Mental ill health among the NHS workforce costs the service another £1bn.
At the same time, of course, the NHS is being asked to make savings of at least £15bn over five years. As the LSE report argues, investing wisely in improved mental health support – particularly for those who currently receive little or no attention – could help the NHS to reduce its overall costs while improving health and quality of life for people of all ages.
The largest current area of NHS mental health spending is on services for working age adults with severe mental illness. Many of these services are under considerable financial pressure, with the requirement to make savings affecting both their immediate and their long-term plans.
At the same time, many mental health trusts are taking important steps to become more Recovery-oriented in the services they offer. Recovery Colleges, for example, are now opening in a number of trusts across England, offering a very different approach to the way service users (and their families) are supported to build lives outside illness. As a briefing paper published this week by the Centre and the NHS Confederation notes, Recovery Colleges can bring about far-reaching changes to mental health services as well as to the lives of the people who learn (and teach) in them.
The current cost pressures on the NHS and the movement towards Recovery have entirely separate, and quite different, origins. Yet their coincidence in time carries major risks as trusts take steps to enhance their Recovery orientation while also being required to cut existing services; all at the same time as many service users are being reassessed for their benefit entitlements and finding themselves worse off financially, too.
These are challenging times for mental health services. Exciting new opportunities lie ahead in achieving the objectives of the government’s mental health strategy – such as extending access to psychological therapies, refocusing on Recovery and developing liaison and diversion services. Yet financial pressures continue to weigh heavily on these developments and threaten to blunt their impact and undermine their value.
The LSE’s reminder of the extent to which we still under-invest dramatically in mental health comes as a timely reminder that we need to be bolder in making the case for more and better mental health support, when and where it is needed, offering the kind of services people want.