Parity of esteem

Sean's blogOriginally posted in the HSJ blog Leadership in Mental Health, 14 August, 2012

Figures released at the end of July show just how big a task achieving that will be. Yet there are signs from outside the NHS that as a society we are starting to make some progress in improving understanding and attitudes towards mental illness and those who live with it.

The annual survey of investment in mental health services for working age adults showed that for the first time in a decade real terms spending on mental health services fell last year. The reduction was a relatively small one: 1% when compared with general inflation. Inflation in the NHS, however, tends to run much higher. And many people with mental health conditions rely on a range of services (for example for housing support, substance misuse and employment), many of which are also experiencing reductions in spending.

The publication last month of the implementation framework for the mental health strategy offered a reminder of the importance of investing in evidence-based approaches, in early intervention and in support for Recovery. On these issues the survey of investment provides a mixed picture. Spending on assertive outreach and crisis resolution services is falling but investment in psychological therapies and Early Intervention in Psychosis services is continuing to rise (if not at such a high rate as previously).

Secure mental health services, meanwhile, continue to grow and to account for almost £1 in every £5 we spend on mental health care.

The survey of investment focuses particularly on services for working age adults and there is a separate survey of services for older adults. The position of funding for child and adolescent mental health services (CAMHS) is not included in the survey but what evidence we have suggests that reductions in spending are occurring in several regions of England, especially to lower tier services (i.e. those with a greater emphasis on prevention and early intervention).

Spending reductions are not unique to mental health services of course. But mental health care already experiences a yawning gap between its share of the burden of disease and its share of health care spending, and news that a mental health services tariff is still some way from being ready makes it vulnerable to further ‘salami slicing’ from commissioners.

Far from the coalface of NHS commissioning, however, last month saw Channel 4’s enlightened and enlightening series of programmes aiming to dispel some of the longest standing myths about mental illness. From Jon Richardson’s exploration of OCD to the appearance of people with a range of mental health conditions across the channel’s programmes, ‘4 Goes Mad’ was an imaginative and thought-provoking way of tackling prejudice and dealing with the crucial issue of disclosure at work.

One of the series’ central messages – that people with mental health conditions can work and should not be denied the chance to do so – is one many NHS Employers have yet to fully heed. If the NHS is serious about ‘parity of esteem’, its employment policies and practices should be as much a part of the process as its spending decisions.

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