Mental health issues received unprecedented levels of media and political attention last year. Calls for fair treatment and better care were louder and stronger than ever, from the centre of government to town halls, social media, television and newspapers. Yet at the same time evidence mounted of growing pressure from all directions on people living with mental health problems and of cuts to vital services.
As we begin 2015, the thirtieth year of Centre for Mental Health’s work, there are signs of both great hope and great anxiety for the near future: of opportunities to build on the progress we have made and of fears that people’s lives will be made harder, poorer and shorter because of a lack of support and understanding.
In planning guidance published at the very end of 2014, NHS England set out its expectation that next year clinical commissioning groups will secure real terms increases in mental health care funding, reversing the cuts we have seen in the last three years. And from April, for the first time the NHS will have specific waiting time standards for two areas of mental health care: Improving Access to Psychological Therapies (IAPT) services for adults and Early Intervention in Psychosis services for young people.
These are, of course, only starting points to turning around a health care system described by care services minister Norman Lamb MP as having an ‘institutional bias’ against mental health. To truly secure ‘equal care for equal need’ for people with mental health problems, the NHS will have to change in many more ways, sustaining extra investment in mental health support and offering each person care and help tailored to their needs and goals. It will need to address the current postcode lottery in the availability of cost-effective, evidence-based interventions such as supported employment. And it will need a payment system that reflects what people want from the NHS, not one which reinforces the current disparity between mental and physical health and rewards activity rather than impact.
Despite the pressures on mental health services, many are innovating and making changes that encourage earlier intervention and support personal recovery. There are now more than 30 Recovery Colleges in mental health services across the UK; more peer support workers are being recruited; and the physical health of people using mental health services is beginning to be taken more seriously by health professionals.
Beyond the NHS, understanding about mental health in society is growing. More and more schools are now recognising the importance of mental health to children’s attainment and future life chances. But mental health support in schools remains patchy and emotional wellbeing is the least taught topic on the PSHE curriculum.
More employers (large and small) are taking the mental health of their workforce seriously. But this is far from being the norm and NHS organisations have been slower than most to support the mental health of their staff. And too many people with mental health problems are getting inadequate help to get or keep paid work despite its importance to recovery for so many. For some, benefit sanctions and conditions have got in the way of finding work and keeping well.
Nonetheless, the year ahead will bring opportunities to make change for the better. People living with mental health problems have a bigger, stronger voice in public debate than ever before, largely through social media. Translating lived experience and knowledge into commissioning and policy development is a vital next step to ensure that mental health services can no longer be planned and delivered without the equal participation of the people they are supposed to help.
In public services, opportunities to improve will come with the limitation of ever-tightening finances. Local councils are subject to particularly tough funding pressures, yet many have found ways to promote better mental health, for example through their public health powers, local partnerships and the work of ‘member champions’.
The biggest opportunity of all, however, is to keep lifting our sights further – to raise our expectations of what we can do and should expect, and no longer to accept the disparities we still see every day as facts of life.