England is witnessing the “biggest expansion of mental health services in Europe”, according to health secretary Jeremy Hunt, who has promised that an extra £1.3bn would be invested annually in mental health services by 2021.
With one in four people expected to suffer from mental illness at some time in their life – whether it’s a new mother struggling with postnatal depression, a teenager with an eating disorder, or an older person isolated and lonely at home – the financial commitment is welcome.
Government pledges to reform the Mental Health Act 1983 – the law that allows the state to step in and detain people in crisis – also offers hope to others, particularly those whose lives are overshadowed by serious illness such as bipolar disorder or schizophrenia.
With anxiety and depression on the rise in younger people, the promise of a green paper by the end of the year to address the mental wellbeing of this age group, is another indication that Theresa May is acting on her promise to tackle the “burning injustice of mental illness”.
Hunt reinforced the positioning of mental illness at the top of the political agenda, when he told the Tory party conference in Manchester last week that mental health was a “personal priority” for the prime minister after “decades” of being a “second class citizen in the NHS”.
But while there are reports that the money is starting to reach the frontline, there are warnings from trusts, staff and care inspectors that the raft of government promises may not be enough – or come quickly enough – to pull services away from the brink.
Sean Duggan, chief executive of the Mental Health Network of the NHS Confederation, admits the political climate is changing: “Mental health is now a priority. We now get invited to No 10 policy group meetings and have the opportunity to talk to Theresa May’s advisers – that never happened so regularly before.”
Duggan says that £1.3bn should be enough to deliver the government’s Five Year Forward View for Mental Health – its planning blueprint – but adds: “The issue, though, is what happens at the end of those five years? It’s not enough money to provide in-depth comprehensive mental health services.”
The report from the Care Quality Commission, the State of Mental Health services 2014 to 2017, described mental health services as “at a crossroads”. It said that some services remained “rooted in the past”, while others were described as world class for the care delivered in hospitals and round-the-clock care in the community.
The report also states that in order to deliver the government’s vision for high-quality mental healthcare close to home, the sector “must overcome an unprecedented set of challenges – high demand, workforce shortages, unsuitable buildings and poor clinical information systems”.
The problem of mental health patients travelling sometimes hundreds of miles to find an available hospital bed has not gone away, with out-of-area placements rising by 40% in two years.
Liberal Democrat MP Norman Lamb, former health and care minister, has long campaigned for an end to out-of-area placements. However, he says that more money is not always the answer, highlighting the success of Sheffield NHS health and social care foundation trust which has – by reforming services and allocating existing budgets in a different way – treated all acute mental health patients within its own district for the past three years.
“This is a progressive, exciting transformation that we need to be doing everywhere, which doesn’t depend on what the government does,” Lamb says. “We need to applaud these brilliant reformers who are re-engineering services, which are much more about partnership with people and peer support. It’s not just about the money.”
NHS Providers, which represents nearly all of England’s 240 NHS hospital mental health and ambulance trusts, says trusts expect demand to continue to increase; 80% worry that money will not reach where it is needed most.
Its director of policy and strategy, Saffron Cordery, admits there have been noticeable improvements in perinatal care, and eating disorder services, but adds: “The core mental health infrastructure – the day-to-day of getting the job done – is exactly where we are with the rest of the health service; it’s still struggling.”
Mental healthcare for children and young people remains a “Cinderella service” and it is crucial that reformers of the Mental Health Act listen to service users. “The reform is an opportunity to tackle the culture of mental health organisations and care more generally,” Cordery says. “But we mustn’t allow that to take our eye off the other places and people, and make sure that people get what they deserve. It’s taken us 10 years to get mental health on the agenda and it’s going to take another 10 years to get us what we want to achieve.”