Ben Quinn, Denis Campbell and Damien Gayle
Each year one in four UK residents experience a mental health problem. Photograph: Jolie Clifford/Glasshouse Images/Corbis
People facing mental health crises will be able to get community care 24 hours a day, seven days a week as part of the biggest transformation of NHS mental health services in England for a generation.
A wide-ranging set of recommendations by an independent taskforce that surveyed a long-neglected and “chronically underfunded” area of healthcare is backed by a pledge from the NHS in England to help more than a million extra people facing mental health problems and to invest in excess of £1bn annually by 2020-21.
The announcement on Monday of the ambitious transformation came as Jeremy Hunt said the government would have to give the NHS “significant” amounts of extra money after 2020, much more than the £10bn being put in before then, so it can cope with the demands of the ageing population.
Speaking in his first interview with the Guardian in his three and a half years as health secretary, to mark the end of a month-long This is the NHS series, Hunt said the NHS would need years of above-inflation cash injections, along the lines of those it received under Tony Blair, in order to remain an “incredible” part of British life.
He passionately defended the service’s basis as a taxpayer-only funding system and he pledged there would be no moves towards replicating the insurance-based health system of the US, which he criticised for denying care to tens of millions of poor Americans and giving doctors a personal financial incentive to advise patients to be treated.
Setting out how services could be transformed over the next 10 years, the report by the NHS’s mental health taskforce for England says its priorities must include ensuring that people have access to mental health care seven days a week and expanding community-based services for people with severe problems who need support to live safely as close to home as possible.
It says new funding should be made available so that crisis resolution and home treatment teams (CRHTTs) can offer intensive home treatment as an alternative to acute inpatient admissions in each part of England. Currently, round-the-clock, community-based mental health crisis care is only available across half of England.
The report recommends recognising employment as a “health outcome”, ensuring that the NHS plays a greater role in supporting people to find or keep a job and tackling inequalities that mean poor people and groups already facing discrimination are disproportionately affected by mental health problems.
Each year, one in four UK residents experience a mental health problem. The taskforce’s report states that too many people have received no help at all for too long “leading to hundreds of thousands of lives being put on hold or ruined and thousands of tragic an unnecessary deaths”.
A call for a concerted drive to reduce suicide rates England by 10% by 2020 in the wake of a steady rise in recent years has been widely welcomed.
Paul Farmer, chief executive of Mind, who chaired the taskforce, said it was a “feasible and affordable blueprint” for transforming services. “We are saying to the NHS, to government, to industry, to local leaders and to the public that mental health must be a priority for everyone in England,” he said.
Speaking on Radio 4’s Today programme on Monday morning, Farmer called for mental health services to be given parity of esteem with physical health within the NHS – with the funding to match.
“We are talking about a major transformation in the way we think about mental health services in the round, from those people with so-called mild to moderate mental health problems like depression, right through to more serious mental problems,” Farmer said.
“Sitting underneath this is a real focus on just creating a much more transparent approach to issues like workforce and payment and funding for mental health services, which historically have been set in a bunker, really, compared to the way we think about physical health.”
Farmer said that the £1bn annual investment ministers have pledged for mental health services was not enough to achieve the goals he had set out, but he acknowledged that it was a significant step forward. Most important though would be a “different mindset” when it came to mental health in the NHS.
“What is changing attitudes is the way we as a public think about it and people with their own experiences talking and speaking up about their experiences,” Farmer said. “That is what’s going to change the way we think about mental health problems overall.”
Focusing on rates of suicide in England, which peaked at 4,881 deaths in 2014 – suicide is now the leading cause of death among men aged 15-49 – the taskforce says every area should develop a multi-agency suicide prevention plan to intervene in high-risk locations and support high-risk groups. Aspects of these plans borrow from successful models at a local level in the UK and in the US.
In the area of perinatal and postnatal care, it calls for new funding to support at least 30,000 more women each year to access specialist services. One in five mothers suffer mental health problems during pregnancy or in the first year after childbirth.
Calling for the NHS to play a greater role in supporting people to find or keep a job, the report describes employment as vital to health and says it should be treated as a health outcome. Up to 29,000 more people per year with mental health problems should be supported to find or stay in work.
Another particular focus is placed on tackling inequalities and groups who are at greater risk, such as black, Asian and minority ethnic (BAME) and LGBT people.
Recommendations include a “data revolution” to improve transparency and sharing across bodies and the appointment of an “equalities champion” at the Department of Health with a specific remit to tackle health inequalities.
“For too many, especially black, Asian and minority ethnic people, their first experience of mental health care comes when they are detained under the Mental Health Act, often with police involvement, followed by a long stay in hospital,” Farmer and the taskforce’s vice-chair, Jacqui Dyer – a counsellor, mental health service user and carer – state in the report’s foreword.
The report, and the commitment by the NHS to honour its recommendations, builds on the back of the spending review settlement and its earmarked funding for mental health.
Savings are envisaged for example through reduced emergency hospital admissions. The report says cuts in local authority budgets are leading to rising pressures on important parts of mental health care, such as social care and residential housing.
Simon Stevens, chief executive of NHS England, said mental health services had historically been the NHS’s “poor relation”, but the service was now committed to putting mental health on an equal footing with physical health by implementing improvements in seven-day crisis care and increases in psychological treatments.
“We asked the taskforce to produce a practical, feasible and affordable set of recommendations. That’s what they have done and the NHS is going to back this,” he said.
The report, which includes recommendations for strengthening the workforce and talks about mental health services as a future “profession of choice”, comes as the junior doctors’ dispute and controversy over Hunt’s push for a “seven-day NHS” continue to cast a shadow over staff recruitment and retention.
Asked about this, Stevens said: “Obviously, the workforce is a crucial part of being able to deliver this strategy. We need to ensure that recruitment into mental health positions continues to be attractive. There is a lot of work to be done with the Academy of Royal Medical Colleges, the Royal College of Psychiatrists and by mental health trusts.”
The taskforce stresses that there are opportunities, “but there are also risks”. It says: “There will be uncertainty about the role and function of commissioning as local geographies change, responsibilities shift and budgets come under pressure.”
One taskforce member, Brian Dow, director of external affairs at Rethink Mental Illness, struck a note of caution, warning that “even the best of reports quickly gather dust on shelves”.
He said: “The important thing now is for all the players in the system to find a way to deliver these recommendations so that we see real change on the ground. That requires a clear plan to measure, report and deliver on the plan. This is an opportunity that must not be lost.”
Welcoming the target for a 10% reduction in suicides in five years, the Samaritans charity said local multi-agency suicide prevention plans were a critical part of this but there needed to be “a clear long-term financial commitment to carry this through”.
It added: “The plans must be transparent, robust and properly funded to be effective, and designed to have the maximum impact locally.”
The Royal College of GPs said it was particularly encouraged by the proposals to expand child mental health services and provide better support for women with perinatal mental health problems. However, it said the report did not explicitly reflect the role played by GPs in diagnosing and supporting patients with mental health problems.
“We would like to ensure every GP practice has easy access to trained mental health workers who can deliver therapies such as cognitive behavioural therapy and other talking therapies that have been found to be incredibly beneficial for patients,” said the college’s chair, Dr Maureen Baker.
The taskforce’s recommendations were announced after a leaked draft of their findings was reported on Sunday, painting a “devastating” picture of NHS mental health services in England, with soaring numbers of suicides and three-quarters of people with psychiatric conditions not being helped.
Credit: the Guardian
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