It would be wrong to say there’s a lack of a plan or direction when it comes to tackling mental ill health in England.
Over the last 24 months, we’ve been given NHS England’s Five Year Forward View (FYFV) for Mental Health, Health Education England’s (HEE) Mental Health Workforce Plan, the launch of an independent review into the Mental Health Act, and – most recently – the Government’s proposals on how to transform mental health provision for children and young people.
However – despite all the plans, pledges and page numbers – parity of esteem still feels a long way off for most and longstanding issues surrounding funding and workforce remain key challenges for the sector to overcome.
Is 2018 shaping up to be the year real inroads are made?
Money – and it reaching the frontline – matters
Funding earmarked for mental health failing to reach the frontline was a key issue last year – a fifth of Clinical Commissioning Groups (CCGs) were not meeting the Mental Health Investment Standard (MHIS) set out in the FYFV for Mental Health and the spending gap between NHS acute hospitals and NHS mental health providers widened further.
NHS England took encouraging steps at the beginning of the month on this front, publishing new planning guidance including the requirement that every CCG meets the MHIS from 2018/19.
The move has been warmly received by the sector as whole. CCGs themselves have also welcomed the ‘clear steer’ from NHS England that investing in mental health care needs to be prioritised, and are hoping this guidance translates into ‘tangible support’ for commissioners on the ground to make the ‘tough spending decisions’ necessary. Only time will tell if the situation on the frontline does improve as a result.
Workforce is as important as funding
Unfortunately, funding reaching the frontline can do very little without the workforce capacity to deliver services. The mental health sector is suffering in particular from acute staff shortages and the ambition to fill 21,000 posts by 2021 remains a tall order. HEE has promised to produce a long-term workforce strategy for the sector that looks beyond 2020-21, following the workforce plan they published last July, and this longer-term plan cannot come soon enough.
Indeed, it’s workforce pressures that present roadblocks for the vision the Government set out in its green paper on transforming children and young people’s mental health provision at the tail end of last year. The Secretary of State conceded that the Government’s ambitions have been tempered, to reach children and young people in just 20-25 per cent of areas over the next five years, because of the current workforce pressures that exist and the lack of capacity. Many haven’t held back from criticising the green paper for lacking ambition – both in terms of its speed and scale.
The power of cross-sector collaboration
Despite the green paper’s shortcomings, the move to engender more collaborative working between the education and health systems to deliver preventative measures and evidence-based early interventions in schools has been broadly welcomed as a step in the right direction. Many see the potential for waiting times to be significantly reduced for those who do need specialist care over the medium to long term if proposals are delivered effectively.
However, question marks remain over the level of resources available to train and adequately support teachers, and other non-clinical staff, to deliver the interventions and refer children if appropriate. Children and Adolescent Mental Health Services (CAMHS) are already under immense pressure, and there is real concern amongst those working in these services that already stretched resources will be spread too thinly in the Government’s quest to deliver on its pledges.
Many in the mental health community are also mindful that a focus on prevention and early-intervention mustn’t be at the expense of treatment for children and young people who suffer from severe mental illness and require specialist care. Currently only one in four children with a mental health condition are receiving treatment, and many with the most severe cases may not be attending school regularly, if at all.
Given the above, we can expect calls for a wider commitment to adequately support CAMHS to only grow in the weeks and months ahead. There will also be calls for cross-sector working espoused by the green paper to not stop simply at education and health – for example how can social care be brought into the mix, given the significant influence of socio-economic factors on aspects of mental health.
Other battles set to dominate 2018
Jeremy Hunt has also opened up battles on other fronts – he threw down the gauntlet last week to the social media giants who he’s said can and should be doing more to help tackle the growing levels of mental illness amongst children and young people across the country.
The Secretary of State’s call on social media companies to shape up fits into a wider and growing agenda of late to make businesses behave more responsibly. Pressure from Hunt on social media companies to act – and the likelihood of legislation being introduced if the current impasse continues – is only likely to grow as the year goes on.
Tackling the practice of locked rehabilitation wards also looks set to feature prominently as a policy priority in the year ahead. The CQC is due to report on the topic within the next couple of months, having expressed particular concern about the practice in its State of Care in Mental Health Services report last year.
Overall, there’s still a long way still to go
Despite steps being taken in the right direction, the mental health sector continues to face longstanding challenges, particularly around funding and workforce, and it’s clear there remains a long way to go to realising parity of esteem between mental health and physical health.
Given these challenges, the sector’s sights will be set on securing a new forward view that looks beyond 2020/21, in order to ensure mental health remains a policy priority and there’s no let-up in the quest to make parity of esteem a reality.