70 Years in the making: Mental health in the NHS
The seventieth anniversary of the creation of the NHS has prompted celebration of what it has achieved, reflection about what it has not, and both hope and concern about its future, writes Andy Bell from the Centre for Mental Health.
Support for mental health has been a part of the NHS since day one but the ways it has been provided have changed almost beyond recognition during that time. Some of the issues it faces have been apparent from early on whereas others have emerged and become a focus over time.
A constant throughout those 70 years has been a tendency to favour concern for physical health over that for mental health. While the NHS brought with it the principle of equity of access to health care, irrespective of our ability to pay for it, it has not been able yet to bring about equal access to care for many people with mental health problems. And by leaving out social care, public health and addiction services from the NHS settlement, longstanding (and arguably now growing) inequities remain between those services that are inside the tent and those outside.
Despite their relative marginalisation within the NHS, mental health services have undergone big changes – from largely institutional long-stay hospital care to predominantly community-based support today. However, the spread of resources within secondary mental health care still remains roughly 50:50 between community and inpatient services.
In the last decade in particular, we have seen unprecedented growth in psychological therapy provision through the Improving Access to Psychological Therapies programme which now reaches about a million people per year in England. While spending on mental health care still lags far behind levels of need, there have been periods (including the early 2000s and currently) of investment in national plans to improve and expand aspects of mental health care.
In 2012, the Health and Social Care Act included a new requirement for the NHS to have equal regard for both mental and physical health at every level of the system. The idea of ‘parity of esteem’ followed a significant rise in public and political attention to mental health issues and a growing awareness that the NHS had for too long favoured physical health care to such an extent that it was both failing to meet millions of people’s basic health needs and wasting money nationwide as a result.
Support for mental health accounts for about 12 per cent of all NHS spending, yet mental health problems account for about twice that proportion of the ‘burden of disease’ in society.
The cost to the NHS is as much if not more for not treating mental health issues, particularly among people with long-term conditions. Some 4.6 million people in England have both a long-term physical condition and mental health difficulty at the same time. The result, without effective help for their mental health, is significantly poorer physical health, earlier death and an extra cost to the NHS of around £10 billion.
The Government’s ‘gift’ to the NHS on its 70th anniversary was a clear long-term funding settlement. While there has been much debate about what this will bring in real terms additional funding, a long-term settlement could help to bring about the level of change necessary to rebalance health and care towards its stated aim of greater ‘parity’.
Part of achieving this will be to shift the balance of investment towards mental health. For example, by offering many more people with long-term physical conditions access to effective emotional and psychological support and by investing in NHS staff to ensure they can recognise and respond to people with mental health difficulties.
We need to look beyond the NHS, at its long-neglected partners in public health, social care and housing to bring about larger scale change. Investment is needed to support young families to nurture their mental health, promote good mental health in schools and offer more holistic and engaging help to people with mental health difficulties.
There is plenty of innovation apparent across the country, but it is by and large at a small scale and often struggles to survive from one spending round to another. The challenge for the next decade is to upscale these things to a national scale and ensure they are sustained. A long-term settlement may give NHS organisations the financial security they need to take a few risks, to work in new ways and bring about lasting change to benefit future generations.