Are commitments for mental health all talk and no action?

Promises, platitudes and plans are piling up for mental health, but how much is going to be delivered?

Mental health accounts for roughly £12bn of the NHS budget. In parliamentary terms the current support for mental health is unprecedented – parity of esteem with physical health services is enshrined in the Health and Social Care Act 2012, plus last year’s spending review made explicit reference to improving quality, choice and outcomes in mental health.

But a recent report by the health select committee on the impact of the spending review on health and social care was sceptical about whether the rhetoric is being matched by actions. The committee called for verifiable evidence that the additional cash promised to mental health was reaching the front line, and that the cultural change necessary to deliver parity of esteem was happening.

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The NHS planning guidance for 2016-21 instructs clinical commissioning groups to increase investment in mental health at least at the level which matches their overall spending increase, but whether this being done is disputed. NHS clinical commissioners insisted to MPs that this is happening while NHS Providers maintained the money is not coming through. It even accused commissioners of using “weird and wonderful calculation methodology” to justify their claims.

The government has made specific promises: more cash for young people with eating disorders, a “system-wide transformation” of children and young people’s mental health and perinatal mental health, and improved access to psychological therapies. But it is far from clear how the money for this will avoid being dragged into the black hole of the acute sector’s deficit.

Even if these promises are delivered, they are still largely focused on crisis management. The big win will come when services routinely support people who are at risk of mental illness before they reach crisis. This is a long way off.

NHS England has just published its implementation plan for the mental health Five Year Forward View. It sets some impressive targets, such as treating at least 70,000 additional children and young people each year from 2020-21.

The scale of the task is ​becoming clearer, but it is daunting.

This target illustrates the enormity of the change being envisaged. For example, inappropriate use of inpatient facilities needs to be eliminated and a drastic increase in community-based support for eating disorders is needed to reach it. At least 1,700 more therapists and supervisors will be required. Local plans to deliver this are supposed to be in place by October.

But delivering national goals on mental health requires transformation well beyond the borders of the NHS. As the Mental Health Foundation points out in its guidance on population-based mental health care, many of the people most at risk of self-harm or suicide are in contact with the police or in prison.

Police forces across the country feel they are routinely left to deal with dangerous mental health crises because of failures in NHS care. Suicides in prison are now their highest for at least 25 years – 100 in 12 months – that’s one death every three to four days. Much closer working with police and prison services is just one of the changes in culture that ‘“parity of esteem” for mental health requires, alongside massive investment in prison services and facilities.

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In the West Midlands, local government is providing leadership on mental health with a commission set up by the region’s combined authority, chaired by the MP and former Liberal Democrat health minister Norman Lamb. It is assessing the scale of mental health problems and identifying good practice nationally and internationally in areas such as suicide prevention, with the aim of driving through reforms to the way public services are delivered based on sound evidence of the costs of mental illness and the benefits of tackling it.

It is a huge objective, but the ambition is there and Lamb is clearly determined to make things happen. The scale of the task of improving mental health is at least becoming clearer, but it is daunting. It means getting into every school, prison, workplace and custody suite. The commitment is growing, but the capacity and the investment are still a long way short.

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Are commitments for mental health all talk and no action?