Dr Karen Newbigging
Today is World Mental Health Day, an annual event to raise awareness and promote the cause of mental health, with this year focusing on people with a diagnosis of schizophrenia. Mental health has been much in the news of late, with Nick Clegg using his party conference speech this week to pledge more money and set targets so that people with mental health problems can access services as easily as they can for physical health problems. It is clear that support and opportunities for people experiencing mental health issues are a widespread cause for concern, with Professor Sue Bailey, the outgoing President of the Royal College of Psychiatrist, describing mental health services as a “car crash” in June 2014. The numbers of people now subject to the Mental Health Act has risen dramatically, since its reform in 2007, to an annual rate of over 50,000, but the reasons for this are poorly understood. The premature death rates of people diagnosed with schizophrenia or bipolar disorder; higher rates of detention and poorer outcomes for people from racialised minorities; access to support in a crisis; poor quality inpatient environments; long waiting lists, including for child and adolescent mental health services; and economic pressures facing people, particularly men, implicated as a cause of suicide are all part of this picture. So are money and waiting list targets the answer?
There is no doubt that mental health services have suffered from historical underfunding and, therefore, no surprise that the promise of additional investment is widely welcomed. However, this needs to be set within a context of growing alarm that mental health services have been increasingly vulnerable to cuts. Specialist mental health teams, established as part of the National Service Framework for Mental Health under the previous administration, have been disbanded or amalgamated into more generic community mental health teams, with the Department of Health reporting a fall of £150 million in expenditure on mental health in 2012, the first reduction in ten years. It is easy for mental health expenditure to become a target in times of financial austerity; its low priority reflecting the lack of awareness and entrenched stigma associated with mental illness. The gaming around waiting list targets for physical health conditions has been widely reported and whilst the need for greater access to appropriate mental health support is irrefutable, the imposition of waiting list targets on their own may be an overly simplistic response.
Alternative solutions lie in the call for more radical action articulated by people with lived experience of mental health problems, who call for recognition of their human rights, for services and support that maximises their opportunities, and places social context and relationships at the forefront of understanding and addressing poor mental health. This points to a profound paradigmatic shift in the way that we approach mental health, and one that should not be dismissed in favour of quick solutions. Indeed, Nick Clegg reflected this in his speech when he described “mental illness as “the last taboo” and his parties’ prioritisation of mental health to end stigma and discrimination. The current policy commitment to parity of esteem between mental health and physical health echoes this but the shift in attitudes and understanding, to drive investment in mental health, needs to go much further. There are promising avenues for this.
- First, as the Chief Medical Officer outlined in her report last month, the growing understanding and evidence in relation to promoting mental wellbeing and preventing poor mental health: through giving children the best start in life, enhancing the role of primary care, tackling violence and abuse, and the social isolation of older people, for instance.
- Second, initiatives that enable people to define the support they need and the outcomes that matter to them: advocacy, recovery and personal budgets, for example.
- Third, building on lived experience and knowledge about what works in enabling people experiencing mental health problems to get on with their lives: peer support, psychological therapies and enabling people to maintain their roles as parents, friends or employees.
- Fourth, reflecting the recommendations of the Schizophrenia Commission, to rethink the diagnosis of schizophrenia, develop recovery houses and take action to address inequalities and meet the needs of all socially disadvantaged groups.
Isn’t it time that we put all this into the melting pot and transformed our approach to mental health: that we welcomed our politicians’ active commitment to mental health but asked them to go one step forward and be audacious?