Does the PM want hard or soft parity for mental health?
In recent years mental health has moved from the margins to the heart of government thinking. The discourse has matured, reflecting a growing awareness that mental distress is not an issue that impacts a few – it affects us all.
In less than 12 months two Prime Ministers have chosen to start their year with major speeches about mental health, committing themselves and their governments to a transformation of the mental health landscape.
But as so many of the statistics and personal stories bear witness; the landscape is not changing fast enough.
In her speech on Monday, the Prime Minister talked about the critical importance of relationships and the role of government to ‘encourage and nurture’ them.
This relational approach was reflected in the PM’s focus on the mental health of children and young people and the welcome recognition that left untreated mental distress can ‘blight lives, and become entrenched’. Half of life-long mental illness has its first signs in the teen years, yet just 70 pence out of every £100 the NHS spends goes towards children's mental health services. It's time the resources followed the rhetoric. Otherwise, we will keep on missing the opportunity to reduce the burden of life-long mental illness.
The PM said she would hold NHS leaders to account for the £1 billion David Cameron promised for mental health in January 2016. But it still remains unclear what has become of the commitment made in March 2015 to invest £1.25 billion to transform children and young people’s mental health services. Reports from the frontline suggest the money isn't getting through everywhere. Getting a grip on the money is essential; it ought to be part of the CQC/Ofsted thematic review of children and young people's mental health services mentioned by the PM.
In her speech, the PM suggests that tackling stigma is more important than resources. I think this misses the point, the underinvestment in mental health is itself a symptom of stigma at an institutional level. Of course less stigma is a good in itself, especially if it enables more people to seek help. But if the help isn't there because of a lack of parity then the results are the same.
Taking a life course approach, looking beyond conventional mental illness services, emphasising the importance of addressing mental distress early – these are all to be applauded. They resonate with the University’s plans to establish an Institute for Mental Health and with our partners in Birmingham and beyond make the mental health of children and young people a research priority.
A whole system response is needed to make real the PM’s ambition. Her recognition of the role of schools is very welcome, it reflects work already happening in a number of areas, for example the schools-based work of the Tavistock and Portman NHS FT.
The PM also acknowledged the need to look at what ‘can be done to prevent mental health conditions’ and ‘build resilience’. Both chime strongly with the goals of the Birmingham policy commission I announced in my inaugural lecture. [LINK: http://www.birmingham.ac.uk/schools/social-policy/news/2016/10/Closing-the-mental-health-treatment-gap.aspx] This requires a new paradigm that looks to address the causes of the causes of mental distress and illness. For example, the growing evidence of the critical importance of the first 1,001 days of a person’s life in laying down the foundations on which so many of their life chances rest.
Plans for a Green Paper on children and young people’s mental health to services in education and for families offer opportunities and pose threats too. But my worry is it delays or derails the implementation of Future in Mind the review by the Coalition Government but committed to by the Conservative Government just two years ago.
Theresa May’s speech is important if only because it is the Prime Minister talking about mental health. She recommitted government to the goal I set in 2011 of parity of esteem between mental and physical health. While the road to parity is paved with good speeches, it needs good deeds even more.
Professor Paul Burstow
Professor of Mental Health Policy, University of Birmingham