A new paradigm for mental health

“I have a simple hypothesis. We can't simply scale up existing models of treatment to meet the current need. We have to change the paradigm from treatment and containment to prevention and early intervention.”


Better mental health has long been a passion of mine. One in four of us will experience a mental health problem at some point in our lives, one in ten children have a diagnosable mental health problem but only one in four of them get access to any treatment and half of all illness before the age of 65 is mental illness.

So on becoming Minister for mental health in 2010 I had the opportunity to reshape the debate about what our goals should be and how we might achieve them.

The mental health strategy that resulted, No Health without Mental Health, advanced the notion of parity of esteem – putting mental health on a level playing field with physical health - proposed a life course approach, recognised the need for cross government action and committed to tackling stigma.

It is sometimes said that the NHS is a command and control system, or was once. Well whether it ever really has been the reality often felt a lot like command without the control.

Some progress was made. Time to Change, the anti-stigma campaign was funded, a new children and young people talking therapy programme started, liaison and diversion services were expanded. My successor, Norman Lamb, set up the Crisis Concordat, which has dramatically reduced the number of people being taken to police stations as a place of safety, he set the first ever national waiting-time standards for mental health and he secured investment in children's mental health services.

I don't think either of us would claim the work was finished. The long march towards parity has a way still to go. The pull of the acute sector continues to see money being sucked out of mental health, some commissioners have invested, but many have not.

So where are we now?

Paul Farmer the CEO of Mind has just finished work on the Five Year Forward View for Mental Health. It is an impressive report. It lays out an agenda for improving and widening access to treatment. To deliver the plan, the Government has committed an additional £1 billion for mental health by 2020. But the devil is in the detail.

There is scepticism about whether the money is real. How will it be excavated from the NHS baseline when so much of the NHS is in deficit? Translating the recommendations into action requires a robust national programme to support and hold the system to account, but to succeed it will require the commitment of hundreds of local commissioners.

And where will the plan get us by 2020?

More people will receive help, young and old alike. More talking therapy, more joining up of mental and physical health, more help to remain in and return to work.

But when it comes to the treatment gap in mental health, the gap will still be huge. For example, the ambition is to move from 15 percent of people who would benefit from talking therapies receiving them, to 25 percent. So what about the other three out of four people?

I have a simple hypothesis, we can't simply scale up existing models of treatment to meet the current need. We have to change the paradigm from treatment and containment to prevention and early intervention. Put simply we have to close the treatment gap by scaling up treatment and reducing the demand.

It is that hypothesis that I hope to test as I join the University of Birmingham as a part-time Professor of Mental Health Public Policy. But more than that, I am looking forward to working with the team here and a wide range of experts across the UK and beyond, to devise a new agenda for action, taking a life-course approach, looking at the best of what works to reduce the burden of mental illness and how to support its adoption here in the UK.