Improving mental health services: it’s everybody’s business

It is over three years since the government published No health, without mental health, which promised to give mental health ‘parity of esteem’ (valuing mental health in the same way that we value physical health). And yet there remains a huge disparity in the quality and availability of care offered to people with mental health problems compared to the treatment of physical conditions.

This month’s newsletter looks at the improvement agenda for mental health, profiling service user views, the latest policy developments and improvement case studies. Looking from these different perspectives, we ask: what needs to change in order to achieve real parity of esteem for mental health?

A stark picture

The Centre for Mental Health estimates that mental health problems in England alone impose an economic and social cost of over £105bn each year. And yet mental health is often referred to as the Cinderella of NHS provision, with outdated services that are not always fit for purpose. People with mental health problems report ‘battles for diagnosis, lengthy waits for treatment, an over-reliance on drugs, and, frequently, an abject lack of compassion’.

These figures from last month’s QualityWatch statement paint an equally stark picture:

• Whereas 95% of patients with physical ailments have a first outpatient consultation within 18 weeks, only 74% of mental health patients are seen in this time (a number that has been falling steadily since 2010/11)
• Access to some services is declining, for example the last few years have seen a 17% reduction in mental health inpatient beds
• There is evidence that people with mental health problems have worse than average physical health, suggesting their wider health needs are not being met
• Mortality rates for people with serious mental illness are three times higher than those for the rest of the population

Taking action

As Felicity Dorman from our policy team outlines, mental health is now a hot topic politically. The policy landscape is full of pledges to improve parity of esteem. These include a new government action plan with an emphasis on recovery and service access, and a ‘crisis care concordat’ which agrees how police, mental health services, social services and ambulance professionals should work together to help people in mental health crisis.

The government has also announced new waiting time targets for common mental health problems. In his party conference speech, Liberal Democrat leader Nick Clegg said ‘If you’re waiting for talking therapies to help with your depression, you will be seen within six weeks – 18 weeks at an absolute minimum – just as if you’re waiting for an operation on your hip’. He also said that more serious problems, such as psychosis, will be offered treatment within two weeks of referral – bringing the service into line with targets for cancer referrals.

Care needs to be integrated and person-centred

However, in order to achieve true parity of esteem, we don’t just need to improve waiting times and access to services, we also need to transform the models and approaches we use to deliver care.

At the Health Foundation we believe that health and social care services should be enabling people with long-term mental health problems to have more control over their health and care. At its heart, this means building a more collaborative relationship between people with mental ill health and their health services.  

This means providing services that:

• see people first and foremost as individuals, with unique abilities, strengths, needs and preferences, rather than as a condition or set of symptoms
• are more joined up across health and social care, considering people’s physical and mental health needs, whatever their condition, in order to improve their quality of life and wellbeing
• use person-centred approaches which support and empower people to take control of their own recovery and be involved in decisions about their care
• deliver services with dignity, compassion and respect at all times.

This month we summarise just a few of the improvement approaches we’ve supported within mental health services, from peer support programmes to shared decision making. Introducing these changes can have a significant impact on the lives of those with mental health problems.

Overcoming stigma is everyone’s responsibility

Hannah Eastcott talks about her experience of feeling stigmatised because of her mental illness in our perspectives piece this month. She has felt judged by some NHS staff whose assumptions reflect many people’s negative attitudes towards people with mental health problems and says we need a more understanding and compassionate approach within services. ‘When professionals are able to communicate on that emotional level you feel you’re being understood and are much more likely to respond to the service’, she says.

As Vicky Pleydell points out in her powerful blog, every illness has both physical and psychological components, therefore improving mental health services is the responsibility of everyone working in the NHS.

She says: ‘We need to start by being honest and open about mental health, to have parity of esteem in every conversation, every interaction with staff, colleagues, friends. We need to challenge every unconsciously unkind thoughtless comment or decision.’

More than this, the compelling story of one person's experience of depression that Vicky describes highlights that it’s not just the health service that needs to change in order to ensure parity of esteem for mental health issues, but also the way society reacts to people experiencing mental health problems. Culture change is needed, both within the NHS and also in society more widely.