Parity of esteem is a much discussed concept – the idea of equally high quality mental health and physical health care is something that it is easy to sign up to. But how close are we to parity? And will current policy ideas get us there?
So where are we now? Mental health services are showing signs of strain, with ongoing stories of cuts in community teams and services for children and young people, meaning increased pressure on acute beds – with reports of clinicians sectioning patients in order to get a bed. Our recent QualityWatch report sets out theevidence of degrading quality, and this year the cut in the mental health tariff was bigger than that in the acute trust tariff – meaning yet more funding pressure.
The longstanding and widely recognised problems with Child and Adolescent Mental Health Services are perhaps intensifying. A recent Health Select Committee report found widespread serious failings in access to local appropriate care, in waits, in experience and in quality of care.
And strain in services should be seen against a backdrop of unmet need in mental health – only a quarter of children and young people with mental health problems are in treatment, and even for severe mental health problems like psychosis, only 65% of people are treated. Mental health problems are the leading cause of sickness absence in the UK, which points to serious gaps in support. And physical health and mental health needs are not jointly met: people with mental health problems (both common and severe) are more likely to die before 75 than the general population, and people with physical long-term conditions are more likely to have mental health problems than the general population, suffering poorer physical health outcomes as a result.
There are also signs of progress. The current focus is exceptional, with strong political drive from the Lib Dems, and the recently announced cross-government task force showing support from across the coalition. There are also positive shifts in society more broadly: attitudes towards people with mental health problems has improved, and there have been thoughtful portrayals of mental health in the media.
And there is a lot going on in mental health policy. Actions include a crisis care concordat, pilots to better integrate employment and mental health services, more pilots to identify and divert people with mental health problems from the criminal justice system, waiting times standards, a new national intelligence network for mental health, CQUINs for inpatient physical health checks, continuing to develop a tariff, a children and young people’s mental health taskforce, the new cross-government task force…
But I’m left wondering, does this activity add up to what is needed to make mental health care and support the best it can be? And if not, what more is needed?
The sector itself has some fairly clear views as to what mental health needs. The Mental Health Policy Group calls for more money for mental health and further development of familiar themes: waiting times standards, employment support, stigma campaigns, crisis care, and liaison and diversion services working with the criminal justice system. There are also a few things in their priority list not in current government actions: mental health on the school curriculum, a better focus on preventing mental health problems through supporting the mental health of mothers and widespread parenting programmes.
Generally speaking, there is good alignment between the ideas from the mental health sector and government policy, although there are differences in the scale of action wanted. However, the question remains as to whether these actions will deliver the vision of parity.
Mental health has exceptional focus considering its history – but it is still a minority interest, rather than a mainstream part of health policy. The actions proposed and in train are essentially evolutionary changes, bringing mental health services in line with physical health, or making current services better.
But the scale of the challenge in mental health perhaps calls for something more: a fundamental rethinking of services – what people want, what services can achieve, the scale required and how to care for all of people’s needs, both mental and physical. A revolution in the way we think about and deliver health care, rather than evolutionary improvements in one sector. What should the future look like? Revolutionary ideas welcome.
Felicity is a Senior Policy Fellow at the Health Foundation, www.twitter.com/FelicityTHF
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