This is a pivotal, and exciting, time for mental health. As we saw in chancellor George Osborne’s spending review, and in repeated statements by party leaders, it is higher up the political agenda than it’s ever been. Also, more employers are actively encouraging greater openness and understanding, and that’s a good thing too. And more people are talking more openly about at least some aspects of mental wellbeing.
But in other ways, we are failing people with mental health problems every day, and destroying lives as a result. Political commitment and promises of funding are fine. But ask anyone at the frontline and they will tell you that NHS mental health services are struggling. Ask anyone working with mental health charities and they will tell you of people being shunted up and down the country because of bed shortages; long waiting times for therapy; too many people, including children, being put in police cells while in crisis; a rise in rough sleeping; a rise in suicides to the point where it is now the biggest killer of young men; and squeezed community teams dealing with more cases with fewer resources.
Why are we not more outraged that people with severe mental illness die, on average, 20 years younger than the general population; that only a quarter of the children who experience mental illness get the help they need; that in the UK 6,000 people a year take their own lives, and that a third of these are already known to mental health services?
This is not just about government, though it must take the lead. As a society we are just not used to thinking about mental health in the same way as physical health and this is reflected in the priority given to it by our public services. We have finally won the argument that it should be given equal priority – everyone agrees that this is the goal; the words are there in the NHS constitution. But a huge gulf between that aspiration and reality remains.
We need crisis care that responds with the same urgency we take for granted when it comes to emergencies such as cardiac arrest or car crashes, 24/7, in all areas of the country. We need enough beds and enough health professionals to meet demand for in-patient services. We need services that look out for and can respond to the needs of people at particular risk of developing mental health problems, such as pregnant women and new mothers.
Mental health also has to become a greater priority in the training of GPs, and in the running of their practices. On average, one in every three of those in the waiting room has an issue related to mental health. We need GPs to have access to a choice of treatments to offer their patients, not just drugs or therapy, which work for many but not for all. We need to continue to increase the number of people receiving talking therapies such as counselling and cognitive behavioural therapy, and we need to see the NHS’s Improving Access to Psychological Therapies programme expanded to include more specialist therapies to meet a wider range of diagnoses.
All this takes resources, of course. But, as we saw with the recent floods, a lack of investment can lead to greater spending when things go wrong. Estimates of the cost of mental illness to the UK economy – in terms of the eventual burden on the NHS, lost jobs, unemployment benefits, homelessness support, police time and prison places – go as high as £100bn. At the moment we spend less than £12bn on NHS mental health services in England, 10% of the overall budget.
Meanwhile, although we know that prevention is often so much better than cure, local authorities spend less than 1% of their public health budgets on preventive programmes for mental health.
Employers, schools, communities, local authorities, criminal justice, the benefits system, the media and all of us as individuals have a part to play in improving everyone’s mental health.
However much we welcome the warmer words and the specific policy announcements of recent years – such as on the waiting times for talking therapy, or additional funding – we must watch this carefully to make sure it is real additional investment for mental health services. Already underfunded mental health services have seen severe cuts that have left them on their knees in many areas, at a time of rising demand.
When the NHS’s mental health taskforce reports, we all know that its big goals will have to be matched by big investment. But we ought also to realise that the big goal of a happier, healthier nation will lead to long-term savings if we have the courage to achieve it.
Thanks in part to the Time to Change campaign – funded by Comic Relief, lottery and government, and run by charities such as Mind and Rethink Mental Illness – stigma and taboo are breaking down, and more people are opening up about mental health and mental illness. But the services have to be there to meet that growing demand.
Progress in awareness and understanding has undoubtedly been made. There are good things to point to in the work done by employers, schools, charities, local authorities, sports organisations and media. But we are a million miles away from where we need to be.
It’s time to get it right, to end the historical injustice, commit the investment and turn those words in the NHS constitution into a reality that actually delivers parity of esteem between physical and mental health.