Plugging the gap in mental health services

Mental Health

On this morning’s BBC Radio Leicester (21/6/16) David Monteith, Dean of Leicester Cathedral referred to the “worrying gap” in mental health services in the city, saying that while they are not headline news in elections, people with severe and enduring mental health problems continue to fall through the cracks.

People and places like the Cathedral do try to pick up the slack, but lack an “accurate map of service provision” and need services in the community that they can work alongside.

As the Dean points out, mental illness is ‘illness’ like any other. Despite all the government promises that we will see parity of esteem, the focus remains on the provision of crisis services. People with chronic mental health problems are being “left dangling”.

People with mental health problems who live alone are more likely to become isolated. Network for Change lead, Gabby Briner is concerned that cuts to voluntary sector funding are removing the community support people need to stay well.

People with mental illness die on average 15-20 years earlier than other people – one of the greatest health inequalities. Responding to concerns raised by mental health charities, a Government report in 2015 concluded that people with mental health problem deserve the same standards of access to treatment as people with physical illness. They deserve the same focus on recovery.

The report coined the term “Parity of esteem” raising hopes that matters would improve. People with other chronic conditions are able to access long term support from nurses who specialist in diabetes, respiratory conditions and Parkinson’s disease. Why should people with mental health problems be any different?

Back in 2009, in Leicestershire County, GPs decided to plug the gap. The Primary Care Trust commissioned a “Mental Health Facilitator Service” giving every GP practice a mental health trained nurse. Their role is to monitor the long term mental and physical health of any patient with a long term mental health condition and to use their local map of community services to ensure people do not fall through the gaps.

Leicester, being a city, is more demographically challenged than the County, with greater deprivation and the tendency for people with mental health problems to drift into town. A Public Health assessment in 2014 stated that, in Leicester:

“The rate of emergency care use for mental illness is high, but recovery is poor. The rate of death from suicide and undetermined injury is stable, but higher than the England average. Whilst most mental illness is treated in primary care, most commissioning focuses on secondary care.”

As Norman Lamb put it in 2015 “The extraordinary gravitational pull of acute hospitals” has been “stacked against mental health services and stacked against the people who use them.”

Leicester City Public Health advised the Clinical Commissioning Group that “In addition to improving secondary care commissioners should meet mental health need, and establish parity of esteem with physical health” and that “Commissioners should develop services in primary care and the community to sustain mental wellbeing and to support people with mental illness.”

It is good to see that this April, six years after the County, Leicester City has finally commissioned its own Mental Health Facilitator service to bridge the gap in care.

Is this investment going to provide the long term support in recovery that the Dean of Leicester and Network for Change are hoping for?

Probably not. The lack of investment in mental health means that cash-strapped Leicestershire Partnership Trust is discharging more people from outpatient services. They are not discharging any funds to follow. The Leicester City Mental Health Facilitator Service is at risk of being overwhelmed before it has had a chance to build the community networks needed to support discharged patients

While acute medical and crisis services weigh heavily on the minds of decision makers, struggling to balance a shrinking budget, “parity of esteem” for mental health continues to dangle tantalisingly out of reach.