Our response to the Labour Party policy document Mental health: the way forward
We welcome the document produced by the party. It is a valuable step on the road. Our remarks here are intended to develop some of the ideas in it, and to point out areas which still need more attention.
Our policy has long been that all government policies should have a health impact assessment. This should include an assessment of the impact on mental health, and the social and economic cost of that impact. Policies to improve mental health should be the responsibility of all parts of government and all Labour Party policy bodies. We are very pleased to see the emphasis on the first 1001 days of a child’s life which in time should lead to profound improvements in mental health.
This document says little about the impact of austerity on mental health. Cuts of all kinds have hit disabled people very hard and there has already been an increase in suicide rates. Work Capability and Personal Independence Payment Assessments are experienced by people with mental health problems as oppressive, unfair and ill-informed. Offers of employment support are often viewed through the filter of possible sanctions and benefit loss. Sanctions for this group are not motivating. They make productive employment less likely. Sanctioning pregnant women is a pretty stupid course of action.
There is good evidence that empowering communities through processes like community development has a strong beneficial impact on mental health. Our approach needs to be less individual and more community based. This would also help us to provide decent support to families and carers and reduce the huge effects of loneliness. The NHS should be working in partnership with the voluntary sector , not simply commission services from them.
Mental health must be looked at with a personal, family, social, economic and cultural context. We need to develop a more comprehensive approach to supporting vulnerable people which needs to extend to housing and employment support. We must look at the issue in a wider context than access to treatments. We need to consider the mental health costs of other policies. Aftercare of service personnel damaged by post-traumatic stress and institutionalisation should be just as much a responsibility of the MoD as fixing broken bodies. The Service Personnel and Veterans Agency needs to be expanded and publicised. We entirely support the points made about occupational health services and their failure to address mental health issues. The costs of increasing stress on children from educational policies should be considered. The incarceration of asylum seekers has an impact on mental health. Prison should not be used to contain people who are mentally ill. Caring responsibilities whether paid or unpaid create stress. Many NHS staff report that inadequate funding and staffing affects their mental health.
The economic impact of mental illness and the cost-effectiveness of preventative measures needs a lot more attention.
Mental Health Promotion
We need action in the non-health sectors of education, employment, housing, criminal justice , social welfare and community development. This needs intersectoral coordination at local and national levels, rather than just intrasectoral action.
Create inclusive environments that respect and protect the basic rights of everyone, including people with mental health problems.
Strengthen community networks and encourage collective responsibility for preventing alcohol/drug abuse, gender discrimination and community and family violence.
Develop partnerships with other stakeholders that are involved in promoting mental health and well-being.
Promote positive interactions between parents and their children to enhance childhood development.
Promote evidence-based programmes in schools that enhance the social and emotional competencies of students to help prevent substance abuse and violence.
Work with the media to change the negative image of people with mental health problems.
The document says nothing about dementia or Learning Difficulties, and very little about drug and alcohol services.
Primary care must integrate promotion, prevention, treatment, rehab and suicide prevention into its daily work so that there is parity of mental and physical health in primary care. Simply adding therapists to primary care is not going to work, partly because of the high prevalence of mental disorders (1 in 3 of all consultations) , and partly because of the lack of knowledge in therapists about physical co-morbidiity. It simply further deskills primary care about mental health issues. We need more focus on mental health in primary care training and in primary care organisational development.
New approaches to treatment such as Triangle Care, Family Work and Open Dialogue have the potential to reduce dependence on medication and improve outcomes. The potential for mobile apps is considerable. We need to improve the practice of evidence-based treament. We should improve the capacity of primary care basing other mental health staff in GP surgeries. We cannot afford specialist care for everyone with mental health problems. Specialist services are struggling to cope with the most serious conditions. We need specialists liaising closely with primary care and the non-health sectors. Simply calling for more and more specialists is unlikely to be successful in the current economic climate, and will only aggravate brain drain from low income countries which have already been heavily damaged, (especially psychiatric nurses from Africa), and will achieve little without fundamental strengthening of primary care.
Much has been said about mental health as a Cinderella service, but less about the Ugly Sisters – acute hospitals, which still get most of the money and political attention. Mental health services were separated from physical health when NHS trusts were established. If we are now planning to move away from a market based approach to treatment we should consider whether the continued existence of separate mental health trusts is a good idea. It is now clear that physical illness in people with mental health problems is often neglected. Staff in mental health trusts often lack the most basic skills in dealing with physical illness. Many physical illnesses have a psychological component. Bringing the two sides together might help.
Treatment for mental health problems are still divided in an unhelpful and discriminatory way by age. Severe mental illness often first presents between the ages of 16 and 25. A divide between services at the age of 18 is disruptive. Nor do we see why people over 65 should get a different and usually inferior service than younger people.
Rationing of mental health services has been much more aggressive than in physical health services. Closing mental health services and letting waiting lists reach ridiculous lengths does not have the political impact that it does in physical health. Mental health trusts are in better financial shape than their physical counterparts, but the price is paid by their patients. If parity of esteem is to mean anything it should mean that waiting times are monitored and managed in the same way. It is only in mental health services that patients are refused referrals. 75% of referrals to CAMHS are refused on the basis that they are not serious enough.
Urgent care for people with mental health problems is often a joke. Even those who have harmed themselves have to wait months to be seen. The evidence is very clear that early intervention is more effective, especially for psychotic illnesses, which impose the greatest costs, both human and financial. Standard advice for people in crisis is often to go to A&E, a place which is unsuitable both for them and the other people using the service. It is good that police cells are less often used as a place of safety, but the facilities in some hospital A&E departments are not much better. We still tolerate a situation where people who are mentally ill are taken, compulsorily, to an institution which does not provide the service they need, and where they are locked up in unsuitable facilities. We improved the outcomes for people with stroke by taking them to the right facilities. Why can’t we do the same for people who are mentally ill? We encourage other patients to seek help outside hospital and to avoid the A&E department, but not people with mental health problems.