Mental health is simply health with mental features. Every GP deals with minor mental disorders every day and occasionally with serious mental disorder requiring referral to the specialist mental health services for serious depression, schizophrenia , dementia, substance abuse , the more crippling anxiety disorders and many other serious conditions.
Labour has a good record for mental health services, from the multiprofessional approach of 1975 on which our present services are based, to the late 1990s when mental health was the first priority. The Tories were very good at closing the asylums: but most of the profits went to their friends the property developers. As with the rest of the NHS, spending has not kept up with need, the extra money granted for mental health is being spent on general hospitals’ debts. Thatcher’s ‘reforms’ of the NHS, were particularly bad for mental health services, causing a separation of mental health Trusts from general medical services, making psychiatrists feel like the ‘alienists’ of the 19th century.
But hey, the future is bright at the forefront, isn’t it? Mental illness is now seen as a neuroscience problem, genomics is fashioning new ways of altering brain dysfunction, psychological treatments are scientifically based and focussed. Demographic change means more elderly: although most are healthier, the incidence of dementia rises with age. Austerity causes more depression, a reversal of the previously falling suicide rate and substance abuse. Cannabis and synthetic street drugs are lighting up those genetically prone to schizophrenia. Managerial interference, arbitrarily changing services without scientific evidence, is leading to disasters. The 2012 NHS and Social Care Act has laid the door wide open for services to be hived off to the private sector, costing more with less accountability. Managerial bed closures means patients are hospitalised hundreds of miles away, often in the private sector.
What is to be done? We had it nearly right in the late 90s. Hospital beds were provided near to where you lived . The front end of the specialist service was a mental health centre in your neighbourhood,.The multiprofessional teams were geographically organised, thus familiar with local social and economic factors. Seriously disabled patients were housed in fully staffed community homes, publicly provided.
What we must ensure is that our services are based on scientifically evidenced research, so NICE, the National Institute for Clinical Excellence, is important for mental health services.
The specialist services for our children has been left to deteriorate so that months can go by without a child receiving a referral, and this in an era when social media is so pathological to children. This is the most urgent funding claim to be settled.
Mental illness services for the elderly could benefit from greater integration into services for the elderly and frail. No-one now seems to know what to do in psychiatric emergencies, because that knowledge is not being publicised.
Our forensic services deal with mentally disordered offenders. Their standard is high, but they cannot cope with the increase in offenders sent to prison. There has been some involvement by the NHS, but prison is still another world in which the suicide rate is rising. Recent disasters have shown how the Police need more education into mental disorder and its emergency handling.
If you are severely mentally disabled, you should be entitled to the appropriate welfare, yet the attitude of the Tory government of thinly disguised discrimination against those in need is particularly harmful. Someone with schizophrenia cannot be assumed to ‘ just go online to find your benefit’. Disability assessment must be carried out by properly qualified personnel, working to standardised procedures.
In UK our legal framework around mental disorder is something to be proud of. It was the first to activate in a mental health case, Labour’s assimilation of the European Convention on Human Rights into all UK law. Human Rights still sadly needs to be fought for and defended.
The remedy is not just funding the NHS to the same level as other major European states, nor even returning the services to their previous standard, but also structural change, to rid the NHS of the artificial split between commissioners and providers. NHS England has recently ignored it, when implementing their Sustainability and Transformation Plans.