Old problems and new solutions to mental health

Tuesday, 16 February 2016

There is a saying in London that you can wait all day for a bus and then two arrive together! This old adage became true in the UK’s mental services when mental health patient advocates, who had been calling for an independent and comprehensive review of the state of mental health services in England, were surprised in February 2016 when two mental health services reviews came out together.

A system under pressure

First to be published was Old problems, new solutions: Improving acute psychiatric care for adults in England that came out on 9 February 2016. The report issued by the Independent Commission on Acute Adult Psychiatric Care, a commission set-up by the influential Royal College of Psychiatrists (RCP), paints a picture of an:

…acute mental health system under pressure, with difficulties in access to care compounded by – in some instances – poor quality of care, inadequate staffing and low morale. Too often inadequate data and information are available but it is clear that the whole system has suffered from a steady attrition in funding from both NHS and local government sources in recent years.

In hot pursuit, a week later, NHS England produced its own response in its report on 15 February: The five year forward view for mental health.

NHS England repeats most of what has been said by the RCP and highlights some fundamental failures like a rise in patient suicides, long waiting lists and a lack of beds for acutely unwell patients. It goes on to reinforce staff shortages and highlights discrimination: there had been “no improvement” in race inequalities in mental healthcare since 2010.

NHS England reserves its last blast for the NHS commissioners! Some say this is the root cause for this decay in one of the oldest universal health coverage systems. NHS England alleges that 'chronic underinvestment' in mental health services and 'a lack of transparency has masked a growing inequality between spending on mental and physical health.'

Measures to address the crisis

NHS England has accepted a five-year blueprint to address the growing crisis in mental health services and pledged to increase investment by an extra £1bn a year by 2020. They will reduce the severity of the crisis by:

  • Improving access to ‘talking therapies’, using telehealth, to deal with anxiety, depression, stress and phobias. This frees resources for acute care 
  • More than 60% of people experiencing first episode psychosis get early intervention services
  • Making sure that the physical health and mental health problems of people are treated together
  • Have more high-quality mental healthcare services for children in place
  • More people with mental health conditions accessing employment support
  • 24/7 community-based crisis services available in every area, including “adequately resourced” crisis teams
  • Liaison psychiatry services available in every A&E department
  • An end to the practice of sending patients out of area for beds
  • Ensure more women each year getting perinatal mental health care

Full reports