seandugganby Sean Duggan

The NHS should be investing in interventions that improve health and wellbeing, not cutting cost effective mental health services, says Sean Duggan.

The funding of mental health care has come under the microscope in recent weeks, with concerns about budget cuts and their impact on services and the people who use them.

Financial pressures are not new to mental health services; even in times of plenty, NHS investment is skewed towards physical health care, and hospital services have tended to get a bigger share of the pie than those that work less visibly in the community.

‘Investing in an otherwise missing level of mental health support can actually create savings in some of the most costly and pressured parts of the NHS’

Evidence published earlier this month by Rethink Mental Illness suggests that in about half of the country financial pressures are taking a heavy toll on some of the most effective (and cost effective) mental health services around.

It found that 55 per cent of early intervention in psychosis services had been forced to cut costs despite the savings such services generate when they are working well. Such cuts will almost certainly turn out to be a false economy, stacking up costs for individuals, families, health and care services for years to come.

Yet in some parts of the country, local commissioners are taking a more creative approach to managing scarcity. In the City of London and Hackney, for example, a group of GPs set up a new service aimed at offering better care and support to people whom neither primary nor secondary care services had previously been able to help successfully.

The primary care psychotherapy consultation service (PCPCS) supports people with medically unexplained symptoms, those with personality disorders and those with chronic mental health problems. It offers training and support to GP as well as providing a range of psychological therapies directly to people who would otherwise get little effective help from existing services.

Economic sense

The Centre for Mental Health recently carried out an economic evaluation of the PCPCS and concluded that it improved people’s quality of life at the same time as reducing the cost of GP consultations, accident and emergency attendances, outpatient appointments and hospital admissions. These savings offset more than a third of the cost of the new service within two years – and the longer term benefits may be greater still. Even on very conservative assumptions cost per quality-adjusted life-year gained is well below the National Institute for Health and Care Excellence’s threshold of £20,000-£30,000.

‘Psychological support can be beneficial to our physical and social wellbeing as well as our mental health’

This illustrates that investing in an otherwise missing level of mental health support can actually create savings in some of the most costly and pressured parts of the NHS. It can reduce the workload of GPs and, like liaison psychiatry teams, prevent expensive hospital admissions. By helping people whose physical health is often very poor, it shows that psychological support can be beneficial to our physical and social wellbeing as well as our mental health.

The NHS is likely to face many more years of austerity. Cutting cost effective services now carries big risks for the near future. Investing instead in interventions that improve health and wellbeing can help the NHS to live with the years of scarcity that are yet to come while offering better care and support to people who need it most.