Delivering the mental health strategy By Andy Bell The first half of 2016 saw the publication of a new NHS strategy for mental health, the Mental Health Five Year Forward View, and an implementation plan to set out how it would be delivered. These two key documents were published, however, in the midst of growing concerns about the overall financial health of the NHS and the impact this and other pressures are having on mental health services. The strategy and its implementation plan set out a clear and detailed blueprint for improvements to a number of mental health services, from care for women during and after pregnancy to supported employment. It gives clear expectations to the NHS and its partners for the changes it has to deliver, such as ensuring 30,000 more women get specialist help for perinatal mental health problems, extending access to psychological therapies to more people with long-term physical illnesses and doubling the availability of Individual Placement and Support employment service places. The strategy is also clear that the work of the previous taskforce, on children’s mental health, remains a priority, and that the local Transformation Plans that have been drawn up as part of Future in Mind need to be implemented in full. Many of the service improvements outlined in the strategy are backed up by strong evidence of economic as well as human benefits (see here). If they are put in practice and achieve their full potential, they should generate not just improvements in people’s health and wellbeing but efficiencies across the NHS and beyond. The strategy focuses not just on specific service improvements but on addressing the ‘hard wiring’ of the NHS that too often disadvantages mental health relative to other health services. That means significantly improving transparency, for example about levels of funding and what they are delivering, the way money flows through the system and the way the workforce is developed to meet people’s needs. The scale of the task can seem daunting. We know that current service provision meets only a minority of the level of mental health need in the population. We know that early intervention is almost always the most cost-effective approach yet service thresholds have been rising incrementally as budgets are stretched and services are forced to ration care to those with the most pressing needs. And we know that many people’s experiences of mental health care leave significant room for improvement, with growing use of the Mental Health Act, high bed occupancy rates in inpatient wards and continued ethnic inequalities at all levels of the system. Despite the challenges, the strategy gives an important platform for bringing about change, and recent announcements from NHS England have made it clear that local areas are expected to ensure that funding earmarked (but not ringfenced) for mental health care is spent as intended and that the improvements set out in the strategy are made in practice. The biggest questions, though, will centre on whether the strategy gets the whole system support it needs to be implemented successfully nationwide. It is as yet unclear how far the 44 NHS sustainability and transformation plans being developed across England will embrace mental health or leave it on the sidelines. We do not know how far local clinical commissioning groups will prioritise mental health over the next five years amid the pressures they face from all angles. And crucially, we know that the lives of people with mental health problems are affected as much, if not more, by factors such as housing and employment as by health and social care services. For this, a cross-government approach to mental health remains essential to deliver changes to policy and practice across the board that will make the biggest difference in people’s lives.