Why access matters by Andy Bell This week the Government and NHS England have set out in a ‘five year plan’ how they will put in place the first meaningful waiting time standards for mental health services in England. In the first instance they will be an 18-week wait for some psychological therapies and a two-week wait for Early Intervention in Psychosis (EIP) services. The plan also includes investment of £40 million this year and £80 million next in improving access to crisis services and filling in gaps in provision of EIP teams. The plan follows an objective in the first NHS Mandate for the NHS to create access and waiting standards for mental health treatment to help to bring it into line with those for other kinds of health care. It sets out a vision, stretching into the next Parliament, for the creation of a much wider range of access standards for mental health services for both children and adults, building and improving on the initial two targets. This is truly an important step on the road towards ‘parity’ for mental health care in the NHS. It raises many questions about how these standards will be achieved given the financial pressures mental health services are facing, whether they are the right places to start and indeed whether they will make a real difference to people’s experiences of mental health support. What is clear from a growing body of research is that the level of unmet need for a wide range of mental health conditions among people of all ages is staggeringly high. Only a minority of people with the most common mental health conditions among children and adults receive any treatment at all despite the availability of effective interventions. Guidelines from the National Institute for Health and Care Excellence are routinely ignored and effective interventions are not offered – a situation that would be unthinkable in any other area of health care. We also know that the longer people wait for support the more damage a mental health condition can do to their health, their family life, their schooling or work and their social connections. Long waits for psychological therapy, for example, don’t just cause distress among those left waiting and their families but they deter many from getting treatment at all. Untreated psychosis can have particularly damaging effects on a young person’s life that effective EIP services can prevent. And people wait in many parts of the mental health system, from being kept in police cells in an emergency and being unable to contact crisis team out of hours to being made to wait for months for psychological support or for a transfer from prison to hospital. These are all important and will all need to be addressed. For the first time, we now have a commitment from the NHS to put in place proper access standards for mental health care. It is vital that this is regarded as the beginning of the journey and not the end. If implemented effectively, it should lead to a rebalancing of NHS spending, putting right decades of under-investment in mental health care by focusing commissioners’ minds on achieving better and faster access to effective treatment and support. In so doing, it will enable the NHS to use its limited resources more cost-effectively, to achieve more health gain and better outcomes by focusing on earlier intervention, more integrated support and timely responses when people ask for help. To do this well, we will need robust performance measures and clear lines of accountability for achieving the standards. It is also crucial that waiting time standards are backed up with the same level of entitlement to cost-effective mental health treatment as we have to medicines and surgical procedures under the NHS Constitution. And of course it will be necessary to ensure access is not achieved at the expense of quality and good outcomes – of all mental health services supporting personal recovery. This may look like a big hill to climb from where we are now, and it is. But that should not deter us from starting the journey. And it should make us determined to get the job done.