2 December 2019
By Louis Allwood and Andy Bell
As the General Election looms, the major political parties in England have now all published their manifestos. Each has made several pledges relating directly to mental health and all have implications in their wider policies for people’s wellbeing and the lives of people with mental health difficulties.
Increased funding for NHS mental health services is a commitment of all the parties. The Conservatives reaffirm their commitment to the NHS Long Term Plan, which includes a ringfenced addition of £2.3 billion for mental health services by 2023/24. The Liberal Democrats and Labour also make specific funding pledges to spend extra on NHS mental health services. And all of the parties commit to making some changes to the current Health and Social Care Act which will affect the way that health services are commissioned.
All of the parties recognise the challenge of expanding the NHS workforce, including for mental health services. The Liberal Democrats, for example, pledge to reintroduce bursaries for ‘specialist nursing’ in areas of the greatest shortages, while the Conservatives pledge a maintenance grant for student nurses and Labour pledge to reintroduce a bursary for nurses, midwives and allied health professionals. The impact of tuition fees on both mental health and learning disability nursing is now becoming clear as the Royal College of Nursing reports a fall in numbers entering training since the end of the bursary.
The mental health workforce is, however, diverse and multi-disciplinary and includes people working in local government and the voluntary sector as well as the NHS and in a wide range of roles including peer support and psychological interventions. This is largely unrecognised throughout, but expanding the workforce across the system will be the key to any ambition to increase mental health support during the next Parliament.
Some parties also make proposals in relation to specific mental health services. They include pledges from Labour to invest in school-based counselling services and ‘hubs’ for children’s mental health support, and from the Liberal Democrats to fund free prescriptions for people with long-term mental health conditions and to establish a ‘student mental health charter’ for universities. The Liberal Democrats also make specific commitments regarding mental health research while the Green Party says it would provide tailored provision for groups experiencing major mental health inequalities.
none of the parties offers a clear plan for social care funding, although some make specific pledges about aspects of service provision and staffing. All state that they will seek a settlement for the long term but with little detail about how this will be achieved
All of the major parties make specific commitments to reform the Mental Health Act. This is an encouraging development which will hopefully help to create cross-party consensus on the need for a modernised Mental Health Act and for full implementation of the independent review led by Sir Simon Wessely. There are also commitments in most of the parties to reform services for people with learning disabilities and autism in response to concerns about the application of the Mental Health Act with this group of people and the slow progress in creating community-based alternatives to the long-term use of hospitals and care homes.
In contrast, none of the parties offers a clear plan for social care funding, although some make specific pledges about aspects of service provision and staffing. All state that they will seek a settlement for the long term but with little detail about how this will be achieved. As a recent Centre for Mental Health policy briefing noted, social care is crucial for mental health support and a sustainable long-term settlement must include provision for people of working age as well as those in later life.
Policies relating to employment, social security and housing show significant differences in approach between parties, all with significant implications for people with mental health difficulties
Most of the parties make statements in their manifestos about prevention and public health. Labour pledges to increase funding for public health services in local government and for Sure Start Children’s Centres, for example, while the Conservatives make a broad pledge to reduce health inequalities, extend social prescribing and take action on prevention of ill health. Several of the parties promise legislation for an equivalent of the Welsh Government’s Wellbeing of Future Generations Act, seeking to shift the focus of decision-making to a longer term view, while the Liberal Democrats additionally promise to institute a ‘health in all policies’ approach to government and appoint a ‘minister for wellbeing’. Manifesto commitments of relevance to mental health go far beyond those that focus on the issue specifically. Policies relating to education, justice and social security all have relevance both to the determinants of mental health and the lives of people who have a mental health difficulty. Here there is a wide range of different approaches and pledges from the parties.
Policies about children, schools and education have significant implications for many of the determinants of children’s mental health and wellbeing. The Conservatives have a major focus on behaviour management in schools, including a call to make greater use of exclusion powers and alternative provision. Children who are excluded from school are both more likely to have had mental health difficulties before being excluded and face a range of disadvantages afterwards, including higher rates of mental ill health. The Conservatives and Labour both promise to review the care system for Looked After Children, another group of young people facing a very high risk of mental ill health. The Liberal Democrats make a range of pledges relating to wellbeing in schools, including a ‘curriculum for life’ and a duty to promote wellbeing which would be part of a reformed inspection regime. Labour promises to develop a ‘Children’s Health Strategy’ and to invest in both health visiting and school nursing. These are all areas where policies seeking to improve children’s wellbeing need to be informed by evidence of what will be most likely to have the most positive impact. There is less of a focus in the manifestos on mental health in further or higher education.
Manifesto commitments of relevance to mental health go far beyond those that focus on the issue specifically. Policies relating to education, justice and social security all have relevance both to the determinants of mental health and the lives of people who have a mental health difficulty
Policies relating to employment, social security and housing show significant differences in approach between parties, all with significant implications for people with mental health difficulties. Labour pledges to abolish Universal Credit while the Conservatives pledge to complete the transition process and to produce a ‘National Strategy for Disabled People’. The Green Party, meanwhile, pledges a Universal Basic Income. Given the links between poverty and poor mental health, and the widely reported negative experiences of people with mental health difficulties of the benefits system, reform of social security will have a critical role in improving mental health and reducing inequalities.
On housing, all parties make extensive pledges to tackle housing shortages and to end rough sleeping in the next five years. The Conservatives set out plans to increase access to affordable housing and to address homelessness, including through greater use of Housing First: an approach also supported by the Green Party. Labour’s housing plans revolve around increasing the supply of social housing.
Criminal justice plans also vary between parties. The Conservatives pledge to ‘introduce tougher sentencing for the worst offenders’, to increase prison places and to make community sentences tougher while also improving education and employment support for offenders. Labour pledges to reduce the use of short prison sentences, making greater use of community sentences and investing in alternatives to custody, while the Liberal Democrats make similar promises including a specific pledge to improve mental health care and treatment in the criminal justice system. Labour also pledges to implement the recommendations of the recent Lammy Review on race equality and criminal justice. The Green Party, meanwhile, pledge to halve the prison population and invest in Women’s Centres and youth services.
In successive elections during the last decade, the profile of mental health and the number and range of mental health pledges in manifestos has risen steadily. On the whole, the 2019 manifestos continue that trend
Most of the manifestos also make some pledges relating to domestic violence: a significant risk factor for mental health difficulties among women and children in particular. The Conservatives pledge to pass the Domestic Abuse Bill from the last Parliament and to offer more support for victims, while Labour makes similar pledges including additional funding for rape crisis centres.
In successive elections during the last decade, the profile of mental health and the number and range of mental health pledges in manifestos has risen steadily. On the whole, the 2019 manifestos continue that trend. While some offer more detail than others, the overall trend is not just towards a bigger focus on mental health services but also on a recognition that improving the public’s mental health should be an aim of government as a whole.
Perhaps the biggest issue in the election is what happens about Brexit. As the Centre’s writer-in-residence Mark Brown recently wrote, Brexit has major implications for mental health
Perhaps the biggest issue in the election is what happens about Brexit. As the Centre’s writer-in-residence Mark Brown recently wrote, Brexit has major implications for mental health: from expanding the health and care workforce to ensuring fair access to travel insurance in the EU for people with mental health conditions. The next Government will need to address these issues regardless of the outcome of the election.
There is little doubt that the 2019 General Election is a landmark moment in British history. Whatever the outcome, improving the nation’s mental health and reducing mental health inequalities will be among the biggest challenges facing the next Government. And with that comes the opportunity to make a real difference: to put wellbeing at the heart of government and to take concerted action to make better mental health for everyone a realistic and achievable ambition over the next five years.