By Tom Cahill

Coming up to the 70th birthday of the NHS gives us a chance to think about where mental health has got to in 2018 and reflect on the changing approach to mental health care over the past 20 years or more. This week I was fortunate to be at the NHS Confederation Conference. The ‘who’s who’ of the NHS world get together to discuss, plan and share issues relating to the current NHS as well as celebrating successes and planning to address challenges. What was striking for me this year, more than any other year, was the emphasis placed on mental health, with many talking openly about mental health being a priority now and in any future settlement for the NHS.

In my current role as Chief Executive of a mental health and learning disability trust, I view this as very positive. However, before I get too excited, we must remind ourselves that, while the profile of mental health is higher than ever, we are still a long way behind where we should be. Only 4 in 10 people with a mental health problem receive the care they need and those diagnosed with a severe mental health problem have an average life expectancy which is 15-20 years shorter than those without. I believe this is a scandal and our challenge is to turn the rhetoric into reality by driving a better deal for those who experience mental health problems.

While the profile of mental health is higher than ever, we are still a long way behind where we should be. Only 4 in 10 people with a mental health problem receive the care they need and those diagnosed with a severe mental health problem have an average life expectancy which is 15-20 years shorter than those without

When I reflect on how the delivery of care has developed over the years, I can see how our approach to supporting people with mental health problems has transitioned from care in large institutions to ‘Care in the Community.’ I experienced this first hand as a Mental Health nurse. In the 80’s, care was still very institutional, with many service users being admitted for years - some institutionalised as a result and their independence very much hampered. Professionals were still caring and compassionate and many went the extra mile to innovate and support service users as best they could. However, our model of care was one referred to as a medical model, where there was an over dependence on medication. As there was minimal support available, too frequently admission was considered the default option.

My reflection, as someone who trained during that period, is that a diagnosis was often stigmatising and became the defining aspect of an individual. Mental health has been on a journey ever since and I am really proud of how far we have come. There is much less dependence on admission as an early form of treatment and greater balance between the use of medication and therapy. The concept of recovery is a key ingredient in our approach to transformation. Models of care and the services have developed and transformed over the years and there is a much greater focus on keeping people at home, well and providing services that best meet their needs.

Mental health has been on a journey ever since and I am really proud of how far we have come. There is much less dependence on admission as an early form of treatment and greater balance between the use of medication and therapy.

There are many definitions out there for recovery, my own being the ability for individuals to be supported, reach their potential and live fulfilling lives in the context of their mental illness. It requires working with service users to focus on their strengths, hopes and aspirations to help them achieve their ambitions. This approach has driven the concept of coproduction, using the experience of carers and people who use services not only to better their own care, but to better the care for others by helping to design and shape future service models. It also ensures that where possible they take individual responsibility for their own care plans and personal budgets.

There is still much to do, particularly in our support for young people and those in crisis. We can draw hope and optimism from our journey so far and from working closely with those who use our services.

Happy anniversary to our fantastic NHS. 


This blog is part of our NHS 70 series. Take a look at other posts in the series.