A long way to equality
By Norman Lamb MP
On the 70th birthday of the NHS, it was uplifting to see people across the country coming together to celebrate one of Britain’s greatest achievements. As we look to the next 70 years, however, it is also important to reflect on areas where the health service has too often failed to protect the wellbeing of some of the most vulnerable individuals in our society – particularly those who experience mental ill health.
There has been a revolution in public attitudes around mental health over the last decade. Campaigns like ‘Time to Change’ and ‘Heads Together’, along with public figures who have bravely spoken of their own personal struggles, have helped to encourage open conversations and break down the stigma that often prevents people from seeking help.
While this has been a great triumph, we are still a long way from achieving equality for mental health in the NHS. I am proud of the progress we made in some areas during my time as Care Minister, such as trebling the number of people accessing psychological therapies and publishing the first ever maximum waiting time standards for mental health.
It is also important to reflect on areas where the health service has too often failed to protect the wellbeing of some of the most vulnerable individuals in our society
But people with mental health problems still do not enjoy the same rights to access treatment, on a timely basis, as people with physical health problems. Instead of getting the right support at the right time, they are too often left waiting interminably as under-funded and under-staffed mental health services buckle under unprecedented demand for care.
A flurry of reports from the CQC has exposed the many ways in which the system is letting people down. Too many people are institutionalised in ‘locked rehabilitation wards’ – a remarkable contradiction in terms – when they should be supported to live more independent lives in their own community. There are serious concerns about the quality of care for the growing number of people detained under the Mental Health Act. And my own research has shown that the use of force in mental health units is still endemic – including the dangerous practice of face-down restraint, despite guidance I issued aimed at ending this practice.
In April, the CQC’s review of children and young people’s mental health services found that the system is “complex and disjointed” – with long waiting times and inappropriately high thresholds for treatment. Although the Government has issued a new green paper, a damning report from the Health and Education select committees concluded that the proposals could leave thousands of children without the support they need.
[People with mental health problems] are too often left waiting interminably as under-funded and under-staffed mental health services buckle under unprecedented demand for care
One of my great frustrations since leaving the Department of Health is the slow progress in implementing the ambitious Future in Mind strategy launched by the Coalition Government. This was a golden opportunity to link schools much more closely with mental health services and improve support for children before they reach crisis point. By failing to deliver this essential support, we are condemning a whole generation of young people to lives blighted by ill health and damaged prospects. It’s both morally unconscionable and economically stupid.
The Prime Minister has promised to tackle the burning injustice of inadequate mental health care. But until the funding and workforce is in place to support this, the brutal truth is that people with mental health problems will continue to be treated as second class citizens in the NHS. Sadly, the new £20 billion funding settlement falls short of the amount experts such as The King’s Fund and The Health Foundation say will be needed.
Expanding access to evidence-based treatment – with a stronger focus on early intervention and children’s mental health – must be a priority. However, it isn’t enough to focus on treatment alone. The country is in the grip of a mental health crisis which can only be tackled by a radical cultural shift from repair to prevention. We need to look beyond the NHS to address the social determinants of mental ill health, rather than trying to cure it once it’s there.
By failing to deliver this essential support, we are condemning a whole generation of young people to lives blighted by ill health and damaged prospects. It’s both morally unconscionable and economically stupid
One exciting initiative is the global network of cities focusing on long-term public mental health strategies. These aim to prevent mental illness across entire populations by looking at areas such as housing, employment, schools and the criminal justice system to ensure that there is proper support for people’s mental wellbeing.
I had these cities in mind when I chaired the West Midlands Mental Health Commission in 2016. We produced an action plan which had public mental health at its heart – including a focus on access to good housing through ‘Housing First’; getting people with mental ill health back to work using the ‘Individual Placement and Support’ model; and keeping people in work through a ‘Wellbeing Premium’ – a tax break for employers that take steps to improve the wellbeing of staff.
We need to look beyond the NHS to address the social determinants of mental ill health
If the new Health Secretary wants to secure a legacy, he should make it his mission to end the historic discrimination against mental ill health in the NHS. However, he must also make the case that the NHS cannot protect the mental health of the nation alone. Other parts of government need to play their part. If done properly, there is the potential to completely transform many thousands of lives – while it will ultimately save the state a fortune.
Image: Jesse Gardner, Unsplash
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