Today, a new report from the National Mental Health Intelligence Network has brought together for the first time a wide range of data about psychosis in England. The picture it presents is one of wide variation between localities in the lives of approximately one million people and the services on offer to them.
The report is a stark reminder that people living with mental health problems face some of the biggest health and social inequalities of anyone in England today. Rates of psychosis are higher in the most deprived areas of the country and among the poorest and most marginalised communities. And people living with a psychosis face a shorter life expectancy and dramatically poorer life chances than most others in our society. The report notes, for example, that just 5.8% of working age people with psychosis are in employment, despite consistent evidence that at least half would like the opportunity to be in paid work. And it offers a reminder that someone living with a psychosis can expect to die 15-20 years too soon, predominantly as a result of poor physical health.
The report also lays bare massive inequalities in the health and social care that is offered to people with psychosis. It finds, for example, that the proportion of people with a psychosis who have a comprehensive care plan under the Care Programme Approach ranges between local areas from just 3.8% to 94.5%. Likewise the proportion who have a crisis plan varies from 0.3% to 85.7%. Some of these extreme variations may be explained by limited data quality. But taken alongside evidence from other sources about variations in CCG spending on mental health services and pressures on local authority social care funding, it is clear that people with a psychosis face a postcode lottery in the care and support they are offered.
The report is as remarkable, however, for the data it cannot present as for what it can. There is very little information about the lives of people with psychosis and how far the services available help them to recover their lives. There is little information about housing, about financial security or about physical health beyond the headlines about premature mortality. And there is little to tell us about the experiences of people from Black and minority ethnic communities beyond the stark inequalities in diagnosed prevalence of psychosis and greater use of the Mental Health Act.
For all the gaps in the data, however, it is abundantly clear that concerted action is vital to address the gaping inequalities laid bare in this week’s report. At the national level, as the Public Accounts Committee stated last week, we need a cross-government strategy to match the ambitions of the NHS’s five year forward view for mental health and transform the support people with mental health problems get from all public services. Regionally, new devolution arrangements and the much-discussed but seldom-seen sustainability and transformation plans (STPs) must address mental health inequalities as a top priority. And locally, the data contained in this report must act as a wake-up call for clinical commissioning groups and for local authorities when they set their priorities and make their spending plans.
The data presented in this week’s report must be regarded as a starting point for change. While it will take time and concerted effort to bring about improvements in people’s life chances, inequalities in service provision can be addressed more quickly and changes that will generate long-term benefits can begin without delay.