Social care reforms miss opportunity to improve support for people with mental health difficulties

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2 December 2021

The Government’s adult social care proposals, published yesterday, are disappointing and could actually lead to more people requiring support.

Centre for Mental Health welcomes the white paper’s aim of enabling people to live independent and healthy lives. But the way extra funds are being raised and the inadequate level of investment in improving outcomes means that this goal is as far off as ever.

One in every £12 of the adult social care budget spent by local authorities is used to support people with mental health conditions living in the community and yet the white paper has very little to say on improving care for this group.

Social care is an essential element of mental health services. It provides support for people to live independently in their own community, it safeguards people’s rights under the Mental Health Act and it offers help to carers.

Investment is needed in mental health social care. In June 2021, 68% of directors of adult social care said they were facing a significant increase in demand for mental health related services. Many local authorities were struggling to meet statutory responsibilities under the Care Act prior to the pandemic. And charities funded by social care have faced budget cuts as councils have had to reduce costs.

Those with lower incomes appear to have the most to lose and least to gain from the Government’s new proposals that, by increasing National Insurance payments to fund additional costs, may mean more people become mentally unwell and require social care and other support.

Most of the extra money raised by the levy will be used to put a cap on the lifetime cost of adult social care to the user, protecting a far greater proportion of more affluent people’s wealth than that of the most deprived. The majority of people requiring social care support in working age are on lower incomes, and many have to pay for some of their support from their benefits.

Of the additional £5.4 billion raised by the Social Care Levy over the next three years, £3.6 billion will be used to cap the amount individuals pay towards their support, leaving just £1.8 billion for ‘wider system reform’. This equates to an average of just £4 million annually per upper tier local authority, which at a time of steeply rising costs and demand leaves little room for improvement.

The white paper recognises that under-investment in local authorities serving the poorest communities causes worse outcomes, noting ‘evidence of poorer quality care in less prosperous areas where local authorities often pay lower rates for care and self-funders are less affluent.’ But the white paper does not address inequities in funding that create this situation, and relying on Council Tax to top up social care funding could extend the gap further still.

The white paper includes a welcome acknowledgement of the importance of supported housing. We know that this is important for people with mental health difficulties, for example to enable people to leave hospital when they are well enough and provide alternatives to admission.

The white paper pledges £300 million investment in housing over three years; this translates to the equivalent of just 20 extra care flats per upper tier local authority.

The white paper recognises that investing in the social care workforce is essential for its sustainability. This includes recruiting and retaining mental health social workers and Approved Mental Health Professionals, whose role is at the heart of reform of the Mental Health Act. Investment in this workforce, and related roles such as independent advocacy and welfare advice, is necessary to modernise the Mental Health Act and provide high quality support long-term.

The white paper acknowledges the emotional toll of the last two years on the wider social care workforce: ‘Much of the workforce suffers from poor mental health and burnout with 26% of care home workers likely to be experiencing some form of depression at the start of this year, and 27% likely experiencing an anxiety disorder (compared with 20% and 18% at the national average)’. Addressing this will require a concerted effort to support staff wellbeing, plug gaps in the workforce and invest in social care long-term.

Centre for Mental Health calls on the Government to go beyond the white paper to better address the causes of vulnerability, especially poverty, invest significantly more in local authorities and ensure better social care support to adults with mental health needs.

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