A new year can create a sense of possibility and hope, or one of foreboding and uncertainty. For mental health policy in England, there is good reason for both.
We’re now almost 18 months into the current Parliament, and Labour’s election manifesto promises are beginning to be realised – albeit at different speeds. They pledged to modernise the Mental Health Act, and in December the Bill finally completed its passage through Parliament. Now it has to be implemented. And that will take time, effort, resources, and determination. We were also promised legislation to ban ‘conversion’ practices against LGBTQ+ people, and we’re still waiting for that.
The Government’s manifesto pledged to put a mental health specialist in every school. That has since been subsumed under the expansion of the previous Government’s programme of mental health support teams, which is due to be completed in 2029. For that promise to be fulfilled, it is vital that the new system is additional to existing provision, and that it provides the right level of support for all children and young people with a wide range of diverse needs and circumstances The manifesto pledged an open access early support mental health hub for young people in every community. Progress towards this goal has been slower so far, and it has been brought under the wing of the Young Futures programme. We’ll be holding the Government to account for achieving the promise in its manifesto as this year progresses, drawing on the blueprint we produced with partners as part of our Fund the Hubs campaign.
The Government pledged to grow the mental health workforce by 8,500 whole time staff within this Parliament. This in itself was a mild ambition, representing a marked drop-off from the rate of increase over previous years. How far those extra workers will go, in the context of rising need and demand for mental health care, remains to be seen. But it is likely to be insufficient by a wide margin.
The Government’s manifesto said nothing about how it would protect or promote our mental health – itself a disappointing omission. But some of its policies could in practice be beneficial anyway. From ending the two-child limit on some benefits to legislating for workers’ and renters’ rights, it has taken steps to address major social determinants of mental health. We could do so much more, however, by taking a cross-government approach to mental health – with a plan of action and a means of testing new policies for their mental health implications early on.
A lot has happened since the election. Ministers have become increasingly concerned about rising numbers of people seeking help for their mental health, and especially the number of younger adults claiming disability or incapacity benefits for mental health reasons. We now have a number of reviews and investigations in train that will report this year. We hope they will provide evidence-based answers with positive policy solutions. We stand ready to share the evidence we have and ensure they listen to voices of experience and especially those of the most marginalised and unheard.
For mental health services in England, and those who use or work in them, the future still looks uncertain. The 10-year health plan didn’t say much about the future of our mental health services, but we will this year have a ‘modern service framework’ for supporting people with ‘serious mental illness’. We’ve also got the 24/7 neighbourhood mental health centres up and running, making crisis care more accessible, the continued expansion of Individual Placement and Support (IPS) employment services across the NHS, and the vital work of the Patient and Carer Race Equality Framework (PCREF) to drive system change in every mental health service countrywide.
Promises of ‘parity’ for mental health still, however, provide little comfort. Mental health services get less than 9% of NHS funding despite accounting for at least 20% of all health need. Waiting time targets for mental health care are still not taken as seriously as those for physical health care. Unsurprisingly, this means that people are forced to wait for long periods or told they are not unwell enough, or their needs are ‘too complex.’ Too many end up at crisis point for lack of earlier help, and are then forced to seek urgent help in emergency departments where they feel unsafe and unwelcome. This is unjust and unnecessary, and it requires an overhaul of our mental health services to build a system that meets people’s needs more quickly and effectively with much less reliance on coercion and institutionalisation.
There are many reasons to be hopeful, nonetheless. Nationally and locally, in communities, schools, workplaces and more, people are taking action to create better mental health and overturn entrenched inequalities. Harmful narratives about the rising prevalence of mental ill health are being countered by those willing to stand up and speak the truth to power. Innovation, compassion and social action hold the keys to challenging the inequities that cause and perpetuate mental distress.
This could be a year of significant progress. It’s our ambition to make it that way. We’re aware that it will not be easy, and we could face even bigger barriers to come. The international context – of aggression, oppression and conflict, the continuing impacts of global heating, and their impacts on people’s lives worldwide, add further to the uncertainty and instability around us. But we will do our part to create a mentally healthier future, working with those willing to go there with us.
