13 March 2020
In a very busy week for news, the first Budget of the new government was announced. The biggest development, necessarily, has been the need to unlock funding to mitigate the impact of COVID-19.
‘Mental health’ is mentioned only three times in this 125-page document. While this is disappointing, it is important to note that a number of spending pledges for mental health have already been made, including extra investment in NHS mental health services. Many of the plans set out in Budget 2020 had already been announced in the Spending Round 2019. Others come from the Conservative Party Manifesto from 2019, which we have explored previously (see our analysis).
Budget 2020 also gave us a timetable for the next Comprehensive Spending Review (CSR). The CSR will set out spending plans for public services and investment, covering resource budgets for three years from 2021-22 to 2023-24 and capital budgets up to 2024-25. It is set to conclude in July 2020, leaving a relatively short but important window in which mental health organisations and campaigners can seek to inform decision-making.
The Budget reiterated what has already been brought forward in the NHS Funding Bill, which is an increase of £34bn a year by 2024. An additional £6bn investment in the NHS was also announced to help it manage the challenges presented by COVID-19. The Budget describes how this will be used to create ‘world class facilities’, including 40 new hospitals, and to recruit thousands of nurses, GPs, and other primary care staff.
It will be important that capital spending is also invested in mental health, ‘some of the worst estate that the NHS has’, so that people with mental health problems too benefit from ‘world-class’ environments which are trauma-informed, safe, therapeutic and conducive to recovery.
At the same time, workforce expansion must include mental health specialisms in order to deliver the NHS Long Term Plan. This, of course, includes mental health nurses but also a range of other roles, including psychological professionals, who can make significant contributions in primary care, as well as social workers and peer supporters (O’Shea, 2019).
The Budget went no further than the Spending Round 2019’s commitment to £1bn extra funding per year for social care to ‘stabilise’ the system. There was no other extra funding announced: a ‘glaring omission’ as noted by the Chair of the Health and Social Care Select Committee. Cross-party talks on the future of social care are expected to begin in May.
Debates about social care funding often focus on care and support for older adults. But it’s just as important that the needs of working age adults with mental health problems are considered. Mental health social care needs to be on the agenda of upcoming talks and must be fairly funded. We also need a diverse and skilled social care workforce which provides vital support so that many people can manage their mental health, stay well, care for others, and live independently.
Children and young people
Budget 2020 confirmed the Spending Round 2019’s commitment to provide an increase of £7.1bn in schools funding by 2022-23. Additional small funds for promoting physical activity and access to the arts were also announced.
While we welcome the arrival of Mental Health Support Teams in schools, with some 123 new sites expected this year, we also need to see resources for whole-school approaches to mental health, including support for schools to become trauma-informed and mental health promoting (Wilton, 2020).
The Spending Round 2019’s commitment to £500m for youth centres was also reiterated, and a new fund of £2.5m for research into supporting the needs of vulnerable children and families was announced.
Youth centres can promote young people’s wellbeing by offering social connection, opportunities, and interaction with trusted adults. They can be spaces where the early signs of distress can be spotted, where access to further support can be facilitated, and where support can be offered to marginalised young people in culturally appropriate ways (Stubbs et al, 2017; Durcan et al, 2017). And yet, the new funding does not bring us back to same levels of funding we had in 2010-11, which means we are missing many opportunities to keep young people safe and well and to intervene early and effectively when they face difficulties.
The Budget reiterated the Spending Round 2019 to invest in police services, including recruiting 20,000 new police officers. It also announced £5m additional funding for the Youth Endowment Fund, £68.5m to ‘toughen’ community sentences, and £156m to tackle prison maintenance issues.
We know that mental health problems are common in the criminal justice system. The condition of the prison estate should be improved and more ‘through the gate’ support should be offered so that our criminal justice system doesn’t perpetuate cycles of trauma or contribute to reoffending. Projects involving therapy dogs (Durcan, 2018) and offering personalised employment support on release (Durcan et al, 2017) are promising examples of how outcomes can be improved.
We welcome the new investment in the work of the Youth Endowment Fund, which funds projects and research taking therapeutic approaches to addressing youth crime and violence. Attempts to engage marginalised young people must be carefully thought through and culturally appropriate (Khan et al, 2017). Further labelling of young people as ‘criminals’ or ‘gang members’ may increase stigmatisation and marginalisation of groups who are already badly served.
The Budget is virtually silent on public health on everything apart from COVID-19. This is a worrying gap with potential short- and long-term consequences for the public’s health and wellbeing.
Public health services in local government play important roles in preventing mental ill health and tackling inequalities. An update on the Public Health Grant is urgently needed. Levelling up and reducing health inequalities is not just about the NHS.
The Budget confirmed the Government’s commitment to rolling out Universal Credit. It also stated that a ‘breathing space’ programme of 60 days’ postponement for problem debt for people with mental health difficulties would be established.
People with mental health problems often have the worst experiences of navigating the benefits system, for example, in proving they are unable to work, and accessing their full entitlements. Universal Credit has been associated with high-profile tragic outcomes, and the impact of a national rollout for people with mental health problems must be fully understood if further tragedies are to be avoided. The benefits system provides an essential safety net for many, yet it is failing to provide safe and effective support for too many people with mental health difficulties. It is therefore vital that people with mental health problems get all the support they need to obtain the benefits they are entitled to, without fearing reassessments, conditions or sanctions.
Reducing rough sleeping was a major commitment in the Government’s 2019 manifesto and the Budget builds on plans made in the Spending Round 2019. £643m will be made available for accommodation and support services to help people ‘to start rebuilding their lives’. This is broken down as: £237m for accommodation, £262m for substance use services, £144m for ‘associated support’. £46m from a ‘Shared Outcomes Fund’ is to be made available to support people with multiple and complex needs.
The Centre will shortly publish a report on Housing First, an evidence based approach to providing accommodation and support for people with multiple and complex needs, including homelessness and trauma. Keys to successful programmes are collaborative working across health, social care, housing and communities, the proper funding of wraparound, holistic support and access to the right standard of housing.
Veterans’ mental health will receive an uplift of £10m in 2020/21 to fund projects and initiatives. This is a welcome move, and it will be important that the funding is spent on services that offer the best chance of supporting veterans’ and families’ mental health, building on the learning from initiatives such as the Forces in Mind Trust mental health programme.