Mental Health – a barometer of the NHS?

30 years of campaigning, research and development by professionals, aided by service users and family members who rely on services, have taken the country’s mental health care from hopelessly inadequate to being one of the world’s best. 

30 years ago, the legacy of neglect was evident everywhere.  The era of placing and forgetting about people in remote monolithic institutions was ending, but 30 years ago these institutions still functioned and their legacy services within remained intact. 

Since then, few of these monoliths still remain, most have gone.  But the care given has been totally transformed, everywhere.  Most mental health care is managed in the community, much by GPs and their staff, supported by community-based specialists.  In specialist providers, practitioners in psychotherapy, clinical psychology and psychiatry work closely together in each service user’s interests, in assessing needs, or in offering or monitoring treatment.  And the single biggest change has been the integration of health with social care, without which many (even most) of the last 30 years of transformation would not have been realised. 

But now, in the present situation of radical cost and productivity improvement, the care models that are so highly regarded internationally are under immense stress.  With calls for stringent productivity improvement by national government, mental health services are doubly hit by swingeing cuts in social care by local government.  And the sheer pace of the financial cutbacks is eye-watering.  In consequence, traditional social care systems are likely to be dismantled and integration of work across organisations is subject to reversal.  A lot is at stake.

Productivity has long been an issue in mental health services – after all, the costs were considerable of maintaining the old institutions that delivered little active treatment, and that money is now spent a lot more productively.  A whole new step-change, of at least equal proportions, is now needed – and fast!  Complete redesign will need to address the workforce, its plethora of disciplines and its effectiveness.  More generically qualified staff, supported by fewer highly specialist colleagues, social care input provided directly by the NHS, long-term placements managed more cost effectively – these are thought to be among the ways forward.  But the tools and the means of predicting, achieving and monitoring these changes are rare indeed.

If a whole society, generally, can be judged by how it treats its disadvantaged citizens, then perhaps its health care system specifically can be judged by its mental health services.  If mental health care is a barometer of the NHS, then there has never been a more important time to secure the hard-fought gains of 30 years, as a baseline from which to advance further.