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Mental health still the underdog

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Maternal mental health services are underfunded Maternal mental health services are still under-resourced despite a £290 million pledge

Towards the end of the coalition government, there was a major drive towards improving mental healthcare in England. Pledges were made, funding was committed, but recently, nine health secretaries and other prominent figures felt the need to publically denounce Jeremy Hunt’s progress on mental health. Recent figures from the Royal College of Psychiatry show that in areas such as Luton, just £2 per head is being spent on children’s mental health. So why, with all the good intentions, is progress so slow?

Every health secretary in the last 20 years, as well as figures such as Sarah Wollaston, chair of the health select committee, and Norman Lamb, the former health minister credited with jump starting the coalition government’s work on mental health, recently wrote a letter to The Times: ‘Despite warm words, one year on we see the same enduring injustice, the massive economic cost, and the distress suffered by countless families across the country.’

The letter came on the first anniversary of the launch of the Equality for Mental Health campaign, which seeks to achieve parity of esteem between mental and physical health.

On the surface, the government seems to have reacted to the pressure from the campaign and other voices. In January, the then prime minister David Cameron committed nearly a billion pounds of additional funding to mental health services. These included:

£290 million to provide specialist care to mothers before and after having their babies.

Nearly £250 million for mental health services in hospital emergency departments.

Over £400 million to enable 24/7 treatment in communities as a safe and effective alternative to hospital.1

Theresa May and Jeremy Hunt have publically lent support to the initiative, with CCGs receiving £693 million earmarked for mental health.

One would expect that mental health services were fully funded, and functioning well. However, there is a wealth of evidence to suggest that this is not the case.

Take, for example, maternal mental health services, the subject of the £290 million pledge. A report in June by the British Psychological Society showed that less than 15% of localities provide effective specialist community perinatal mental health services for women during pregnancy, and 40% provide no service.2

According to Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, across the UK only 3% of CCGs have a maternal mental health service strategy.4

This lack of resources is impacting the frontline provision of mental health services for new mothers. ‘Although midwives take the time to assess all pregnant women’s mental health well-being, there is a gap in resources to provide support particularly for women with mild to moderate mental health issues,’ says Nina Khazaezadeh, consultant public health midwife at Guy’s and St Thomas’ NHS Foundation Trust.

There have been anecdotal increases in demand on the frontline for maternal mental health support, although this is largely down to ‘better assessment and recognition and an increase in clinician’s skills and awareness,’ Ms Khazaezadeh says.

Despite the commitments to provide a large injection of cash into mental health services, alarmingly, this seems to have been siphoned off at CCG level to cover pressures elsewhere.

An investigation into CCG spending on mental health by Luciana Berger, the former shadow minister for mental health, in October 2016 found that of the 128 of 211 CCGs in England that replied to a Freedom of Information request, 73 of them (57%) planned to spend less of their total funding on mental health in the coming year compared to 2015/16.5

Overall, the proportion of spending across these CCGs on mental health is just under 10%.5

One CCG planned to increase the share of their budget on mental health by 22%, the biggest increase, while another planned to cut it by 15%, the biggest decrease. The amount CCGs plan to spend on mental health services varied between West Hampshire, which will spend just 5% of its budget on mental health services, to Haringey which plans to allocate 16% of its total budget to mental health – an 11% range.

According to Ian Hulatt, the RCN’s mental health lead, a long-standing institutional bias against mental health, combined with a lack of transparency in CCG spending figures, has allowed the organisations to use money pledged to mental health for other sectors.

‘We have to acknowledge the acute sector is a thirsty beast,’ said Mr Hulatt. ‘It absorbs a great deal of money with it’s expensive and innovative interventions. . . assurances are being made and yet the money is taking a while to find its way down to frontline mental health services.’

However, mental health might be about to turn a corner, thanks to increased political will and improved transparency in CCG spending. On 28 November, it was announced that another £60 million will be allocated to 20 different areas in England. Each will be given a share of £40m to establish new or expand current specialist perinatal community mental health services. The other £20 million will come in 2017.

CCGs also have a responsibility to deliver the plans detailed in the Five Year Forward View for Mental Health, including commitments to improve access to and availability of mental health services across the age range, and develop community services.

‘The ambition is for an equitable service,’ says Mr Hulatt. ‘There are other variables such as the continued reduction of stigma and public awareness and political enthusiasm. I think those combination of factors make me cautiously optimistic.’

References

1. Turnbull A. Community mental health services to receive boost to funding. www.independentnurse.co.uk. 11 January 2016.

2. Griffiths J. More psychological support needed for pregnant women and new mothers. www.rcm.co.uk. 8 June 2016.

3. Council of Deans for Health. New report calls for an urgent review of funding for nurses, midwives and allied health professionals. www.councilofdeans.org.uk. 12 January 2016.

4. Royal College of Obstetricians and Gynaecologists. RCOG’s response to government’s pledge for revolution in mental health treatment. www.rcog.org.uk. 12 January 2016.

5. Full Fact. Spending on maternal mental health. https://fullfact.org/health/spending-mental-health-services. 26 October 2016.

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