Arguably in no specialism are government attacks on the NHS more keenly felt than in mental health. Services have been cut, closed and downgraded, staff are leaving in droves due to unsafe and unfair working environments and squeezed salaries. Beds have been drastically reduced leading to insufficient capacity in the system and severe underfunding has created a situation where both patient safety and the mental wellbeing of staff is suffering.
Mental ill health in Britain is a crisis in itself. Figures reveal that suicide is the leading cause of death in men under 50 and the number of young people presenting in A&E with psychiatric issues has doubled since 2009, highlighting the fact that traditional routes to care have failed.
Between 2010-2015 Mental health services were subject to £598m of cuts. Any subsequent action by the government would clearly need to be dramatic in an attempt to account for years of previous neglect.
In January 2017 Prime Minister Theresa May made a speech in which she asserted of mental health that “there was not enough help to hand.” She seemed to acknowledge the issues for those suffering and vowed to improve provision.
However, the figures since this admission sadly speak for themselves and no amount of spin from her political ‘doctors’ can change the fact that her government is failing miserably on implementing a positive change in this area.
May’s new ideas have included £15m for crisis cafes and community clinics. There has been an emphasis on reducing stigma instead of addressing underlying funding issues which are the real barriers to successful treatment. The initiatives her government has put forward are far cheaper and do not involve the necessity for trained clinicians to staff them. They therefore offer a reduced level of care and are highly inappropriate for those in a real mental health crisis.
Hospital capacity for those with the most serious needs is also woefully inadequate. Mental health beds were cut by 40% from 26,929 in 2007/8 to 18,730 in 2016/7 Damaging cuts mean patients are often sent many miles from home in order to access an in-patient bed, further isolating them at a time of personal crisis. Indeed, there are times when no mental health inpatient beds are available in the whole country, separating families and causing additional suffering to patients.
The Child and Adolescent Mental Health Service has not escaped cuts and some of the most vulnerable in our society have consequently suffered the most. Retired Paediatrician and Keep Our NHS Public co-chair Dr Tony O’Sullivan says;
“As a [retired] paediatrician the thing that hurts me most are stories such as a child with severe mental health problems needing admission in England and the nearest hospital bed being in Scotland. The parents had a 400-mile round trip to see their ill child.”
The Impact of Austerity
Austerity has undoubtedly greatly contributed to the rise in mental illness in the UK since 2009 when David Cameron’s Conservative government initiated their policy of cuts to the public sector. Its implications have been far reaching and the effect on NHS services has been significant. In November last year a study by UCL found that cuts to health and social care were responsible for 120,000 excess deaths in England.
Iain Duncan Smith’s ‘Fit to work’ tests, 2010-2013 for the sick and disabled coincided with 279,000 cases of mental illness, 590 suicides and 725,000 more prescriptions for anti-depressants. This probably did more to increase the amount of people accessing healthcare and subsequently escalate costs, than it attempted to save financially.
“A national emergency” in staffing
Reports published earlier this month asserted that a shocking 2000 mental healthcare staff are leaving the NHS in England every month. A total of 23,686 staff left the NHS between June 2017 and the end of May 2018 with one in 10 mental health posts unfilled.
In July 2017 Hunt committed to increasing staffing in this area by 21,000 by 2021 with the aim of providing round the clock provision. However, as of March 2018 only 915 people have been recruited, (or 0.5% of the target).
The Kings Fund have now called the crisis in NHS staffing a “national emergency”. Last year Theresa May Promised £1bn to fund 10,000 extra staff but gave no indication as to where this money would come from. Unsurprisingly therefore this initiative has failed, as has her joint promise to tear up the 1983 Mental Health Act which is now only to be ‘amended’ highlighting the fact that it is policy as well as provision that is suffering under her watch.
Mental Health – the poor relation
Mental health funding is not ringfenced and because individual trusts are struggling parity of esteem is not matched by government in practice across mental and physical health. Money is allocated to the local authority for mental health but research from the charity Mind published in 2015 found that in reality, only 1% is used in spending in this area. It is obvious that when budgets are stretched across the health service, robbing Peter to pay Paul is sadly inevitable.
According to the Kings Fund 40% of mental health trusts saw their budgets cut in the period 2015-16. By March 2017 £800m that had been earmarked for mental health had been directed into other areas of the NHS.
What does the future look like?
This government have so far failed spectacularly in implementing improvements in mental health care. Targets on mental health have not been met, and the pressures on services across the board caused by 8 years of austerity makes for an altogether worrying forecast.
As with so many other areas of the NHS what is required is not fancy new initiatives or the pretence of sympathy, but direct actions, adequate funding and increased staffing. Mental health provision will not improve purely by talking about it, no amount of therapy will solve this particular problem.