- Great strides have been made to increase investment in mental health services and deliver on aspirations to improve quality and access, following a decade of campaigning by the sector. Not only have mental health services received a substantial cash injection in recent years, but the sector also has a fully costed programme for mental health delivery with the Five year forward view for mental health, which has been significantly built upon by the NHS long term plan that makes further progress on improving people’s mental health and wellbeing a priority for the next decade.
- More people than ever are receiving treatment and care for mental health conditions and the majority of NHS mental health services are providing good care, with 71% of core services rated as good and 10% as outstanding by Care Quality Commission in 2019. The sector has also been a trailblazer for innovation and work to deliver new integrated models of service delivery in partnership with health and care partners across systems, and mental health leaders are thinking positively about how changes to commissioning and increased system working will help them be more efficient and strategic.
- Despite this progress and promise for the future, there are significant, specific challenges facing mental health provision and those trusts providing mental health services that need to be addressed. Many of these challenges are rooted in the fact that the mental health sector has suffered a historical, structural disadvantage compared to physical health provision.
- The stigma surrounding mental illness and mental health sits at the heart of the sector’s disadvantage. There is a lack of equity of treatment that is reflected in how we view, support and deliver mental health services. While aspirations are growing, supported by politicians and senior healthcare leaders, the healthcare system is still operating in the context of a 'care deficit' where we accept that not all those that need help and treatment will seek or be able to access support. It also means the provision of mental health services is not prioritised across the whole of the NHS.
- How mental health services are commissioned and paid for also translates into the mental health sector’s historical and structural disadvantage. Unlike physical health care, the majority of mental health services are delivered through block contracts which are inflexible and do not reflect changes in demand once they have been agreed. The commissioning of mental health care and wider services supporting mental health service users, at a local and national level, is also severely fractured, impacting on the efficiency of service delivery and continuity of people's care.
- The transparency and governance of funding flows is a further key issue facing the sector. Despite the mental health investment standard (MHIS), there continue to be concerns raised that funding for the mental health sector is not always making its way to the frontline services that need it most, with the standard being seen in some cases as a maximum limit based on affordability, rather than a minimum based on need.
- Mental health trusts also need capital investment. Only three mental health trusts (out of 20 trusts) were allocated funding in the first wave – and none were allocated funding in the second wave – of capital investment for trusts announced by the government in September 2019. The under prioritisation of investment in the mental health estate is having a real impact on patients and mental health trust leaders have expressed their concerns that lack of capital investment places their patients at increased risk. Greater capital investment in services would not only make a huge difference to patient and service users’ recovery, but also improve the morale of staff.
- There are other issues trust leaders have told us are contributing to financial pressures for the sector this year. These include growing demand for inpatient care, which is leading to high use of out of area placements and delayed transfers of care, and the need for trusts to recruit more staff. Trusts are facing the increasing costs of staff recruitment and retention including the Agenda for Change pay uplift. Combined mental health and community trusts also continue to be affected by cash reductions in local authority public health contracts. The frequency of re-tendering for services in the mental health and community sectors, which means there is less financial security over the longer term, is a further key issue.
- In order to address these challenges and deliver on the ambitions for supporting people’s mental health and wellbeing over the next decade, there are a number of priorities and challenges that both mental health trusts and the national bodies will need to consider. These include:
- improved and transparent mechanisms that guarantee that mental health funding reaches the frontline services that need it most
- clear expectations around delivering on national investment and initiatives for clinical commissioners and systems to deliver against, tightly monitored and enforced
- meeting providers capital investment needs so that urgent improvements can be made to estates
- further progress on data collection and data quality to give a better understanding of mental health activity, access and outcomes to enable better commissioning
- greater understanding within systems of the mental health and wellbeing needs of local populations to ensure mental health service delivery is prioritised accordingly to overcome the demand challenge facing mental health services, and derive full value out of investment committed to the sector, national policy must focus on increased support for both mental health and public health
- less fragmented approaches to commissioning and a reduction in the frequency of retendering
- expansion and roll out of mental health new care models that are adequately funded and resourced.