- The NHS long term plan, and the Five year forward view for mental health before it, have set out ambitious plans and increased investment to improve the quality and accessibility of mental health services in England. This welcome progress follows a decade of campaigning to dismantle the stigma of mental ill health and achieve equity between the treatment of mental and physical health.
- However despite this progress, our survey of frontline mental health trust leaders shows there is a substantial care deficit in mental health that must be addressed. There is significant unmet need for a number of mental health conditions – particularly community services for adults and children, gender identity services and crisis home treatment teams - and NHS commissioning decisions have resulted in services being cut or reduced. Our survey indicated that 69% of mental health leaders are worried about maintaining the quality of services over the next two years.
- Demand for services is outstripping supply and socio-economic factors are contributing to this. 92% of trusts tell us that changes to universal credit and benefits are increasing demand for services, as are loneliness, homelessness and wider deprivation. Cuts to services funded by local authorities also mean that preventative approaches and early intervention services are less available. Mental health leaders pointed to rising demand during winter but it is clear that these pressures on services are a year-round phenomenon.
- To overcome the demand challenge facing mental health services, and derive full value out of this investment, national policy must focus on increased support for both mental health and public health. There also needs to be greater realism about the level of demand and what is needed to meet them, as well as better planning with inputs from trusts, commissioners and the national bodies.
- Pressures on the workforce are twofold. Only 9% of trusts tell us they currently have the right staff in the right place and nearly two thirds of leaders are very concerned about the numbers and skills of staff in two years time. Moreover, current staff capacity is also being diverted to support service users with a greater number of non-clinical issues such as negotiating the benefits system.
- Action on workforce is a top priority. A national plan, with appropriate focus on the mental health workforce, must be published as soon as possible, coupled with adequate funding from the comprehensive spending review that meets the plan’s education and training budgetary requirements. Providers also need a detailed implementation plan that sets out exactly what commitments from the long term plan will be delivered and when, with priorities for each year matched against the funding and staff available.
- In terms of financial investment, there are three important issues:
- First, although additional money is welcome, the funding for mental health will only rise as a share of the NHS budget 0.5%. This raises questions about how much of the NHS long term plan can be delivered and how fast. Mental health leaders are warning that this rise is not adequate to close the care deficit and 95% do not believe overall investment will meet current and future demand.
- Second, despite the mental health investment standard, trust leaders tell us that additional funding does not reach the frontline. Greater transparency and controls over the allocations are welcome steps but must be tightly monitored and enforced.
- Third, the moves to new payment systems will help substantially as block contracts are inflexible and do not reflect changes in demand once they have been agreed.
- While the focus in the Five year forward view for mental health on a number of priorities has delivered progress in, for example, eating disorders services and perinatal mental health care, we must ensure that this does not come at the expense of investment in core community services. These are a fundamental element of mental health provision which must not be overlooked. An overwhelming majority (81%) of trust leaders said they are not able to meet current demand for community CAMHS and 58% said the same for adult community mental health services. In relation to overall community provision, 85% disagreed or strongly disagreed with the statement that there are adequate mental health community services to meet local needs.
- The rapid move to system working has changed the mental health landscape. Trusts have mixed views on the impact of integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) on their role, but the roll out of new care models in mental health is reported as a positive step which will help both overcome the fragmentation of commissioning and service provision in mental health and also drive greater value from the investment in services.
- As we move from high level plan to implementation, there are a number of priorities and challenges that both mental health trusts and the national bodies will need to consider. They include:
- continuing to focus on reducing the number of out of area placements and addressing inpatient capacity problems, whilst recognising the sustained demand here
- meeting providers capital investment needs so that urgent improvements can be made to estates
- promoting careers in mental health and retaining the current financial incentives to recruit mental health professionals
- continuing the progress already made on data collection and data quality to give a better understanding of mental health activity, access and outcomes that can then enable better commissioning.