Britain’s mental health provision: a crisis in need of intervention

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Originally published by Contributoria August 2014.

Last year, the Mental Health (Discrimination) Act 2013, was formally enacted, with leading mental health charity, Bipolar UK lauding it as a “major step in the quest to break down the prejudice surrounding mental health”. Its enactment removed legal barriers which had previously prevented those suffering from mental health problems from being MPs, serving on jury duty or being a director of a company. It was also symbolic, regarded by many as sending out a wider message that discrimination based on mental health would not be tolerated. Government ministers are able to point to the bill as proof of their commitment to taking mental health seriously. This has been epitomised by the care minister, Norman Lamb, who has repeatedly stated “there is no justification for disadvantaging mental health as against physical health”.

However, a number of figures, including mental health charities and the Royal College of Psychiatrists (RCP) have repeatedly warned that Britain’s mental health provision is at crisis point. Professor Sue Bailey, outgoing president of the RCP described the UK’s mental health service as “a car crash,” noting that the “sums of money that could make a difference are not huge but they could make a huge difference”. Indeed, despite the lip service paid by government figures to mental health provision, cuts to services have been severe and widespread.

More than 1,700 mental health beds have been lost since the Coalition Government came to power in 2011. The number of beds available has seen a 9% reduction in the last year alone. This comes at a time when leading healthcare professionals, such as Dr Martin Baggaley, medical director of the South London and Maudsley NHS Trust say there is a “genuine increase in demand” for mental health services. Declining beds mixed with an increase in demand makes for a seriously deadly cocktail. A survey of 28 mental health trusts found that the average occupancy rate for psychiatric beds was 100%, with more than half of those trusts running at more than 100% capacity. Every single one of the trusts asked were running above the 85% occupancy rate that is recommended by the RCP.

With so many services run at or beyond capacity, many people who need help are simply having to be turned away, in some cases leading to “avoidable deaths and suicides”. It would be almost unthinkable for a patient with urgent need to be turned away in another area of the health service. When beds aren’t available, some patients are being sent as far as 300 miles away to receive care. This added stress and disruption will likely massively affect the chances of a speedy recovery. The number of patients being sent to out-of-area care has more than doubled since 2011, with over 3,000 being sent to different regions in the last year alone.

Research carried out by YoungMinds, the nation’s leading children and young people’s mental health charity last month found widespread cuts to Children and Adolescent Mental Health Services (CAHMS) at the local level. 77% of NHS Clinical Commissioning groups reported having frozen or cut their CAHMS budget for the following year, whilst some 60% of local authorities cut or froze their budget since 2011. YoungMinds Chief Executive Sarah Brennan remarked that these are “deeply distressing figures,” adding “Children and young people’s mental health services have been chronically underfunded for decades. The latest round of cuts will add to the devastation of local services and compound the struggles of children and young people and their families.”

There is much debate about whether the Government has increased or decreased spending on healthcare since it came to power, pledging an increase of 0.1% across the course of the parliament, which is disputed by the opposition. However, one thing seems fairly clear, and that is in the last two years spending on mental health has seen a real-terms decrease of more than 2%. The pledge to increase spending across the NHS – whether adhered to or not – whilst clearly cutting from the mental health budget would seem to directly contradict Lamb’s and the Government’s claims to treat mental health the same as physical health.

Other evidence clearly bears this out. Mental health issues account for 23% of the “disease burden” on the NHS and yet receive just 13% of its overall budget, indicating the funding it receives is clearly disproportionate to the level of need. In March of this year, Monitor, the NHS’s economic regulator announced that tariffs for non-acute services, which includes mental health, would see a 1.8% reduction, compared to the 1.5% reduction for acute services. The 0.3% difference may seem minimal, but it is significant, not only will it put lives at risk, it is also a direct contravention of the pledge to treat physical and mental health equally. Lamb himself described the move as “flawed and unacceptable”.

The reason for this disparity – between mental and physical health, between rhetoric and actions – must surely still be in part to societal prejudice and misconceptions about mental ill health. It may be unsurprising that people with mental health problems are more likely to be in poverty and unemployment than those not suffering; these are interrelated problems which compound each other. However, it isalarming that the Mental Health Foundation reports that those suffering with mental ill health are even less likely to be in work, a stable relationship or be “included in mainstream society” than other groups with long-term health conditions or disabilities. Mental Health awareness campaign, Time to Change reports that whilst attitudes towards mental health sufferers are slowly improving, the stigma surrounding mental health is still worryingly prevalent. Nearly nine out of ten people with mental health problems reported having suffered discrimination as a result of their condition.

Despite the fact that the workplace can be one of the greatest causes of stress, anxiety and even depression, 55% of people said they would be uncomfortable talking to their employer about their mental health issues. This had actually increased by 5% between 2010 and 2012. Worryingly, 35% of people surveyed still associate people who suffer mental health problems as being “prone to violence,” which is no doubt a result of sensationalist media coverage. The reality is that people suffering mental ill health are more likely to be the victims than the perpetrators of violence; in fact, a recent study showed those with a mental health issue were 250% more likely to be the victim of a homicide than the general population.

Although attitudes do seem to be improving in general, there is clearly still a stigma attached to mental ill health, both at an individual and institutional level. Given that one in four adults will suffer from a mental health problem in any given year, the stigma really needs to be addressed. Raising awareness is obviously the most important step, as is dispelling the severe misconceptions many still hold about mental health sufferers. Just last year Asda and Tesco stocked ‘Mental Health Patient’ Halloween costumes which featured a disfigured face, a bloodstained strait-jacket and a meat cleaver. Attitudes naturally take time to change, but we cannot let residual stigma stand in the way providing the care so many people so desperately need. As leading experts keep telling us our mental health services are at breaking point, we must act now to ensure the safety net is in place for everyone who needs it. Mental health services are in crisis, we all have to be there for their intervention.

Image: Taken by Chris Beckett used under Creative Commons License

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