Changing the mental health paradigm

Mental health policy often gets caught up in the political zeitgeist of the time.

Over the past year, we have moved from revelations following the horrific Nottingham attacks, to the present targeting of mental health conditions for benefits cuts.

I am old enough to have gone through a number of these cycles, some of which have been driven by the news headlines.

Mental health is either attacked as a symptom of the ‘woke’ agenda or acknowledged as relevant to both social wellbeing and the wider economy, without always being followed up by real actions that create change. 

Despite the increase in awareness, it always seems odd that that while one-in-four people will experience a mental health issue each year, the most common being depression and anxiety, the way in which mental health is discussed would lead one to think that people with mental health challenges are very much ‘other’; almost alien.

We need to be clear. It’s not ‘them’, it’s us. It’s all of us.

The truth is that the society in which we exist and which we help create, also creates many of the mental health challenges that we all face.

A wish to be different

The mental health bill, which is currently wending its way through parliament, acknowledges the need for greater patient voice; greater accountability for clinicians and a concern about minimising restrictions and liberty; alongside the importance of patient and public safety.

All of these are very welcome. However, I fear that it's not enough. Indeed, my contribution to the second reading of the bill focused on the necessity for resources to follow.

As always, the issues here are not dissimilar to much of what's happening in the wider NHS right now. 

“…this isn't just about money, it's about looking at value”

There is a wish to change, a wish to be different, but the articulation of those wishes is often not followed up by the prioritisation of resource.

Now, in saying this, one might expect me to continue by asking for more money (that would be nice if someone from the Treasury is reading this). But actually, this isn't just about money, it's about looking at value. 

If we have a situation where one-in-four of our citizens has some kind of mental health problem, where excessively long waiting lists for mental health services have been normalised, and where those most in need tend to get it the least - the inverse care law - we need to ask ourselves whether this is acceptable.

We also need to face up to what we should expect to follow as a result: the direct impact on individuals and their ability to contribute to society.

Early interventions

Austerity is a very expensive way to run a country. It hits those facing deprivation hardest, but there are obvious repercussions for everyone else. 

We know many of the risk factors for mental illness and we know what happens if we do not address them early. These are all areas where simple, affordable interventions would prevent the steady flow of demand onto waiting lists. 

These interventions should be about support, prevention and early intervention, not penalising people who have already developed mental health difficulties. 

“…making it harder for those with a mental health condition to claim disability benefits does not wipe away their need for this support”

 

To cite just one example, making it harder for those with a mental health condition to claim disability benefits does not wipe away their need for this support, and while we know that positive efforts to support people into work may improve outcomes for some, changes initiated in this area must acknowledge that much of the underlying need will remain.

We cannot afford to go backwards at a time when demand is at its highest and is affecting not just the economy generally, but other health services.

Having said all this, if I have a critique of the mental health world, it is that it has become used to being beaten and it has become used to pleading for more. All of which I understand because, as someone who ran an organisation that was responsible for the provision of significant mental health services, I'm one of the people who has often pleaded for more. But I think the problem with being beaten is that it takes away a confidence. And the language of non-confidence means that in the current world you fail to get listened to. 

“We have a duty to keep looking at the language, the facts, and the stories that we tell until we feel understood and heard”

We must change the paradigm in which mental health finds itself. We need to be more confident about the argument. Not just asking for more money or drawing an either/or distinction between mental and physical health services. Not just being louder, but clearer.

We have a duty to keep looking at the language, the facts, and the stories that we tell until we feel understood and heard. 

“…mental health needs to be part of a central argument about the future of the NHS, and that central argument must revolve around equity and equality”

Both the ten-year plan and the mental health bill are in the delicate stages of having been started but not completed.

My fear is a of lack of a bridge from where we are to where we all agree we need to be. 

While we await and actively feed into the development of both of these pieces of work, it is clear that mental health needs to be part of a central argument about the future of the NHS, and that central argument must revolve around equity and equality.

Whatever ambitions we arrive at, these then need to be backed up with action and resource.

This again comes back to values, the core mission of the NHS, and the society we want to create for ourselves and future generations.

Failure to deal with mental health as part of a solution to managing demand generally across the NHS has the same effect as failing to deal with mental health as a systemic problem in the economy at large.

Victor Adebowale is chair of the NHS Confederation. You can connect with Victor on LinkedIn. To hear Victor discuss the implications of the government's plans for mental health with Sally Warren, director general for the 10 Year Health Plan at the Department of Health, sign-up for our annual Mental Health Network Conference and Exhibiton on 23 April.