Towards a brighter future for mental health, autism and learning disability services
We are in the midst of a crisis. In England, demand for mental health, autism and learning disability services is outstripping supply. For too long, support for these services has flown under the radar. If we are to avoid more people being left without the help they need, support must be prioritised and acknowledgement given that this cannot be fixed without action across society.
That’s why it was disappointing for many mental health leaders to see the previously announced ten-year cross-government strategy for mental health and wellbeing rolled into the new forthcoming major conditions strategy. It will be important to work closely with the government to ensure it is informed by the views of experts in mental health.
A burning platform
The need for change is pressing. Currently, only between a quarter and a third of people with a mental health difficulty receive treatment for it. It is estimated that between 10 million more people – 1.5 million of them under 18 – will need extra support with their mental health because of the pandemic. The economic and social cost of mental ill health was calculated as £119 billion in 2019/20 and is expected to grow in the next decade.
While the elective care backlog garners attention, there is less focus on the accumulation of need in mental health. Our members experienced a surge in demand for mental health support during the pandemic. The people they have been supporting have serious and complex needs, meaning they often need to be admitted to hospital and are staying there longer.
Life expectancy for people with learning disabilities and people with long-term mental health problems is 15 to 20 years shorter on average compared with the general population
In spring 2022, 1.2 million people had been referred to community mental health and learning disabilities services but had yet to receive their second appointment. The number of children and young people urgently needing access to eating disorders services skyrocketed during the pandemic, and as a result the waiting list remains high.
There is significant and unacceptable inequity in our mental health, autism and learning disability services too. Black people are four times more likely than white people to be sectioned under the Mental Health Act and ten times more at risk of getting a community order. Life expectancy for people with learning disabilities and people with long-term mental health problems is 15 to 20 years shorter on average compared with the general population.
With so many challenges on so many fronts, can mental health services move beyond this crisis?
A roadmap to the future
Our recent report with Centre for Mental Health identifies a positive, realistic vision for mental health, autism and learning disability services for people of all ages in England in ten years’ time.
It shows that by 2032 we can be in a better place. One where services are more proactive, equitable and holistic; where there is a focus on prevention and early intervention; where there is no wrong door for people needing support; where there is treatment for the whole person; and where structural inequalities are addressed. The report spells out that to get there requires mental ill health and services for autistic people and people with learning disabilities to be a priority.
Three things are needed to achieve this: sustained and sufficient investment; long-term workforce planning; and support for innovation and change.
Investing in the health of the nation
It is clear that a tightening economy and budget cuts will jeopardise the investment put aside for mental health to do the very basics, let alone achieve this vision. But the stark reality is that services will need sustained investment over the next ten years to meet growing demand and to change ways of working. Cuts in the wider public sector are another risk and for many this is already leading to the erosion of early help and support. If this continues to happen, more people will be left to hit crisis point to access a service.
Securing the workforce
The workforce is an important part of the investment equation. There are about 132,000 vacancies in the NHS and nearly a quarter are in mental health services. It will also be necessary to see a different mix of roles and other solutions to meet these ambitions. To make it possible we need long-term workforce planning. It was pleasing to see the government commit to this, but now we need it to happen and to be backed up with the correct resourcing.
The clinically led review of standards in mental health proposed waiting time standards which, when implemented, will help speed up access to services, provided the funding and workforce are there.
Enabling radical reform
Even with more money and more people, we cannot continue to do the same things. As our report with Centre for Mental Health says, there needs to be radical change within organisations that design and deliver mental health, autism and learning disability services. That reform needs to go beyond them too.
The plans to modernise the Mental Health Act, which we have been very supportive of, are essential for making it more equitable, including ensuring that autistic people and people with learning disabilities are not subject to mental health legislation, and detained for prolonged periods with little benefit.
Tackling the social determinants of mental health is essential, as they account for about 50 per cent of health outcomes
The Act is just the start. A ‘health in all policies’ approach in decisions made by national and local government and other policymakers is vital. Tackling hate crime, reducing poverty, helping people into employment, creating more inclusive schools and addressing racism can all make a difference.
Tackling the social determinants of mental health is essential, as they account for about 50 per cent of health outcomes. These largely sit outside of health, so we need the government’s major conditions strategy to commit to and implement a cross-government approach. There is a key role for integrated care systems here too in addressing health inequalities and taking a population health approach. Their strategies will be incredibly important.
Mental health, autism and learning disability services cannot make improvements in isolation: they will need to work together with social care providers, housing providers, the voluntary, community and social enterprise sector and more. Only then will a vision of more proactive, equitable and holistic care for anyone who needs support become a reality.
Sean Duggan OBE is chief executive of the Mental Health Network. Follow him on Twitter @NHSConfed_MHN.
