Providing better help and support for mental health services
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
The Secretary of State for Health talks about the government's plan for improving mental health.
Before I begin I just want to thank the Royal College of Psychiatrists and Professor Sir Simon Wessley for inviting me to speak here today.
I know today you have released your report into schizophrenia. Your report was brought to life yesterday when I was visited Manchester MIND and sat down with a mental health service user who movingly told me of his determination to beat the statistic that his life would be cut short by 20 years because of his schizophrenia. Your report rightly shines a light into glaring differences in life expectancy for those with mental ill health.
Every week I go out somewhere different in the NHS. Usually people are pretty friendly to me, but sometimes I get a back-handed compliment like “you’re much nicer than we thought you’d be.” So today, on World Mental Health Day, I want to start by paying tribute to some of the remarkable mental health doctors, nurses and patients I have met on those visits.
For example, at Springfield Hospital in south west London, where I played table tennis and football with young patients. When we were making muffins together a 14 year old girl who had just been permanently excluded from school challenged me about funding for CAMHs services – a smart young lady! I then had the privilege of meeting her mother, who had adopted her with huge love and commitment just two years earlier, and met the remarkable doctors, nurses and healthcare assistants looking after her.
At the Alpha hospital in Woking I saw the pressures of running a secure unit with patients who had the potential to be a danger to themselves and others. I won’t forget the words of one doctor who said: “I don’t know if any of my patients will actually get better – but if I can just offer them some hope then my job is worth it.”
I would also like to thank the patients in the Redwoods Centre in Shrewsbury who movingly told me that whilst the hospital care was superb, they didn’t believe the community care amounted to what they needed or were promised - even when they were suicidal.
I would like to thank the committed nurse who looked after me in a session in East London NHS Foundation Trust, where I joined an exercise called “Who am I?”, in which I and a group of patients had to describe our life by cutting out a collage of magazine cut-outs and stick them on a bit of paper to describe who we were. I seem to remember choosing mobile phone and car ads to depict harassed ministers being driven from meeting to meeting alongside a big picture of a baby to represent my domestic chaos of three children under five. I just remember thinking it may be no bad thing to ask politicians more often to look in the mirror and consider their own identity.
And I would like to pay tribute to all the organizations, patients, campaigners who have made the case for mental health that has resulted in this week’s announcements which would not have happened without their extraordinary commitment. I know I am speaking for the Deputy Prime Minister, Norman Lamb and myself – this week could not have happened without the incredible engagement of yourselves.
Today I want to tell you how we intend to make further tangible progress towards parity of esteem. I am proud this government legislated for the first time for parity of esteem between physical and mental health services. But however noble the ambition, parity of esteem is meaningless - just words - if it doesn’t change the experience of actual people with actual mental health conditions.
So let me start by saying that the things the Deputy Prime Minister set out on Wednesday and other things I say today cannot be the end of the story, but rather the start of a journey. But I do hope to give you confidence that the destination is no longer so far away as to be out of sight.
Mental Health – The Myths
First though, I’d like to slay a few myths. One myth about mental illness we must challenge is the perception that there is only limited scope for effective treatment – that people can’t recover or won’t get better. In general terms treatments can be as effective in psychiatry and psychology as they are for the physician and the surgeon. Indeed, we have in the outcome data for IAPT hard facts that demonstrate that treatment works and transforms people’s lives. This is even true for degenerative conditions like dementia where there is clear evidence that medicine and lifestyle changes can have a significant effect on slowing the onset of the disease for some people.
We must also avoid the trap of seeing mental health purely as the fiefdom of mental health trusts. We need the whole system to be equipped to offer mental health care in a coordinated way – across social care, general practice, liaison psychiatry and mental health specialist organisations. Indeed if we are to tackle the root causes of much mental illness we need to reach beyond even the NHS into housing, education, employment and prisons.
Another myth - mental health should not be something you invest in during the good times, or when the other bits of the healthcare system have finally declared themselves fully funded. Economising on mental health is a false economy. Investment in mental health is a credit, not a debit.
This is because mental health costs the country £100 billion each year – including 70 million lost working days, additional welfare benefits, lost tax receipts and the costs of treating avoidable illness. Investing properly in mental health is not just good for individuals, but good for the economy and good for society.
Nor within the NHS should mental health be addressed in isolation from physical health. We know the stress of chronic mental illness leads to much higher rates of smoking and obesity and shorter life expectancy - and it goes the other way too, with chronic physical ill health closely linked to depression.
We need to address all these myths not just because it is right for patients for whom they have too often been a reason to delay access to vital treatment. But also because it is key to ensuring the ongoing sustainability of the NHS itself.
Nearly a third of people with long term physical conditions have at least one mental health problem as well, exacerbating their physical condition and increasing costs of treatment by as much as 75%, or £10 billion. If integrated care could unlock just a fraction of that amount, we would make a huge contribution to securing and expanding NHS provision more generally.
Progress on Mental Health
Before I talk about how we resolve these issues I would like to pay tribute to some real areas of progress despite a very challenging financial environment.
For example on dementia, where the Prime Minister has taken an international lead, devoting a G8 summit to encouraging drugs companies to do more to find a cure, setting a diagnosis ambition of two thirds for the NHS and supporting the Alzheimers Society in signing up over half a million dementia friends with a target of getting a million Dementia Friends by next spring.
When it comes to IAPT, over 2.4 million people have now received evidence based and cost effective talking therapy, meaning an extra 100,000 people are accessing IAPT every year. In addition to making a profound impact on the quality of hundreds of thousands of individual lives, the programme has, since 2008, seen nearly 90,000 people move off sick pay and benefits.
We have also invested £54m in a dedicated programme for children and young people and established the new Children and Young People’s Mental Health and Well-Being Taskforce.
The first ever Mental Health Crisis Care Concordat, signed by 20 national organisations, has secured commitment from key agencies to work together so that people in crisis – when they are most vulnerable and most in need of care - are kept safe and helped to find the support they need. The expectation is that each locality will have agreed a Mental Health Crisis Declaration by December 2014.
And this week the Deputy Prime Minister took a huge step forward by announcing that parity of esteem also means maximum expected waiting times for treatment in mental health, just as we have in physical health. For the first time, from April next year, most patients needing talking therapies will be guaranteed the treatment they need in as little as six weeks, with a maximum wait of 18 weeks. We will also aim to provide treatment within two weeks of referral for patients experiencing their first episode of psychosis, bringing it into line with cancer, something we know will dramatically improve chances of recovery.
Although we need to continue to improve access to services, we must also keep focusing on reducing the stigma around mental illness. Charles Walker became the first MP ever to make his obsessive compulsive disorder public in this current parliament. Such individual acts of courage, together with the Time to Change campaign, continue to break taboos and challenge misconceptions.
Encouragingly there is evidence that recently there has been a significant reduction in discrimination from friends, family and in social life - so I am delighted to announce that the Government will continue to support Time to Change and my colleague Norman Lamb will be setting out our plans for this today.
Named Accountable Clinician for Mental Health
Another thing we have committed to was spurred on by a conversation I had with 15 young mental health patients a few months ago organized by Rethink and Mind. I hope she won’t mind saying, but one of the people at the discussion was Jazmin who I believe is here today – is she here? I asked the group and you’ll remember [addressed to Jazmin], what they wanted most to change - was it shorter waiting times, was it better support for families, was it access to medication?
And for nearly every person in that group the top priority was that there should be someone in the NHS who took responsibility for their care. Not just a single point of contact to join up and coordinate services they receive. But the sense that there was someone where the buck stopped, someone who would take ownership of the issue in exactly the same way that an orthopaedic consultant would take responsibility for replacing a knee successfully or a cancer consultant takes responsibility for removing a cancerous tumour.
So today I can announce that we intend that all people who receive mental health treatment should have a named accountable clinician. This will mean people who use mental health services get more effective, more personalised and better coordinated care, helping them to access the help they need when they need it.
And just as we are bringing back accountability for primary care by bringing back named GPs for everyone in the new GP contract, I want to see the same accountability for clinicians in mental health services. The Department and NHS England will now work with the Royal College of Psychiatrists and people who use services to set out how this can be achieved.
Our five year plan for mental health services published earlier this week is a practical blueprint for fundamental change. We have committed £40m for this year and £80m next year, but this is the start of a wider programme to set access standards for mental health equivalent to those which have driven investment in access to physical care.
At the same time, data flows will be developed to allow measurement of performance against those standards with new commissioning and tariff models developed to support them. Our intention is that over the next five years a new powerful set of incentives will counteract the immense gravitational pull of acute care not by setting one type of care against another but by making sure both physical and mental health benefit from the development of truly integrated care.
Getting the right data is the critical bit of plumbing to make this work. We have seen this with the success of the National Schizophrenia Audit. But we need to apply the lessons much more widely.
So last month I launched MyNHS, a website that enables organisations and patients to compare performance against a wide range of factors that are important in health – safety, effectiveness, responsiveness, waiting times and so forth. I think this is a critical step towards changing the culture in the NHS from management by top down targets to driving up standards through transparency and peer review.
Today I can announce the first set of mental health measures to be published on MyNHS. The data I am publishing today shows startling variations in care which ask for either explanation or action. Why, for example, do some trusts seem to perform significantly better than others on areas like patient experience and on areas like care planning for a crisis?
Why do some organisations lose as many as one in ten bed days because they can’t get people home with suitable transport?
More worrying, figures for seven day follow up after inpatient discharge – which is a really important measure for preventing suicide and self-harm – range from 96% to just 40%. It is simply unacceptable that some organisations should fail patients on such a key area – and clearly much more needs to be done to make sure everybody comes up to the standard of the best in this area. Now this data is for the first time visible to us all I hope that will be a spur to real improvement.
But the information made public today is only a start. We need to know not just trust by trust but commissioner by commissioner both the quality of care provided and the access to that care. We can then start to tackle variation and develop NHS-wide a culture of continuous learning and improvement.
So today I can also announce that I will be convening a dedicated group of mental health specialists, including representatives from NHS England and the Royal College of Psychiatrists amongst others, with a remit to recommend the best way to measure quality, access and outcomes that can be published on MyNHS.
And I have asked that group to report before the Election.
Let me finish by saying this, that when I lived in Japan I learned in Japanese the proverb ‘the journey of 1,000 miles starts with one step.’ We have made, I think, more than one step in recent years and indeed this week. But more importantly I hope we have confirmed this government’s determination to complete that journey. Parity between mental and physical health, is part of that but the real objective is better help and support for the one in four adults who during their lives are traumatised by anxiety, depression, OCD, schizophenia, dementia or another mental health condition.
We can and must do better for you - and we will.