Labour kepts its promises on mental health?
ago the government set itself seven targets to meet on mental health
provision. How's it got on? Adam James investigates
up. It’s now a decade since the Labour government vowed to
tackle NHS mental health services with steely vigour.
health would have an equal priority to heart disease, said the then
health secretary Frank Dobson in 1999. A national service framework
in mental health promised seven standards in care and treatment
would be met. And so expenditure in adult mental health increased
6.7% in real terms from 2000-6, and by 3.7% from 2006-8.
framework ended last month. Care services minister Phil Hope proclaimed
NHS mental health care has been “transformed”. But,
by honing in on the seven standards, is such high praise justified?
two standards representing the aim to deliver “effective”
services for people diagnosed with a severe mental illness were
perhaps the most ambitious. The 1999 targets included such people
being able to access mental health services 24 hours a day every
government subsequently recruited 64% extra consultant psychiatrists,
71% more clinical psychologists, and 21% extra mental health nurses
to help fulfil this aim. Plus, in a bid to turn around an under-fire
community care policy, 740 assertive outreach, home treatment early
intervention and crisis teams were set up. This development has,
in particular, been welcomed.
an alternative to hospital, these services seem to be working,”
concludes Paul Corry, director of public affairs at Rethink. There’s
“no doubt” these new services benefit patients, says
Chris Heginbotham, former chair of the Mental Health Act Commission.
such services are credited with delivering progressive recovery
approaches. “I know many home treatment teams who are really
embracing recovery”, says Marion Aslan, trainer with Elemental,
an organisation working with NHS staff.
45% of service users have no access to crisis numbers out-of-hours.
Plus, although NICE has since 2002 been recommending CBT for everyone
diagnosed with schizophrenia it’s not happening. Just 14%
of patients with psychosis have received CBT, according to Rethink.
The framework also promised all patients will have a copy of their
care plan. But, as of last year, 40% of community patients had not,
says the Healthcare Commission.
for inpatient care for such severely ill people, Mental Health Act
commissioners reported in 2008 that many private and NHS wards are
"tougher, scarier places” than 10 years previously. Royal
College of Psychiatrists president Dinesh Bhurgra weighed in by
even saying that standards were so atrocious he would never allow
any of his relative into an inpatient unit.
talk infuriates Louis Appleby, national director for mental health.
“The commission is completely wrong,” he said. “They
[commissioners] can not be looking at the same wards as me.”
Appleby highlights that government investment financed many safer
and therapeutic units.
appears that either the Mental Health Act Commission or Appleby
is being frugal with the truth. What does Marjorie Wallace, director
of Sane, think? “All I can say is what most of the people
who contact us tell us,” she responds. “I have a letter
here from a woman who says her husband was in a psychiatric ward
and it was so bad it made him want to kill himself.”
black and ethnic minority people continue to be five times more
likely to be compulsory detained, despite a Delivering
Race Equality plan.
progress is acknowledged. For example, NHS trusts which from next
year fail to provide satisfactory single-sex mental health wards
will be fined. “Fifteen or twenty years ago it was difficult
to say that any safe and therapeutic ward existed. But now some
do,” says Corry.
standard was to prevent suicide. In England suicide is now at its
lowest recorded level, with a 2007 suicide rate - the most recent
year for available statistics – of 7.5 deaths per 100,000
people. In 1995 the rate was 9.2 deaths. “Preventing suicide
has been a success story,” says Mind’s policy director
Sophie Corlett, before adding, “although we know that rates
depend upon the state of the economy which did boom over recent
about the standard of promoting the nation’s good mental health
and combating stigma and discrimination against people with mental
health problems? The 2007 adult psychiatric morbidity survey in
England revealed that, in fact, there has been a rise in self-reported
“common mental health problems” from 15.5% in 1993 to
17.6 in 2007 (although there had been no rise since 2000). Plus,
8.2% of adults had screened positive for ADHD, the first time this
statistic had been recorded. With a projected ADHD co-morbidity
of 25% that’s around 3million of the population with mental
health problems who, until 2007, had never been accounted for.
such figures, surely the government can not be credited with improving
the nation’s mental health? Appleby disagrees. “The
survey relies on self-reporting. The suicide rate is a much better
indicator of the society’s mental health. And that’s
fallen,” he says.
for anti-discrimination, the government-backed Shift campaign has
been ongoing. Nevertheless, this year a department of health survey
reported 11 per cent of people said they would not want to live
next door to someone with a mental health problem - an 8 per cent
increase since 1994. Mental health act debates linked violence and
psychiatric illness. Nevertheless, Wallace argues the media has
covered mental health markedly more positively. “Mental health
stories have been much more of a currency for media coverage over
the last 10 years,” she says.
some service user activists are angry that the anti-stigma message
has been infused with a traditional medical model, implying that
people will always be a victim to a biology-based illness. “I
actually think the anti-stigma campaigns have made stigma and discrimination
worse,” says Aslan.
"There’s now a raft of information that people are ill
and need to be treated with medication, rather than a holistic approach.
The general public believes schizophrenia is an illness only treatable
by drugs. It’s not.”
of the standards demanding an improvement in primary care and access
to services? The government points to its drive to provide CBT therapy
for 900,000 depressed and anxious people, and the recruitment of
an extra 3,700 psychological therapists.
Appleby this initiative is “one of the most ambitious mental
health programmes of this century”. The mental health sector
is supportive. Yet Corlett says it’s too early to make a call
on the initiative’s success. “From next year psychological
therapy funds will go straight to primary care trusts, rather than
being ring-fenced as it is now. So we’ll have to wait and
see,” she says.
final standard was ‘caring for carers’. The government
promised all carers would have their own written care plan. With
less than half of patients having their own written care plans,
it is worse for carers, says Drew Lindon, of The Princess Royal
Trust for Carers. “But there have been improvements,”
he adds, pointing to an extra 700 mental healthcare support workers.
is now moving onto New Horizons - the government’s mental
health strategy over the next 10 years - which is out for consultation.
Among its priorities are continuing where the framework left off,
and stepping up improving the nation’s mental good health
and tackling links between poverty and mental ill health. But there
could be a spanner in the works. A general election.
How has the
government performed on its National service framework for mental
health – out of five
Sophie Corlett – 3
Marion Aslan - 2
Louis Appleby – 4
Paul Corry – 4
Marjorie Wallace – 3 (community service users); 1 (inpatients)
Chris Heginbotham – 3.5
This article first appeared in Mental
Health Today magazine
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