Chris Naylor: Is mental health finally becoming a political priority?

Last week saw announcements on mental health from both the government and the opposition. With the Liberal Democrats pledging to put mental health on the front page of their election manifesto, and Andy Burnham, Shadow Secretary of State for Health, making mental health a core part of his concept of “whole person care,” are we starting to see mental health becoming a higher profile political issue?

Last week Nick Clegg announced a national initiative to reduce deaths from suicide, building on quality improvement programmes already under way in Liverpool and elsewhere. On the same day, the Labour party published the report of an independent mental health taskforce commissioned by Ed Miliband. Responding to the taskforce’s recommendations, the party has indicated that improving the mental health of the population—and of children in particular—will be a priority if they form the next government, with greater emphasis on mental health in professional education for all health professionals and school teachers.

The new legal requirement for the NHS to achieve “parity of esteem” between mental and physical healthcare has generated significant activity at the policy level and has led to a number of specific measures being introduced. In recent months NHS England has committed to introducing the first ever waiting time targets for (some) mental health services, and in its annual planning guidance directed clinical commissioning groups to increase spending on mental health in 2015/16, at least in line with each group’s overall budget increase—ensuring that mental health receives a proportionate share of additional funding.

The attention being paid to mental health by politicians and policy makers is to some extent part of a wider shift in public attitudes towards mental health. Speaking at our recent breakfast seminar on mental health, Paul Farmer, CEO of the mental health charity Mind, stressed that data from the Time to Change anti-stigma campaign shows that attitudes are changing for the better (although stigmatising beliefs remain stubbornly widespread in some parts of the population, notably including the NHS workforce). As the public begins to place more importance on psychological wellbeing and timely access to mental healthcare, this can only encourage further political attention.

The critical question, of course, is whether the rhetoric can be matched by reality. There have been some significant recent achievements, such as the large reduction in the number of people being detained in police cells during mental health crises. However, there is also no shortage of fuel for those who question how much of a difference policy commitments will make in practice.

The financial squeeze affecting many public services is creating intense pressure in some parts of the mental health system, and services such as inpatient care for mentally ill children have fallen foul of the fragmentation of commissioning across NHS England, clinical commissioning groups and local authorities. The reduction in the tariff prices paid to mental health providers in 2014/15 (which exceeded reductions for acute trusts providing physical healthcare) led many to conclude that institutional bias against mental health remains as strong as ever.

The King’s Fund has supported the call for mental health services to be placed on an equal footing with physical healthcare, and we have included this as one of our 12 priorities for the incoming government. This will only be achieved if the priority placed on mental health at the national level is transmitted to clinical commissioning groups and other local bodies. Commissioners I have spoken to tell me that considerable importance is being placed on the new waiting times targets for mental health. However, they have also indicated that some of their peers feel ill equipped and under supported when it comes to ensuring those targets are met—particularly as they are being asked to do so within existing budgets.

If political parties are to make good on their commitments to give greater priority to mental health, thought will need to be given to how to support those working at the local level to turn political ambition into reality.

Chris Naylor is fellow, health policy, King’s Fund.

This blog also appears on the King’s Fund website at http://www.kingsfund.org.uk/blog/

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