Sometimes it’s good to revive an old slogan. The one that’s been running round my head recently is that 80s environmental campaign: think global; act local. There isn’t necessarily an instant connection between that and mental health until you consider the underlying intention: small scale changes, grass roots action, and commitments carried out by individuals can have a large scale impact.
I’ll take a bit of “blog licence” and tweak the slogan: think national; act local. So much has been happening at a national level in terms of mental health over the past few years. The previous government made progress in putting mental health on the policy and political map—it was a key item on the coalition’s health and social care agenda. Parity of esteem was the key phrase.
We have seen some step changes—the first ever access standards for mental health. Wherever you stand on the “targets” debate (Do they work? Don’t they work?), the commitment to widen access to support is undeniably important. After all, what gets measured matters. The standards and commitments span talking therapies, early intervention in psychosis, liaison psychiatry, and, more recently, much welcome support for perinatal mental health. However, the jury is still out as to whether the additional funding announced for mental health will a) fill the gap left by substantial underinvestment over previous years, b) be sufficient to support the implementation of standards and maintain the critical infrastructure of mental health service delivery, and c) actually reach the frontline.
We eagerly await the report of the Mental Health Taskforce, led by Mind’s chief executive Paul Farmer, which will set out the programme for mental health. This emerged from the NHS Five Year Forward View‘s analysis that there are three gaps that need to be closed: the health and wellbeing gap, the funding gap, and the quality gap. Mental health was a particular focus in that report. The taskforce’s recommendations will be important tools to implement parity of esteem—which essentially translates into better services and quality of care for service users, their families, and carers.
Lord Crisp’s independent commission to review the provision of acute inpatient psychiatric care for adults in England has taken a thorough look at inpatient mental healthcare. His final report, to be published next week, should, if the interim reports are anything to go by, make important points about some fundamentals: quality is not just about being able to access the right services, it’s also about being able to leave the care of services in a timely and supported fashion. The focus on delayed transfers of care that has emerged from his work are important in that it not only points to an area where quality and experience can be improved for individuals, it also demonstrates the extent to which mental health services are part of the whole health and care ecosystem. Our independent “Right place, right time” commission on delayed transfers of care also majored on mental health and the changes that are needed. It has been overlooked.
These are all welcome, national actions, which along with financial support intend to turn the rhetoric of parity into reality; although many of us would say, of course, that they are not enough and do not go far enough.
Politics is important here: it bridges the gap between national and local. And I believe that we have reached an interesting point politically in terms of mental health—there is a “moment” to be seized. The three main players—Alistair Burt, Luciana Berger, and Norman Lamb—span the political spectrum and they each have a different and important responsibility in keeping mental health top of the political, healthcare, and funding agenda.
Community and social care minister, Alistair Burt, is a self-declared “consensus politician,” and he has the responsibility over the lifetime of this administration to maintain the momentum on mental health in his role in the Department of Health. Much happened before he took over, there is much still to be done, and consensus is the order of the day. Luciana Berger, as shadow minister for mental health with a place in the shadow cabinet, must be the responsible voice of opposition and challenge. It is she, politically, who should hold the government to account on their commitments and push them to go further. Norman Lamb has his legacy to preserve and expand, and continues to campaign to maintain the momentum behind a cause very close to his heart.
As MPs each of them has a role in national policy making to tackle mental health stigma, but also a role as a member of Parliament and as a fundamental link with local constituents—one in four of whom will have their own mental health story to tell.
At NHS Providers we take very seriously the responsibility to tackle the stigma experienced by those facing mental health problems. We have made a public commitment by signing the Time To Change employer pledge. And today we are proud to be taking part in #Timetotalk. This is an opportunity to start a conversation about mental health within our organisation. Some of us have baked cakes, we’re making cups of tea, and we’re taking just a bit of time to talk to colleagues and friends to ask them how they are. Very small, very local actions, but that’s how change actually starts.
Saffron Cordery is director of policy and strategy at NHS Providers. You can follow her on Twitter @Saffron_Policy
Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None.