Adrian James: The end of the Five Year Forward View—what is next for mental health?

The Five Year Forward View (FYFV) was an important milestone for mental health and marked the start of a committed government agenda on mental health that has now become one of the most discussed in health policy. As the strategy came to an end last month, it’s important to reflect on how far we’ve come in the last five years. 

Mental health has been driven forward on the healthcare agenda, as it should be. There is now a mental health team at NHS England and NHS Improvement with a seat at the top tables, working very hard to keep our joint priorities in focus. We have collaborated with them closely and will continue to do so, building on the progress we’ve made along with others in the sector. 

Thinking about the targets of the FYFV itself, a few key areas really stand out. For example—there is increased spending on mental health as a whole driven by the development of the Mental Health Investment Standard. Children and young people’s access targets have been hit and exceeded, and Children and young people’s eating disorders teams have been rolled out across the country. All local areas in England now have perinatal mental health teams, and Early Intervention in Psychosis and Improving Access to Psychological Therapies (IAPT), access targets have been met.

It’s thanks to the hard work and collaboration between different parts of the mental health system, down to individuals and patients themselves, who have helped this become a reality across these different services.

But there have been setbacks in meeting targets, workforce being a standout one. In the workforce plan to deliver the FYFV, there was an ambition to deliver 570 new psychiatrists, but as of the latest published data and at the end of the plan, two out of three of those posts sadly remain unfilled. 

Reducing Out of Area Placements (OAPs) has also been a huge challenge, despite the target to eliminate them altogether by 2021. Physical health checks for people with severe mental illness have stalled. Progress on improving data has just not been quick enough. And although children’s and young people’s eating disorder services have been rolled out, waiting times are still too long. 

And although we should be proud of successes, we should also be cautious. The progress we have made is fragile and has been set back by covid-19. 

The NHS Long Term Plan (LTP), and its Mental Health Implementation Plan, have helped build on the successes, and overcome some of the challenges. But the LTP is already facing significant hurdles of its own such as the lack of a workforce plan to deliver it, and the huge impact of the covid-19 pandemic.

As we navigate our way out of the pandemic, we can’t let progress on delivering these essential services stall. They’re now needed more than ever. We will continue to fight to make sure the momentum set in place by the FYFV carries forward, and that the LTP deliverables are kept on track and adaptable to the changes set in motion by the pandemic. 

We’re also heading into a chapter of new healthcare infrastructure, with Integrated Care Systems being set to move onto a legal footing with commissioning responsibility, increased collaboration in the health system, and new public health infrastructure. We’re looking forward to seeing the new cross-governmental covid-19 mental health and wellbeing recovery action plan put into action with the additional £500m funding announced last year in partnership with colleagues across sectors. This funding is welcome, but we need it in future years, not just as a one-off.

Workforce planning, expanded funding for services, infrastructure, technology, and prevention is still critical to ensuring people with mental health needs get them met and prevented. The LTP is a huge part of that, but we shouldn’t forget the lessons from the FYFV.

The FYFV marked a major step forward in our efforts nationally to prioritise mental health. When we reach this same stage for the LTP, I hope we can look back at the progress we’ve made and celebrate how far we’ve come in ensuring people with mental illness get the support they need, when they need it.

Adrian James in president of the Royal College of Psychiatrists. Twitter: @DrAdrianJames

Competing interests: none declared.