{"id":43019,"date":"2018-09-13T11:42:56","date_gmt":"2018-09-13T10:42:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43019"},"modified":"2018-09-17T13:29:36","modified_gmt":"2018-09-17T12:29:36","slug":"paul-burstow-mental-health-time-stop-chasing-demand-start-tackling-causes","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/13\/paul-burstow-mental-health-time-stop-chasing-demand-start-tackling-causes\/","title":{"rendered":"Paul Burstow: Mental health\u2014time to stop chasing demand and start tackling the causes"},"content":{"rendered":"<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-41129\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/Paul_Burstow-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/Paul_Burstow-150x150.jpg 150w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/Paul_Burstow.jpg 160w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><i><span style=\"font-weight: 400\">\u201cThe future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.\u201d<\/span><\/i><\/span><\/p>\n<p><span style=\"font-weight: 400\">That statement from the <\/span><em><a href=\"https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2014\/10\/5yfv-web.pdf\"><span style=\"font-weight: 400\">Five Year Forward View<\/span><\/a><\/em><span style=\"font-weight: 400\"> was true when published in 2014 and it is just as true today. Yet it failed to gain any traction. Spending on prevention<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">as far as we measure it<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">has fallen. Chasing demand remains NHS business as usual, but in the long run it is unsustainable. We desperately need that radical upgrade.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Nowhere is this more the case than in mental health\u2014especially children\u2019s mental health. Today <\/span><span style=\"font-weight: 400\">only one in four children get access to the help they need<\/span><span style=\"font-weight: 400\">. By 2021 the ambition is for one in three to have access to child and adolescent mental health services (CAMHs).<\/span><\/p>\n<p><span style=\"font-weight: 400\">Half of lifelong mental illnesses display the first signs by the age of 15, three quarters by the age of 25. Despite this, just 0.7% of the NHS budget is devoted to getting the right help at the right time to children and young people.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The consequences of this underinvestment in the mental health of our young people is profound and for many has a lifelong impact.\u00a0<\/span><span style=\"font-weight: 400\">So how should we close this treatment gap?<\/span><\/p>\n<p><span style=\"font-weight: 400\">An analysis by the <\/span><a href=\"https:\/\/www.nhsbenchmarking.nhs.uk\"><span style=\"font-weight: 400\">NHS Benchmarking Network<\/span><\/a><span style=\"font-weight: 400\"> for the University of Birmingham Mental Health Commission, which I have chaired, estimated that the workforce of clinical psychotherapists, psychotherapists, allied health professionals, and mental health practitioners would need to grow by 23 800 at an annual cost of \u00a31.77 billion if access for all was to be achieved. Given that gaps in the workforce are currently rated as the biggest threat to delivering the <em>Five Year Forward View<\/em>, it is hard to see where these additional staff would come from. <\/span><\/p>\n<p><span style=\"font-weight: 400\">By adopting a prevention and early intervention approach, a much broader workforce across local government, education, and health would have a part to play.\u00a0<\/span><span style=\"font-weight: 400\">For these reasons scaling up access to treatment alone would be a mistake. \u00a0We have to get serious about prevention too. <\/span><\/p>\n<p><span style=\"font-weight: 400\">In a report from the University of Birmingham, <\/span><em><a href=\"https:\/\/www.birmingham.ac.uk\/research\/impact\/policy-commissions\/mental-health\/index.aspx\"><span style=\"font-weight: 400\">Investing in a Resilient Generation<\/span><\/a><\/em><span style=\"font-weight: 400\">, the commission argues that there is already good enough evidence to support a range of practices and programmes with impressive returns on investment. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The commission identify four building blocks for a prevention first approach: positive family, peer, and community relationships; minimising adverse experiences and exclusions; mentally friendly education and employment; and responding early and responding well to first signs of distress. Each of these already has promising and well evidenced interventions and approaches.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The impacts of trauma, adverse childhood experience, and inequality are already well documented enough to justify concerted action. <\/span><\/p>\n<p><span style=\"font-weight: 400\">So why is the evidence not sticky? A <\/span><a href=\"https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/640665\/27072017_Stocktake_of_local_strategic_planning_arrangements_for_the_prevention_of_mental_health_problems.pdf\"><span style=\"font-weight: 400\">stock take<\/span><\/a><span style=\"font-weight: 400\"> by Public Health England last year found that while most local areas had taken some steps towards the prevention of mental health problems, progress varied significantly. A recent analysis by the <\/span><a href=\"https:\/\/www.health.org.uk\/?gclid=EAIaIQobChMIit60nveR3AIVTvlRCh06MwBVEAAYASAAEgLyGvD_BwE\"><span style=\"font-weight: 400\">Health Foundation<\/span><\/a><span style=\"font-weight: 400\"> found that spending on public health per head of the population has fallen by 23.5% in five years<\/span><\/p>\n<p><span style=\"font-weight: 400\">Spending on prevention and early action has to compete with day to day spending, and with dealing with the presenting need. The way that public spending is accounted for means that when budgets are tight, preventative spending loses out to reactive spending. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Over 30 years ago the Treasury changed the rules to protect spending on buildings and infrastructure from competing directly with the day to day demands of public spending. Separating out capital from revenue spending in our public accounts makes the consequences of underinvestment more visible in the nation\u2019s vital infrastructure.<\/span><\/p>\n<p><span style=\"font-weight: 400\">A similar approach for spending on our social infrastructure, on prevention, and early action could help to break the cycle of underinvestment. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The new NHS 10 year plan must start this shift. It needs to set out how the NHS will work with local government, civil society, academia, business, and others to deliver this, and make clear how much the NHS will invest to secure that radical upgrade in prevention. <\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Paul Burstow<\/strong> is chair of the University of Birmingham Mental Health Commission. He chairs the Tavistock and Portman NHS Foundation Trust and he\u00a0served as minister of state for care and support between 2010 and 2012. Twitter\u00a0<a href=\"https:\/\/twitter.com\/paulburstow?lang=en\">@PaulBurstow\u00a0<\/a><\/span><\/i><\/p>\n<p><b>Competing interests:\u00a0<\/b><span style=\"font-weight: 400\">I do not believe that I have any competing interests, however these roles might be relevant: c<\/span><span style=\"font-weight: 400\">hair, Social Care Institute for Excellence; chair, Tavistock and Portman NHS FT; professor of mental health public policy, University of Birmingham; managing director, Indy Associates. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u201cThe future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.\u201d [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/13\/paul-burstow-mental-health-time-stop-chasing-demand-start-tackling-causes\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":43022,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-43019","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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