Monday, February 2, 2015

How to really improve mental health

 “I want this to be a country where a young dad chatting at the school gates will feel as comfortable discussing anxiety, stress, depression, as the mum who is explaining she sprained her ankle.”

Nick Clegg to Liberal Democrat Autumn Conference, 2014.

It has – and this is a good thing – finally become fashionable for politicians to call for mental health services to be high on their agenda.    And the Liberal Democrats are making this a key plank of their election campaign, having committed to an additional £500m a year for mental health services.

Of course, any extra funding to the NHS is welcome.  But the devil, as so often, is in the detail:  how it is spent is key.

Green Party policy supports the concept that mental and physical health is equally important and often inter-related.  Our stance is holistic. It is hard to think of any Green Party policy that does not aim to improve the quality of life for everyone. 

For the Greens, mental health is promoted through a positive society with security of income and housing for all, with access to nature, based on equality of opportunity. It is not achieved with a stress-inducing programme of austerity, benefit sanctions and reduced public services, all of which the Liberal Democrats have gone along with over the past 4 years.

In a previous job I worked as a manager for a small mental health charity in Bristol. We provided self-help groups aimed at people experiencing anxiety and depression. However, since the service was open to anyone, we found that up to 50% of our attendees were actually suffering from mental health conditions which had formerly required secondary mental health care: bipolar disorder, schizophrenia and personality disorders were common.
We had repeated episodes of people coming to our groups in great distress, sometimes deeply suicidal, often summarily discharged by services that they depended on. The trusting relationships they had - often painfully - built up with mental health staff were suddenly terminated. In many cases, the strain they were under was compounded by the threat to their incomes from disability assessments and tribunals.

We were sometimes worried that we wouldn't see some of these people again.

Many mental health conditions need sustained, often lifelong, care. The NHS, in contrast, is now geared towards turnover.

Target setting and the endless search for cost-effectiveness means that people who need on-going support to maintain even a basic level of wellbeing are screwing up the figures. The impetus is towards getting them off the books and turning attention to those who can (hopefully) be sorted with a quick fix.

Back in the office, we faced another problem. As a small charity, secure funding was becoming harder to find. The trustees were keen to consider NHS-commissioned work as an option.

At that time the so-called ‘talking therapies’ in Bristol were being re-commissioned under a new system (Any Qualified Provider), which supposedly offered opportunities to small voluntary organisations. There were plenty of loopholes to jump through to be eligible but the real obstacle was the price that was on offer. Unlike a traditional tendering process we did not put in a bid based on the costs of providing a service, but a fixed amount was on offer and we could apply to supply a service for that figure.

When I looked at the numbers it just didn’t add up. Ours was a low cost service but it looked as if we might not break even; in fact we could have ended up subsidising the NHS with our other income (from grants and fundraising).

The only service that would be able to be provided at this price would be extremely short-term and shallow. It would have to be run by a large organisation with significant economies of scale – with all that that implies   And, crucially, the long-term effectiveness of these therapies was not being properly evaluated:  results were measured at 3 months, and never again, and no-one was counting re-entry to the system.

In short, the NHS market, set up by Thatcher, extended significantly by Labour, and bound into by The Coalition’s Health and Social Care Act 2012 (which Clegg refuses to repeal), is not working in favour of UK citizens. Nowadays even the commissioning process itself is being put out for commission!

Genuine and sustainable mental health policy

Good general public policy will increase mental wellbeing but we recognise that there will always be people needing care, and a good mental health service is an integral part of a healthy society. The Greens will promote mental health at three levels.

The first will be making people’s lives more equitable, secure and less stressful through wide-ranging public policy.

The second will be to repeal the Health and Social Care Act and return the NHS to a non-profit, publically-run body, where medically trained people can deliver care in ways which benefit the people needing their services. The health service will be entirely in public ownership.

The third is to fund the service adequately. In direct contrast to the programme of austerity that is crippling this country - the current economic policy of all the other major parties - the Green Party will pay NHS staff adequately and provide them with the necessary resources to research, treat and care for all people with mental illness.

What the Greens want to see is not just a dad feeling ‘comfortable’ discussing his mental health problems, but a dad who has fewer anxieties and stresses in the first place and, if he needs them, is able to access similar services as the mum who has sprained her ankle.

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