This week the Government announced extra funding for talking therapies in the NHS, crisis care, as well as a focus on preventing illness and proposals to strengthen early intervention and to integrate mental health services into primary care.
The austerity agenda over the last 7 years has severely impacted the budgets of mental health services and affected frontline services, so the news of additional funding was met with a bit of a fanfare in the news outlets. We know that not being able to access services invariably intensifies feelings of isolation, desperation, a sense of worthlessness and depression. Rejection can be routinely experienced in a personal way when patients can perceive there is something wrong with them when they can’t secure an appointment.
The unfortunate reality of access to talking therapy is that only about 16-17% of adults who need therapy are currently able to get it on the NHS. The additional funding, whilst very welcome, will only seek to increase this to 25% by 2020/21 (for children it will be 35%).
I would argue that quality means having enough therapists within the service to provide enough sessions and it means a choice of therapies for patients. Historically the NHS and NICE guidelines has been almost fixated on the CBT approach given their medical model of therapy services and their quest for an evidence base. This one size fits all approach does not, in my opinion, meet the diverse needs of patients. There is other evidence to suggest that the relationship and the therapeutic alliance is what heals, not manualised scripts. Improving quality means employing therapists trained to deal with the complexity of cases they face. Access and quality must, therefore, go hand in hand and waiting times need to be addressed.
I made these points on Sky News on Monday when interviewed with Dr Marc Bush of YoungMinds.
Parity of esteem between physical and mental health services is a laudable ambition that hasn’t been followed through in practice. Take the level of research funding, for example. Approximately £8 is invested in research per person affected by mental illness. To evaluate this rate of investment it is worth noting that 22 times more is spent on research into cancer, and 14 times more on dementia.
Mental health services in the NHS are being pressured by rising demand, historical underfunding, staff shortages, poor staff morale and the failure of funding to reach the frontline. Public health promotion campaigns, such as the Heads Together campaign, can do commendable work but they can also have the effect of increasing the pressure on existing resources by boosting demand.
The devil will be in the detail of how the extra funding is allocated and whether the additional funding makes the NHS more attractive as a potential employer for therapists. Delivering these new integrated services within primary care is critical to building care holistically around the needs of the person to improve their health outcomes and support them to achieve wellbeing.
What we might need to acknowledge is that whilst additional funding for mental health services is to be welcomed a lot of mental anguish might be inseparable from far deeper and wide ranging problems such as social fragmentation, poor housing, trauma, unstable employment and discrimination.