Yesterday, Jeremy Hunt (Health Secretary, UK Government) announced plans to recruit almost 10,000 staff to mental health posts over the next 4 years. The money would be drawn from the £1.3bn ‘committed’ to improve mental services (with the aim to bring services in parity with physical health). As a mental health campaigner, I was initially encouraged by the headlines that greeted me when I awoke on Monday morning. But does it all add up?
I have been campaigning for better mental health support for several years, especially for young people and for mothers (and fathers) experiencing mental health problems in the perinatal period (see www.andrewmayers.info1). I am an academic psychologist at Bournemouth University, specialising in mental health. Through my external commitments and professional practice, I belong to a number of campaign groups (such as the Maternal Mental Health Alliance and I contribute to the All Party Parliamentary Group for perinatal and infant mental health group, 1001 Critical Days. I was driven to join these groups because of the chronic underfunding in mental health for decades (or probably ‘forever’, as Paul Farmer, CEO Mind Charity, put it yesterday). Through my work with local and national mental charities (such as Dorset Mind), I have seen the impact of cuts to services, reduction in public health and local authority funding, and the effect of austerity on communities. I was also compelled to tackle public stigma towards mental health, which ostracises sections of our society and discourages seeking help.
Let’s not forget that 1 in 4 of us will experience some mental health difficulty at some stage of our life. If you have not encountered problems, you no doubt know someone who has. Some conditions, such as depression, are a major burden to health services, and yet mental health only receives a fraction of the overall health budget. So, surely, I should welcome the promised investment and the commitment to recruiting the workforce to sustain that? Well, it’s a little more complex than that. Partly as a result of our campaigning, we have seen some encouraging funding pledges, especially in perinatal mental health. But there needs to be more. The promised £1.3bn investment in mental health needs to be put into context. Some might say that this funding only partially replaces what has been lost over the last decades. Where pledges have been made (even recently), the actual funds have failed to reach front line services. But let’s say we give Mr Hunt the benefit of the doubt this time. He claims, to properly invest in mental health, we need a strong workforce to implement that. Hence the call to recruit thousands of new workers. That’s OK, in theory, but what is the reality?
Part of the recruitment drive is to employ a further 2000 nurses by 2021. Surely that has to be a good thing? Well, it depends. To ensure that these nurses are in post, fully-trained, by that time, they would need to start their undergraduate courses by September this year. And yet, we are seeing a reduction in the numbers of applicants for nursing posts following the introduction of fees. There is little incentive for people to enter nursing, with the prospect of high debts to pay for the fees, and then years of chronically low pay. Why not waive the fees? Why should future nurses be paying to get the training needed to benefit society? Then there’s nurses pay itself. While the pay rise cap remains, where is the reward for hard work (especially in the highly demanding and stressful role of mental health nursing). When questioned on this yesterday, Mr Hunt sidestepped the issue, focusing instead on praising how hard nurses work without addressing the problem with low pay. Hunt says that he is confident that they will recruit the nurses. But how convenient it would be, should the recruitment fail, to use that as an excuse not to spend the £1.3bn pledged. We might hear “well, we made the commitment, but no one took us up on it, so we will spend the money elsewhere”.
It’s not just about the pay either, or just nurses. All mental health staff have incredibly stressful jobs. Many of those staff enter the profession because they have their own lived experience and want to give something back. That experience is very powerful; I have seen that in the contact that I have with staff and service users. However, very little (until recently) has been done to protect those staff from the impact of working in those challenging conditions. Investment is needed in ensuring that all staff have access to proper clinical supervision. It’s also not just about staff working directly in mental health services. All health professionals (GPs, acute hospital staff, practice nurses, community teams, etc.) need mental health training, so that (at the very least) they can properly signpost and/or refer to specialist services.
Of course, most of what I have said to this point applies to ‘patients’ with chronic or acute mental illness. There are considerably more people with sub-threshold mental health problems who do not qualify for treatment. But many still need support. That’s where the third sector comes, especially through local mental charities. In many cases, someone with (say) relatively minor mood or anxiety problems might simply need structured, effective, peer support. Local charities can provide that expert support, especially through peers with lived experience. However, as Patron and Trustee for Dorset Mind, I can attest that our biggest challenge is finding the funds to runs the services. Very little comes from local authority, public health budgets, or local commissioning. A great deal comes from grant funding. Simply by providing these local services, we can prevent so many people escalating into more acute mental illness, and becoming a great burden on NHS budgets. Surely, one answer is to use LA and/or local clinical commissioning to ensure that all areas have access to expert services, away from the NHS.
So, was I happy with Mr Hunt’s announcement yesterday? I welcome any funding, and certain applaud a drive to increasing staffing. However, this was not properly thought through. There is a much bigger picture that is being missed, quite probably because those making the decisions simply do not have the understanding about mental health that is needed to truly make the changes that are needed.
Dr Andrew Mayers