New mental health outcomes strategy

This is a shortened version of a LGiU policy briefing written by Fiona Campbell. The full version of the briefing, and all others, is available to LGiU members through this link

The Department of Health has published a mental health outcomes strategy for people of all ages. The emphasis in the strategy on early intervention and early years, support for young people with mental health problems, court diversion services and psychological therapies have been broadly welcomed by mental health and professionals and campaigning organisations.

However, there is considerable scepticism about the capacity of the proposed new health infrastructure and funding regime to deliver the strategy. In particular, the claim that £400 million is to be invested in psychological therapies has been questioned, as it appears that this money is already part of PCTs’ budgets. Some doubt has been expressed, including by doctors’ organisations, about the ability of GPs to commission for specialist mental health services.

 Mental health problems – the statistics

  • At least one in four people will experience a mental health problem at some point in their life and one in six adults has a mental health problem at any one time.
  • One in ten children aged between 5 and 16 years has a mental health problem, and many continue to have mental health problems into adulthood.
  • Half of those with lifetime mental health problems first experience symptoms by the age of 14, and three-quarters before their mid-20s.
  • Self-harming in young people is not uncommon (10–13% of 15–16-year-olds have self-harmed).
  • Almost half of all adults will experience at least one episode of depression during their lifetime.
  • One in ten new mothers experiences postnatal depression.
  • About one in 100 people has a severe mental health problem.
  • Some 60% of adults living in hostels have a personality disorder.
  • Some 90% of all prisoners are estimated to have a diagnosable mental health problem (including personality disorder) and/or a substance misuse problem.
  • Mental ill health represents up to 23% of the total burden of ill health in the UK – the largest single cause of disability.

 

The strategy

The DoH document states that the development of functional mental health teams has delivered very good care in some areas, but in others has led to the fragmentation of care and inefficiencies across services. Only recently has attention been paid to the importance of employment and housing in the recovery process. Not all groups have benefited equally from improvements – for example, many people from black and minority ethnic communities have received less benefit. Access to services is uneven and some people get no help at all. This contributes to health inequalities within and between groups with ‘protected characteristics’

The strategy to address these issues sets out six shared objectives to improve the mental health and wellbeing of the nation is intended to support the ‘localism’ and ‘Big Society’ programme.

The six shared objectives of the strategy are:

More people will have good mental health

More people of all ages and backgrounds will have better wellbeing and good mental health. Fewer people will develop mental health problems – by starting well, developing well, working well, living well and ageing well.

More people with mental health problems will recover
More people who develop mental health problems will have a good quality of life – greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates and a suitable and stable place to live.

More people with mental health problems will have good physical health
Fewer people with mental health problems will die prematurely, and more people with physical ill health will have better mental health.

More people will have a positive experience of care and support
Care and support, wherever it takes place, should offer access to timely, evidence-based interventions and approaches that give people the greatest choice and control over their own lives, in the least restrictive environment, and should ensure that people’s human rights are protected.

Fewer people will suffer avoidable harm
People receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service.

Fewer people will experience stigma and discrimination
Public understanding of mental health will improve and, as a result, negative attitudes and behaviours to people with mental health problems will decrease.

In determining the success of the strategy, much will depend on how well the NHS Commissioning Board, the Public Health Service and GP commissioning work and how responsive the latter are to the joint strategic needs assessments developed by health and wellbeing boards, to which the mental health strategy appears to assign a central role. Monitoring the strategy’s effectiveness will depend on the ability of the new outcomes frameworks for health, public health and social care to capture improvements in mental health in sufficient detail.