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Understanding the mental health battle

Understanding the mental health battle

The Prime Minister must deliver on her promise to improve access and care, says Dr Kailash Chand
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The Prime Minister must deliver on her promise to improve access and care, says Dr Kailash Chand

A longstanding criticism of health and social care in England is that people with mental health problems often fail to receive the same access to services or quality of care as people with other forms of illness. There are large gaps in terms of health outcomes, too: people with the most severe mental illnesses die on average 15 to 20 years earlier than the general population.

Despite this evidence, more than 50% of clinical commissioning groups (CCGs) cut their mental health budgets last year. Mental health services have always been the poor relation in health systems in general and the NHS in particular. One in four adults experience at least one diagnosable mental health problem a year. But it is a postcode nightmare: where you live is what you get.

Evidence from the World Health Organization suggests that nearly half of the world’s population is affected by mental illness. They may experience stress, depression, anxiety, learning disabilities, mood disorders or other illnesses. Their emotional health can affect their physical health and lead to problems such as substance abuse.

A government report leaked last year painted a devastating picture of England’s mental health services. The number of people killing themselves is soaring, three-quarters of those with psychiatric conditions are not being helped and sick children are being sent ‘almost anywhere in the country’ for treatment. Black African and Caribbean men are on average detained fi ve times longer in secure care than those in other groups. We are still in the dark ages of the management of patients with mental health conditions.

The average defi cit of NHS mental health trusts has increased by 6.3% in the past two years, the Independent Mental Health Services Alliance has found. The fi rst quarter of this year has already seen 31 trusts – nearly half – experience a deficit. Independent thinktank the King’s Fund concluded that about 40% of mental health trusts experienced a cut in income in 2013/14 and 2014/15.

The fund pointed out that, in the same period, 85% of hospital trusts saw their income increase for acute health. Stephen Dalton, then the chief executive of the Mental Health Network, said this was evidence of institutional bias in the NHS and local authorities regarding mental health funding.

In austere times, health commissioners tend to raid mental health budgets to plug the deficits in the acute hospital sector. I have been a GP in Greater Manchester for more than 30 years and mental health services have always struggled to survive.

The scale of the challenge has been underestimated. NHS England has set out its roadmap for achieving the recommendations made in 2016’s Five-Year Forward View for Mental Health.

The NHS has promised an extra £1bn a year. But, as welcome as more funding is, it will not stem the tide of distress if the basic causes remain in place.

The Prime Minister has talked about the burning injustices in society and she has highlighted the impact of poor mental health on people. Now is the time to deliver on that. We need political will and action. There is no health without mental health.

Dr Kailash Chand is an honorary vice-president of the BMA and the chair of Healthwatch Tameside 

@kailashchandobe

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