‘Weak commissioning’ and the lack of a collaborative vision has left London unable to create parity of esteem for mental health, the King’s Fund has claimed.
The healthcare thinktank has identified nine key steps to help to achieve the quality mental health care including: creating collective leadership around change; strengthening commissioning; and the effective use of contracting tools.
London spends almost £7.5 billion every year addressing mental ill health, which alongside the wider social and economic impacts of mental illness adds up to an estimated annual cost of £26 billion. But service user satisfaction is particularly low, with many needs not being met.
Good practice often happens in isolation, with wide variations in availability, quality and effectiveness of specialist services, the report found.
With more than 80 organisations responsible for mental health provision in London, a lack of strategic collaboration is holding London back, says the report.
Mental health has been identified as a priority by the London Health Board but there is no agreed action plan for improving provision and addressing the unique challenges of achieving this in London.
Current challenges include:
- The complexity of London’s NHS structures and systems for commissioning and delivering services.
- High levels of deprivation, and a diverse and transient population.
- High demand for services – significantly higher than the national average in more than three quarters of boroughs.
- The authors of Transforming mental health: a plan of action for London found that while stakeholders generally agreed about the priorities for improving mental health provision in London, there was no collective view for delivering them.
- The report identifies a number of longstanding barriers between stakeholders that continue to hinder progress such as:
- Different political and historical agendas.
- Unconstructive communication.
- Insufficient attention to collaboration in developing strategies.
- Weaknesses in commissioning.
The report highlights examples of innovative practice and some of London’s unique strengths – such as the fact that many of the world’s leading academic institutions focused on mental health research are in the capital.
It suggests that academic health science networks (AHSNs) should play a greater role in disseminating the latest research and good practice, while NHS England and Public Health England also have a role to play in supporting organisations in improving practice.
While the total level of funding for mental health provision remains a contentious issue, the report argues that there is a unique opportunity to improve services through more collaborative working, so how limited resources are spent is crucial.
Helen Gilburt, fellow at The King’s Fund and the report’s lead author, said: “Over the past 25 years mental health provision has undergone a dramatic transformation, with services moving from institutions to community settings. Our report shows that mental health services in London need to move away from siloed working and embark on a second phase of transformation to deliver the change needed to improve services.”
The nine key steps to support systemic implementation of a shared vision are:
- Collaborative commissioning to facilitate change.
- Driving change through collective systems leadership.
- Ensuring that service users, carers and clinicians are at the core of provision.
- Using contracting systems to support integration.
- Building a public health approach to mental wellbeing.
- Developing pan-London solutions to increase impact.
- Developing data to support improvement.
- Utilising London’s academic infrastructure to disseminate best practice.
- Creating a new narrative for mental health.
Paul Farmer, chief executive of Mind, the mental health charity, has said: “It is significant that an organisation with the King’s Fund’s weight is challenging mental health provision in London and we welcome the report and its recommendations.
“Our own work with the We Need to Talk coalition has found that one in five people in London wait longer than six months to access talking therapies, and reports of bed shortages in some London trusts show the pressure on secondary services.
Meanwhile public health programmes designed to prevent mental ill health lag far behind those for obesity and smoking that we now take for granted.
“We need a collective approach to improving mental health in London. The London Health Commission is due to publish its plans for health in London next month – this report shows that mental health needs really to be at the heart of its thinking.”
