Dr Ed Mitchell, Clinical Fellow to Martin McShane, NHS England’s Director for Long Term Conditions, outlines new moves to give mental health parity with physical health issues:
When the historians of the future write about healthcare in the twenty-first century, they will remark upon one of the more curious aspects of our healthcare system – the way we separate physical and mental health.
Odd, they will think, that we should arbitrarily divorce these two aspects of our health and wellbeing. They will think it even odder given the increasing evidence of what a huge effect each has upon the other.
We might hope this curious separation was simply destined to provide a footnote in some future history book. Unfortunately, it has far reaching and serious effects on people right here, right now, today.
Mental illness causes almost a quarter of our burden of disease (22.8 per cent), yet receives only 11 per cent of NHS funding. (For comparison, cancer causes 15.9 per cent of that burden).
Whilst 92 per cent of people with diabetes are in receipt of treatment, only 28 per cent of people with mental illness get treatment for their problems. Yet we know that people with serious mental illness are at risk of dying up to 25 years earlier than those without such illness.
At a time when we are focusing on cost-pressures in the health service, having a co-morbid mental health problem increases the costs of services for a patient with a long term condition by 40 to 75 per cent. More than a third of GP consultations are related to mental health (approximately 150 million consultations per year). Up to 40 per cent of A&E attendances across London are related to mental health, drugs, and alcohol.
So, as these statistics demonstrate, we know that mental health has a major human and financial cost, yet it’s still very much the ‘Cinderella’ sister to physical health. It’s time to do something about it.
NHS England, the Department of Health, The Royal College of Psychiatrists, and a range of third sector and patient organisations have come together to address ‘Parity of Esteem’ for mental health. This initiative will place emphasis on the design of health services to address the mental health of people with physical disorders, and the physical health of those with mental disorder.
We know there is a huge amount we can do in NHS England to influence the parity agenda, including fostering capability and leadership in mental health within CCGs, ‘industrialising’ improvement in the care of people with psychosis, promoting value-based commissioning and care for people with mental disorder, and getting mental health informatics right so we can commission the right services for the right people.
But we can’t do this alone. The people who provide mental health services day in and day out are our partners in this.
Often we talk of a ‘purchaser-provider’ split in the NHS, as if those providing services should have nothing to do with those commissioning them. That kind of ‘silo-thinking’ won’t improve services. We need to work together to integrate good physical healthcare for people with mental disorder, and to start building mental health and wellbeing into services and pathways for people with physical disorder.
Most importantly, we need to co-design these services with the people who use them day in and day out.
The National Clinical Director for Mental Health at NHS England, Geraldine Strathdee, recently spoke with the Foundation Trust Network – the voice of NHS acute hospitals, mental health, ambulance services, and community services organisations – on valuing mental health (Geraldine’s slides ‘Valuing mental health’ are available to view here).
Her argument was not that we have a dearth of evidence-based guidelines and standards in mental health – indeed, quite the opposite. We have over a hundred NICE Health Technology appraisals, NICE guidelines, Public health related guidelines and Quality standards.
The problem is that we haven’t learned from those that can, and have, implemented these guidelines – and spread ‘what good looks like’. There is still too much variation, with some pockets of great practice.
At the recent Future of Health conference we learned from each other, and from service users, about great examples of integrated care – we need to do this not just at conferences once a year, but every day. Providers, commissioners and service users need to work together to make today’s exceptional practice tomorrow’s normal practice.
It is often not easy to look outside our own organisations and learn from others. But if we don’t do so we’ll continue to fail to provide for the health needs of some of the most vulnerable people in society.
Ed Mitchell is a junior doctor training in psychiatry, and currently one of Sir Bruce Keogh’s clinical fellows, working in Domain 2 (Enhancing the quality of life for people with long term conditions) of NHS England with Martin McShane. He has a particular interest in integrating physical and mental health. Before studying medicine on the graduate entry course at Oxford, he was a Fulbright fellow at Harvard University and a junior research fellow at Pembroke College, Oxford.