The announcement of the Mental Health Taskforce shows that mental health is now at the leading edge of transforming England’s health system.
It also means that mental health is at the forefront of delivering the NHS Five Year Forward View modernisation.
People who have experienced mental ill health, those who commission and provide services, academics and professional leaders who make up the taskforce will be shaping these changes.
The taskforce will identify the best ways to provide people and communities with the information and support they need to develop good mental health and resilience. Those communities and their services can protect people from the preventable causes of mental ill health, and the taskforce aims to make this happen at scale.
It also aims to provide a road map to improved access to services with early detection and access to timely, effective, personalised, compassionate care for all mental health conditions, in acute, primary care and specialist settings.
The taskforce will break down the barriers between mental and physical health care to make sure that people’s minds and bodies are assessed, treated and supported together. This will involve ending the stigma and exclusion of the mentally ill in the healthcare system and improve radically, their life opportunities and outcomes.
The taskforce will take a life course approach, setting out the vision and standards of care needed from conception, through infancy, childhood, adolescence and working ages, to healthy older age and end of life.
To develop the vision and implementation programme, the team will use the latest international scientific and economic knowledge. It will identify the best commissioning and provision of support and spread what works, so that people can expect the same high standards of care, across the country. There are many excellent services and we want to learn from them.
This work is needed because although mental ill health is very common awareness about what causes, prevents and treats it is relatively limited. There has been a culture of stigma, and even fear about mental illness, in society and among health professionals. This is changing, as courageous, high profile political and celebrity figures have spoken out about their illnesses.
The public has taken to their hearts the many brave people who are increasingly speaking out to describe their experience of illness, the long waits to access treatment, the lost personal, family, employment and economic opportunities.
For too long too many have not been able to access the treatment and care they need, as rapidly as they can access the good physical health care, of which we are rightly proud.
In primary care, where many people first go to seek help, mental ill health accounts for one third of the daily work of each practice. Yet, less than a third of GPs and less than one per cent of practice nurses have had support to access mental health training.
Across England, transformational new models of primary care mental health are springing up: integrated physical and mental health assessment at registration and in consultations. The skill-mix of staff working in primary care is changing, with greater access to enhanced practitioners, psychological therapists, ‘secondary care’ specialists, care managers and peer supports. Learning from the advances in primary care mental health internationally and the Models of Care innovation in England, the taskforce will identify how to build on this emerging best practice and integrated care for the individual and across pathways.
A majority of clinical commissioning group mental health leaders have now had training in mental health commissioning, and the new thinking and models of care they are driving will be of great interest to the taskforce.
- South Central England GP Mental Health Commissioning Skills and Leadership Development Programme 2014/15
Mental ill health also has a major impact on acute care. Mental illnesses, including depression and anxiety are among the commonest comorbidities. If unidentified and untreated, patients present more often to accident and emergency departments, are admitted unnecessarily to acute wards and care homes and attend acute outpatient clinics repeatedly. They have poorer outcomes, suffer greater levels of premature mortality and disability, and use a great deal more health resource if they do not receive integrated physical and psychological treatments in their care pathways. The taskforce will bring together the case for change, and the many growing best practice examples in acute care across the country.
- Long-term conditions and mental health – The cost of co-morbidities
- Economic evaluation of a liaison psychiatry service
- Investing in emotional and psychological wellbeing for patients with long-term conditions
People with episodes of severe mental illness, tells us they want to be treated as equal partners in their care, that they prefer to be treatment in their own home, with seven day care and supporting for them and their families. They want holistic care that addresses their social, mental and physical health needs.
For people who need access to specialist mental health treatments, there is major variation in rates of early identification, timely access to treatment, access to the evidence based treatments that deliver the best outcomes. People with serious mental illnesses die up to 20 years earlier due to lack of access to the essential physical and psychological treatments they need. The results of the recent National audit of psychosis shows us the scale of the transformation needed for all services to progress to the standards of the best.
There are outstanding examples of excellent care across the country but the level of variation needs to be addressed thorough ‘industrial’ improvement programmes, and this will be a key focus for the taskforce.
And the taskforce will want to develop plans that lead to a robust, sustainable future for excellence in mental health in England. It will want to build on the work to develop skilled leaders and a well-trained workforce, to establish underpinning information programmes, and maximise the spread of innovation and excellence.
The work of this taskforce has the power to transform the lives of millions. It is a tremendous opportunity and responsibility to deliver the recommendations to the Five Year Forward View partners to realise that ambition.
- Dr Geraldine Strathdee is NHS England’s National Clinical Director for Mental Health.