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NHS commits to major transformation of mental health care with help for a million more people

The NHS in England today (Monday) commits to the biggest transformation of mental health care across the NHS in a generation, pledging to help more than a million extra people and investing more than a billion pounds a year by 2020/21.

It is making the move in response to the final report of an independent taskforce, chaired by the Chief Executive of Mind Paul Farmer, set up by the NHS as part of its Five Year Forward View to build consensus on how to improve services for people of all ages.

The taskforce gives a frank assessment of the state of current mental health care across the NHS, highlighting that one in four people will experience a mental health problem in their lifetime and the cost of mental ill health to the economy, NHS and society is £105bn a year.

In a wide ranging package of recommendations, it proposes a three-pronged approach to improving care through prevention, the expansion of mental health care such as seven day access in a crisis, and integrated physical and mental health care.

The taskforce suggests, and the NHS accepts, investing over £1bn a year of additional funding in NHS care by 2020/21 to reach one million more people – this investment is in addition to the previously announced new funding for children, young people and perinatal care.

The report says:

  • In recent years there has been a significant expansion in access to psychological therapies, yet only 15% of people who need it currently get care. More action is also needed to help people with anxiety and depression to find or keep a job, as well as to ensure that people with long-term conditions have their physical and mental health care needs met.

By 2020, new funding should increase access to evidence-based psychological therapies to reach 25% of need, helping 600,000 more people access care. Combined with investing to double the reach of Individual Placement and Support for people with severe mental illness, this should support a total of 29,000 more people to find / stay in work each year by 2020.

  • People with mental health problems receive poorer physical health care, and those living with severe mental illness at risk of dying on average 15-20 years earlier than the general population. They are three times more likely to attend A&E and almost five times more likely to be admitted as an emergency.

By 2020, at least 280,000 more people living with severe mental health problems should have improved support for their physical health.

  • Between 2013/14 and 2014/15 the number of referrals to Child and Adolescent Mental Health Services increased five times faster than the growth of the workforce in these services.

The £1.4bn (over five years) committed for children and young people’s (CYP) mental health should be invested to ensure that by 2020 at least 70,000 more children and young people have access to high quality care. The Taskforce endorses the recommendations in the Future in Mind report in 2015.

  • At present only half of the country offers a 24/7 community-based mental health crisis service.

New funding should be made available so by 2020/21 Crisis Resolution and Home Treatment Teams (CRHTTs) can offer intensive home treatment as an alternative to acute inpatient admission in each part of England.

  • Only a minority of A&E departments currently have 24/7 liaison mental health services, even though peak hours for people presenting to A&E with mental health crises are 11pm-7am.

New funding should ensure by 2020/21 no acute hospital is without all-age mental health liaison services in emergency departments and inpatient wards, and at least half of acute hospitals meet the ‘core 24’ service standard.

  • One in five mothers suffers from mental health problems during pregnancy or in the first year after childbirth. It costs around £8.1 billion for each annual birth cohort or almost £10,000 per birth. Yet fewer than 15% of areas have the necessary perinatal mental health services and more than 40% provide none at all.

New funding should be invested to support at least 30,000 more women each year to access evidence-based specialist mental health care in the perinatal period.

  • Suicide is rising after many years of decline.

To reduce suicides by 10% by 2020 all areas should have multi-agency suicide prevention plans in place by 2017 that are reviewed annually.

The taskforce also calls for the practice of sending people out of area for acute inpatient care due to local acute bed pressures to be eliminated entirely by no later than 2020/21. It also states that clinical standards, including maximum waiting times for NICE-recommended care, should be developed and rolled out as soon as funding allows.

Plus the NHS must make significant improvements in mental health research and kick-start a ‘data revolution’ to ensure transparency on spending and the quality of care that people receive.

Paul Farmer said: “This is a landmark moment for mental health care in this country, a once-in-a-generation opportunity to transform services and support for people with mental health problems. We are saying to the NHS, to government, to industry, to local leaders and to the public that mental health must be a priority for everyone in England. We need to prevent problems in the first place, and to respond to people’s mental health problems at the earliest possible opportunity. As part of this, the NHS can and should be a world leader in care which treats people’s minds and bodies equally well.

“This report is a feasible and affordable blueprint for how to significantly improve care for people with mental health problems. We have consulted with the experts – people with experience of mental health problems, professionals providing care and the public. It’s time to make positive change.”

Simon Stevens, the Chief Executive of NHS England, said: “One in four of us will suffer from depression, anxiety or other mental health problem, but mental health services have historically been the NHS’ poor relation. Putting mental and physical health on an equal footing will require major improvements in seven day mental health crisis care, a large increase in psychological treatments, and a more integrated approach to how services are delivered. That’s what today’s taskforce report calls for, and it’s what the NHS is now committed to pursuing.”

Prime Minister David Cameron said: “For too long there hasn’t been enough focus on mental health care in this country meaning too many have had to suffer in silence.

“The Taskforce has set out how we can work towards putting mental and physical healthcare on an equal footing and I am committed to making sure that happens.

“This means that if you are struggling with a mental health condition you will get the help and support you need.”

Health Secretary, Jeremy Hunt said: “We have made monumental strides in the way we think about and treat mental illness in this country in the last few decades — from a society that locks people away in asylums to one giving mental health equal priority in law.

“But we must accelerate progress even further. Our shared vision of a seven day mental health service means people will get the care they need, when they need it, and will help us do much more to prevent mental illness in the first place. We will work across Government and with the NHS to make the recommendations in this landmark report a reality, so that we truly deliver equality between mental and physical health.”

The report states that evidence indicates that enabling good mental health, and effectively responding to mental health problems when they arise, is dependent on a wide range of socio-economic factors. In recognition of this, the Taskforce makes a series of recommendations for wider government. These include:

  • Significant increase in public transparency through changes in how spend on NHS mental health care is tracked and reported so it is clear what is being spent in communities on which mental health conditions.
  • A government champion for equalities and health inequalities.
  • The creation of prevention plans in every community across England to help integrate public health, social care and housing and improve mental health outcomes, with mental health champions in each community.
  • An independent system for scrutinising the quality of investigations into all deaths within in-patient mental health settings.

The Taskforce garnered views from 20,000 members of the public, people with experience of mental health problems and healthcare professionals to understand what they believed was necessary to change how mental health care is delivered across the NHS.

They took all the feedback into consideration when drafting the report, working alongside experts to set recommendations. NHS England will lead work to ensure changes are made, working in partnership with the six health arms-length bodies, people who use services, Taskforce organisations and health and care leaders across England.

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26 comments

  1. In the last eight years the male suicide rate has gone from circa 1.75 the female rate to 3.5 times the female rate or to about circa 14 men a day taking their own life vs circa 4 women a day. Strangely this report makes no mention of it nor makes it a priority nor suggests any additional funding to tackle it – can anyone suggest why this glaring omission? What about the Public Service Equality Duty or don’t males count? Excuses like men won’t talk or it’s a masculinity problem with men just don’t wash anymore; politicians need to consider medical need not mopping up votes from the so called minority groups.

  2. Sarah says:

    This all sounds wonderful and I for one sincerely hopes that it works in practice as well as it sounds in theory.

    Are we going to stop the privatisation of MH services? I ask because then private companies would no longer be allowed to cherry pick the easier services to work with whilst the NHS gets to foot the bill for the.most challenging.

  3. Michelle. RMN staff nurse in general nursing says:

    I am an RMN who is passionate about meeting mental and physical health needs, and with my previous job, within a NHS medium secure mental health unit, I completed a university module in physical health assessment to enable me to address physical health needs within a mental health hospital. When I saw a job advertised for RMNs in a General Hospital I jumped at the opportunity and was successful in gaining a position, initially within Critial Care and now on a respiratory ward. I thought that the trust was very forward thinking in wanting to employ RMNs to address mental health needs within a general hospital setting. I have had to undertake university training in degree level regarding nursing the accutely ill patient. However, alot of the RMNs that have been employeed within this trust, have left and gone back to mental health environments as we are being utilised as general nurses only and we do not have time to address mental health issues of the client group that are in the general hospital environment, which are many, especially within the older adults. I have worked for this trust for over a year now and it is heart breaking that I am not able to address this area of their care. I had additionally hoped to help train the general nursing staff in understanding mental health to enhance in-patient care. It is not our ward managers fault, as they do not have budgets to have us as mental health nurses although that is what we are employed as.

  4. mrs maureen west says:

    i am a women of 78 but i like to do a lot of things for myself,since i was 8months old i started to have siezurs ihave them since ,the doctor that i used to go and see as she has retierd left me with this other doctor younger and when she left she asked if i could manage,she meant the noise also that i have in my head which is so load that i cvannot hear the telly.the new doctor that i went to see october all she did was give me another tablet for my seizures i askerd her about my noise all she said wassee me next time when next i had apointment it was not till june then next she changed it until september thats a long time to wait with this noise which has taken over my life it leeps me awake at night which means i dont get the sleep that i should because of my elipsey that i have all my life.

  5. Max says:

    Interesting article here, some good points have been raised.

  6. Anonymous says:

    The way I keep getting rejected and denied help from mental health services, I doubt I’ll still be here in 2020.

    • Counsellor says:

      Sometimes people feel that they are being rejected simply because they do not approve of the choices being offered…Support is definately out there for those willing to engage.

  7. Mental Health

    I find word mental very harsh
    My immediate thought is insane,
    Many hide behind curtains
    So what about this? Menbrane.

    What’s your thoughts? Share!
    Please comment for all to see,
    Would menbrane help to encourage?
    More patients to visit GP.

    Mental health covers very wide range
    It’s associated with things in brain,
    Would you visit Mental Health Hospital?
    Or prefer the Hospital? Menbrane.

    Now my name is Bill Mckechnie
    Have you heard of mindfulness?
    It affects every single one of us
    Is it important to you? Well! Yes!

    Mindfulness is already known
    To be successful! This is true,
    Helps with physical & mental health
    For everyone including you.

    You may think you’re unaffected
    But ask yourself this question,
    Do I struggle to sleep at night?
    Or do I shout without intention?

    Mental Health sounds harsh I know
    But it does not mean you’re insane,
    It can be physical or mental health
    From daily stress to chronic pain.

    Even a lack of concentration
    Eating disorder causing you strife,
    Depression, anxiety, past memories
    Preventing enjoyment of life.

    So what exactly is mindfulness?
    Well it’s about leaving past behind,
    Not worrying about your future
    It is caring and helping your mind.

    There are lots of help and support
    Don’t suffer in silence be bright,
    If you have access to the internet
    I’m sure you can find a site.

    Or make yourself an appointment
    With a mental health nurse or GP,
    I know what I’m writing about
    Mental health! Sleeping! That’s me.

    By
    Bill Mckechnie
    http://www.wild-bill.co.uk

  8. John Kapp says:

    I am pleased to see the government at last addressing the problem of children’s mental health disorders, which have reached epidemic proportions, which were unknown 50 years ago, before the pharmacological revolution. I believe that the medicalising of mental illness has caused this epiodemicm .. The NHS is toxic with drugs, as an article in the Mail on line says see http://www.dailymail.co.uk/health/article-3460321/How-Big-Pharma-greed-killing-tens-thousands-world-Patients-medicated-given-profitable-drugs-little-proven-benefits-leading-doctors-warn. I met you and Chris last summer, and would like to meet with you again about commissioning more mindfulness courses in the city with the money given for mental health, including the new £1bn pledged for mental health 2 weeks ago.
    See also Robert Whitaker’s ‘Anatomy of an epidemic’ 2010

  9. rogerjohnson says:

    The biggest and most fundamental problem to mental health services is the fact that the system is reliant on GP’s as the sole gate keepers for access to treatments.

    Compared to other areas of medicine GP’s are very poorly trained in mental health issues. Many GP’s regard mental health issues as “not proper medicine” or else outside their areas of interest.

    Many people do not have a good relationship with their GP, or cannot even see the same regular GP due to high demand. People are often unable, or unconformable discussing their emotional and mental state to GP’s. There desperately needs to be an alternative route to access mental health services than seeing your GP.

    At present, largely due to the failings of GP’s, people are being left untreated, or without adequate care, until their mental health condition deteriorates to the point of crisis and they end up in A&E and hospitalised – after which point they are picked up by mental health services. Not only is this a personal tragedy, but a terrible waste of resources. If mental health conditions are caught early, and treated correctly, this can save huge amounts of money. People are able to get off social security and return to work more quickly, they require less expenditure on health care and consequently less pressure on the NHS.

    My suggestion is to establish a national initiative of mental health clinics. This service would be run by a psychiatric nurse (or similarly experienced mentlal health professional) and offered as a drop in service in GP surgeries or NHS walk in centres across Britain. This service would offer diagnoses, treatment and access to mental health services – and most importantly provide another means of entry to care and treatment than their GP.

    GP’s are often over-burdened, therefore these new mental health clinics would ease the pressure on GP’s and allow doctors greater time to treat other people with physical health issues – of which their GP training is more suited.

    Unless the fundamental problem of GP’s acting as the sole gate keepers to mental health services is challenged – and an alternative offered, any improvements further up the chain will be largely inconsequential on a national scale.

    The system needs changing from the very beginning. Starting with the GP.

  10. Sarajane aris says:

    The task force report is excellent news and the recommendations specific and commendable. What measures will be put in place to ensure spend on mental health will be honestly tracked monitored and reported meaningfully. How will public transparency be assured? Do we need another independent system for scrutinising and monitoring this other than via organisations such CQC or do CQC need to develop a specialist arm to do this work?
    What is the definition of a community as distinct from a region? If prevention plans are to be drawn up in every community it is essential it is clear to the public where a particular community begins and ends. Thank you. Sarajane Aris

  11. Disappointed says:

    I think the report has huge holes
    I believe the mental health taskforce has been watered down and have been negotiated down on things it can achieve.

    What about prisons? Why are individuals with mental health problems filling of prisons is having a mental health problem now a crime?
    The Centres is consistently saying think about systems don’t think about individual organisations.So in systems thinking why is it not considered substance misuse and the public health agenda fully in this report.
    Why is the national director for mental health really leaving?
    This report is the equivalent of the Empress new clothes- crisis teams are known, liaison teams are known, perinatal services are known.
    This Report should actually be entitled-what the clinical commissioning group’s have not commissioned even though the evidence has been there for years?
    Is this world class commissioning delivering on its outcomes. If CCG’s are assessed by the CQC on effectiveness and responsiveness to demand would this mean that they are well led?
    NHS England are responsible for oversight of the CCG is so significant parts the country have not been following known evidence does that mean NHS England has no control or are they just not aware of the evidence.

    We must think systems and deliver in finance and quality. Is it systems thinking when failure to intervene would mean that individuals are more ill for longer and then a lot of work and help and more expensive mental health treatments to be up to get them back to living and working when early access treatment not just IAPT would have got them on the check to you to improvement? Is this systems thinking and long-term planning?

    I’m sure the Treasury will be pleased. With more benefit applications

    It’s nowhere near enough

    Will you answer these questions?

  12. AbI Hodgson says:

    Would be nice to see if their is going to be some improvements in mental health funding ..As a service user myself on section 117 aftercare I have had not only no support or help from mental health services but lack of any help since moving out of ATU units & moving out of my care home in south Yorkshire to Leicester not through choice with the promise of adequate care in the community it failed ..I ended up on police safeguarding at risk & Vulnerable in the community when my health Funding authority Covestry & Warwickshire partnership trust Failed me in the community on section 117 aftercare and my community care placement broke down not once but three times ..I got put at risk in the community. .I’ve had no support or help since coming off safeguarding ..I have borderline personality disorder & Recently diagnosed with autism with a learning disability …I’m also physical disability ..I Feel my case collapsed because of no adequate services to help me ….Warwickshire just argued repeatedly with Leicester it was like being Passed from pillar to post while Two NHS mental health trusts repeatedly argued who’s responsibility I was ..I was originally sectioned on section 3 in Warwickshire not Leicestershire but Warwickshire would say I was Leicestershire responsibility & Warwickshire would say I’m Leicestershire, s ..I was not able to get any help or support while the arguments repeatedly continued even when I was on police safeguarding at risk & vulnerable it continued even with the police getting involved in the arguments with Warwickshire. .The police had had enough with Warwickshire. .I had Leicestershire police on my side & my family & friends ..It isn’t the point though ..They shouldn’t be moving people into the community without adequate support ..I now have a solicitor involved ..& livingautism. .It’s not right a lot of people like me are failed each and every day by mental health services. .Unless more is done more & more people with mental health will be failed ..I’m one of those people who as yet are still waiting to receive any such service…I’m hoping to move back to Yorkshire once my solicitor sorts it all out ..

  13. paul weber says:

    Hello, I’m already a qualified NLP practitioner working in local schools with children with behaviour and emotional problems and I’m looking to expand to be able to provide help to people of all ages in my community, I understand their might be a possibility of funding and hopefully some guidance on how i go about achieving this, please could you help me achieve this, hope to hear from you soon..many thanks,
    paul weber

  14. Peter Rooney says:

    The intent is good, though the recommendations are very short of being comprehensive enough. Not yet the basis for a good plan if 75% will still not be reached by 2020. I would particularly highlight addressing the needs of our frustrated young adults (25+). Now more than ever they remain standing alone in the shadows cast by newly-stated priorities, yet have the potential to contribute most back if helped, before our society bears the load of a lost generation.

  15. Gordon Allan says:

    The report is to be welcomed as it highlights the chronic under provision of mental health srevice switching the NHS and states the need for equality of funding for physical and mental health services. If achieved the recommendation will significantly improve mental health provision within the NHS. Even if the target is achieved by 2020 75% of people who require a psychological therapy will not receive one; that means a lot of people who suffer from anxiety or depression will not receive the treatment they need to improve their mental health. It will take time to develop services, recruit and train staff but the government needs to plan to achieve 100% now.

  16. Gordon Allan says:

    The report is to be welcomed as if all the recommendations are followed there will be a step change in NHS mental health services. The targets however need to be more ambitious, it is unacceptable to say that by 2020 75% of people who need a psychological therapy will not receive one, that means a lot of people with anxiety and depression will not receive the treatment they need to improve their mental health. It will take time to recruit and train staff to meet the needs of everyone but the government need to plan to meet that target now.

  17. About time. Parity of esteem should be enacted and not just talked about. When are you going to stop the downgrading of clinical psychology and other posts. This has resulted in a loss of much expertise to the NHS. You need to retain staff with clinical expertise in the NHS and enable progress through clinical leadership linked to ‘experts by experience’ and measure meaningful change ie as rated by service users and families as well as CCG’s. Linked up work with employers and criminal justice system is a good idea as meaning and purpose are integral to good mental health

  18. Robert Blackman says:

    One hopes that the 5 year forward view really will take into account the important role played by carers and families (where patients have one) and also friends and experts from the third sector, like Mind and Rethink, who provide vital support for the mentally ill. For years NHS support services have been cut back to the bare minimum and even beyond that – so that, quite rightly, any support for the mentally ill has been regarded as a Cinderella service – run on a tight budget with not enough staff or premises to function the way the NHS should. Let us all hope the money – and 5 year forward view – will really improve things.

  19. Pearl Baker says:

    This is absolutely wonderful news, but I have heard it all before, how can you actually access the system you have just been discharged from? Carers are ‘picking’ up the pieces regarding Health & Social Care, and using their own money to support those who need it.

    I will test the system this evening to see if West Berkshire Council implement my son’s ‘needs assessment’ and accept my position as a Carer defined in LAW, ensure they implement Section 117 and ‘safeguarding’ issues.

    The Newbury District Clinical Commissioning Group also need to ‘get up to speed’ regarding their responsibilities under the Care Act 2014 by ensuring my son’s accommodation cost is met under ‘joint finance’ and NOT by using his savings to pay his Rent. The original ‘Care Plan’ confirms he was placed into this ‘specific’ accommodation by the LA confirmed by them in writing, they refuse to accept my Carers status, and on this basis refuse me to make any comment on my son’s Health and Social Care? he is now escorted to London by me where he now seen by a Consultant Psychiatrist, who communicates with his GP regarding his Medical Treatment.

    The failure in the system is NOT entirely due to the lack of money, education, training, co-ordination, and ‘integration’ play a very important part.

    The above is NOT an isolated case. I fail to see how individuals likes my son and their Carers can be helped by a system that is in denial of the facts and the LAW.

  20. Sue says:

    Any evidence of investment is good news , however a crucial aspect has been missed. increased resources for Crisis team will be helpful but we need more crisis beds / in patient care . this is fundamental , however to admit to needing this will be exposing how the government have stripped beds over the last 5 years . They have made a mistake and this still needs addressing . You would not do open heart surgery in someone’s home , leave them and check on them over the next few days hoping they will steadily recover . You would risk complications , infection , collapse , death .You wouldn’t expect them to call if they felt unwell or leave a relative in charge of their care . Then if you did admit them put them up to 3 hundred miles away from there home . So why do we do this when someone significantly suicidal ?? . Crisis Bedswith experienced staff , not institutions please .

  21. nick parkin says:

    what would be really helpful is quick clarification as to how these funds are going to be allocated and not just put into CCG bottom lines but clearly ringfenced and ear marked for Mental Health

  22. Maysie says:

    No more beds then so people actively suicidal can be safe? Just more people in an office available 24 hours a day who a suicidal person won’t call.

  23. mark says:

    This is a really good report – thanks Paul

    My hope is that Local Government and Social Care will be given funding to ensure that the vital work of Mental Health Social Care Workers and services will be able to continue and play their vital role.

  24. Mark Trewin says:

    This is a brilliant and positive report plan. Thank you Paul.

    My plea is that funds are given to local authorities to ensure that social care can play its vital role in mental health crisis, prevention and recovery provision. The catastrophic cuts to social care will put this all at risk.