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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.