The next steps for Mental Health: funding, resources and policy priorities

In my two years as NHS England’s national clinical director for mental health I have been lucky enough to see enormous progress.

That progress is due to an army of leaders who have pushed mental health further up the political agenda and into the public consciousness than we have ever seen before. Crucially these leaders, who I celebrate, are not just medical professionals but service users, carers, charities, commissioners, academics, local and national politicians and many others.

The prominence and integration of mental health in the NHS Five Year Forward View is testament to how far we have come and sets out the next policy steps.

It continues the momentum our army of leaders has created and has also led to the establishment of the Deputy Prime Minister’s mental health taskforce and the children and young people’s mental health and wellbeing taskforce. This cross-government work will support improved prevention and early intervention particularly in those critical early years when 75 per cent of lifetime mental illness first occurs.

Ministers, experts and service users talking to each other about mental health policy is, of course, to be welcomed but what is also needed is urgent action to make improvements in service.

The most significant recent action we are taking is to introduce access and waiting time standards for mental health delivering on the policy objective of working towards creating ‘parity of esteem’.

Applying these standards will mean that everyone who needs care gets the right support at the right time. Measures to meet these standards in the coming financial year will be paid for with £40m to support implementation of the early intervention in psychosis standard, £10m to support the Increasing Access to Psychological Therapy standard and £30m targeted to support the development of liaison mental health services. In addition £30m for the next five years has been committed to improve timely access to evidence-based community eating disorder services.

Ending low levels of access to effective care and treatments for so many people who live their lives in distress and despair will prevent unnecessary suffering and spending downstream. I have written at greater length about this in an earlier NHS England blog.

To be effective action like this needs to be based on good evidence, information and intelligence. That is why we started, and have continued to develop, the National Mental Health, Dementia and Neurology Intelligence Network. Improving data, intelligence and using it to improve services will be a major area of development in the coming months and years.

In NHS England our area teams, strategic clinical networks, academic health science networks and collaborations for applied health research and care are working on new discovery but also, very critically now, to help translate their research findings into the language that will inform the public of the exciting work.

A public that is informed about mental health is one that we can conscript into our army. The Time to Change programme has made an excellent progress in this with stigma decreasing and public understanding growing.

We now need to build on this with public education and health literacy to build more understanding of how to build positive mental health and promote resilience.

An educated public is a good place to start for a serious drive on preventative work which needs to follow a life course approach enabling the best support to be available at all stages of life from perinatal, through childhood and adolescence, adulthood and old age.

The basis of positive mental health is growing up in a nurturing home and community free from abuse, neglect and bullying. Supporting parents with better perinatal mental health care and parenting programmes will help support children to fulfil their potential at school where social and emotional education is shown to be hugely beneficial.

If children do develop a mental health problem, and one in 10 of them do, then that needs to be recognised by trained teachers, school nurses and health visitors. Currently only one-in-four of children with a mental health problem get any professional help and we have to work to ensure that they get the help at the right time.

In adulthood work can be both a protective factor and a potential source of stress and distress that can lead to illness. We need to support people at higher risk into supportive employment and make sure all employers know how to look after their employees properly to the mutual benefit of everyone.

Better understanding of mental health will help us promote positive mental health and wellbeing reducing the frequency and severity of illness and freeing up services to support people who need help as early and effectively as possible. Our new access standards will help us to do that and is just the start of a transformation of mental health services into a valued and integral part of the wider system as set out in the Five Year Forward View

We have had two years of making unprecedented progress in mental health. We have to continue this pace and scale over the next 10 years to redress decades, if not centuries, of stigma and ignorance about mental health.

Mental illness has preventable causes, we have highly effective and cost effective treatments and we have the economic evidence that investing in mental health nearly saves literally billions of pounds and transform lives.

Let’s get out and make the transformation that is so overdue.

  • Dr Geraldine Strathdee is NHS England’s National Clinical Director for Mental Health. This blog is taken from an address she gave to a Westminster Health Forum Keynote Seminar: Next steps for mental health – funding, resources and policy priorities.
Dr Geraldine Strathdee OBE,

Dr Geraldine Strathdee, OBE, MRCPsych, is the National Clinical Director for Mental Health, NHS England, a consultant psychiatrist in Oxleas NHS FT, and Visiting Professor, Integrated mental health education programme at UCL Partners.

For over 20 years she has held senior roles in mental health policy, regulation and clinical management, at national and London regional levels, and advises internationally on mental health service design and quality improvement, while working as a practising clinician. She has been involved in transformational large scale service development programmes, moving services from hospital based, to 24/7 home care and primary care models, in roles which have included: the Trust Director of Clinical services in Oxleas NHS FT (2005-2007), Director of Service development at the Sainsbury Centre for Mental Health and Senior Lecturer, UMDS ( 1995-1998). She was the National Professional Adviser in mental health to the Healthcare Commission and the Care Quality Commission (2005-2012).

Her particular commitment is to the translation of policy and best practice evidence into front line routine clinical practice, empowering service users to reach their potential, and staff to maximise their time to care. She is passionate about the development of leadership competencies and using information to enable informed decision-making.

As London SHA Associate Medical Director (2009-2013), with responsibility for mental health, she led transformational change through the development of clinical networks for dementia and primary care mental health CCG leaders, developed ground breaking commissioning support care pathway profiling informatics tools, and high impact educational programmes. She was awarded the prestigious RCpsych Psychiatrist of the Year award in 2012.

Clinically, she has worked in a wide range of primary care, inpatient and community services, and latterly with people with complex and multiple needs, as a Consultant Psychiatrist for the Bromley Assertive Community Treatment team in Oxleas. She is committed to providing services which enable services users to live in their own homes, develop their own personalised care plans and self management expertise to achieve recovery, while at the same time working with community agencies to deliver coordinated, responsive, care pathways.

Service evaluation and research interests: Her teams have won awards for their use of technology in improving care, using patients as experts in staff training and leadership awards for new Ways of Working, the redesign of roles. Her research interests have included the fields of primary care mental health, evaluation of community services and dual diagnosis. Current research interests include the evaluation of competency based leadership programmes and clinical networks to drive transformational improvements, and high impact educational programmes.

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  1. Keith Dudleston says:

    Dr Strathdee,

    I was sorry to read the lack of emphasis, in your report, about our very troubled in-patient services.

    People are now much more likely to be detained in hospital under the mental health act, then moved to units long distances away from home (where relatives can’t visit) and be discharged unnecessarily on to compulsory community treatment.

    It is difficult for me to regard all this as “unprecedented progress” or “enormous progress”. Sorry to be negative but a dose of realism would help.

    Improving access and waiting time standards, data and intelligence, public education, parenting, and children’s services may all provide improvement down the line. However services are in crisis now – and you don’t appear to be aware of the situation.

  2. Chris says:

    I am staggered that you think we have made ‘enormous’ progress in mental health. My experience of trying to access services is appauling. Long waiting times, poor communication and inexperienced mental health staff mean that parity of esteem is a long way off. It simply isn’t possible to put a positive spin on this story.