What next? Making the Long Term Plan real for mental health service users

We know people with a serious mental illness can live active, contributing, and rewarding lives and have a right to do so. The right support is crucial to this. As a registered mental health nurse of 34 years, and now as National Director for Mental Health at NHS England, I am passionate about ensuring people are receiving the treatment and support they need.

You have told me about your experiences, and it drives me to ensure we are creating mental health services that actually work for you, with expanded access, and care closer to home. Living with schizophrenia, bipolar affective disorder, personality disorder or experiencing psychosis can be very scary, and lonely. We know that you want to be treated in your own communities, close to your social networks.

The NHS Long Term Plan is loud and clear in its commitments. Often, when receiving mental health support for a severe mental illness, it can feel like you’re giving up choice and control. We know this is wrong, and we are addressing this. By 2023-2024, 370,000 adults with severe mental illness will have greater choice and control over their care. We will also test four week waiting times for adult and older adult community mental health teams, to help us understand how best to improve access and outcomes.

The reality of living with a serious mental illness, means that you are also likely to also have a physical long-term condition, such as asthma, diabetes, obesity, chronic obstructive pulmonary disease, or cardiovascular disease. It is easy to think of conditions as separate, but the reality is that your mental and physical health impacts your day-to-day life, every day. The Long Term Plan is committed to further increasing the number of people receiving physical health checks to an additional 110,000 people per year, bringing the total to 390,000 checks delivered each year including the ambition in the Five Year Forward View for Mental Health.

If you’re living with a severe mental illness, I know your goals and aspirations are the same as anyone else’s –  steady employment, an active life. Why would they be any different? The connections between feeling fulfilled and employment are well known. This is why the NHS will support an additional 35,000 people with severe mental illnesses to participate in the Individual Placement and Support programme each year by 2023/24, bringing the total to 55,000 people supported per year. This programme helps people to find and retain employment, and we know that maintaining stable employment is a huge factor in maintaining good mental health.

But what next? Commitments and goals are all well and good, but we need to make this Plan real, and the hard work is happening right now at a fast pace. Services need to be on the ground. One way we are making this Plan a reality, is ensuring that money is actually reaching local services. We are closely monitoring local spend with the Mental Health Investment Standard – ensuring complete transparency and accountability. The Mental Health Investment Standard means that local areas have to make sure the percentage increase in spend in mental health is greater that the percentage allocation increase they receive.

I have said before that mental health commitments are not ‘optional extras’ for local areas. I am committed to making sure that the money invested in mental health reaches the services you use. I also know that your life is much wider than the NHS – we desperately need to value social care. Wider society too must understand its own vital role and responsibility in people’s lives.

As the leader in Mental Health, you may assume I only have a ‘birds-eye’ eye of what is happening around the country, but the truth is that I visit local areas regularly and the message is loud and clear – mental health is the priority, and change is happening, for the better. I am determined.

Mark Winstanley, CEO of Rethink Mental Illness: As the Chief Executive of Rethink Mental Illness, I am also determined. I am determined to make sure this once-in-a-generation chance to improve services for people severely affected by mental illness is delivered – but we need wider non-health sectors to get involved to help make it a success.

This is the most exciting opportunity in public policy I have seen in my three decades with Rethink Mental Illness. For the first time, ambitious plans have now been set out in the NHS Long-term plan to transform community services for people severely affected by mental illness and ensure 370,000 people have more choice and control over their care.

I have therefore made it a number one priority for us to work closely with Claire and her team, as well as local commissioners and providers to ensure these ambitions are delivered in full. But we cannot let the huge amount of expertise and hard work, not to mention funding, that’s gone into this plan, not be delivered to its full potential because of wider issues.

One vital factor, for example, is ensuring everyone has a safe place to call home. We hear from NHS Trusts and CCGs all the time about the fact that they know a population of their patients in hospital would be much better treated in the community but until they can find them supported housing, due to a severe shortage in supply, they have to remain in expensive beds. Most importantly, it isn’t right for patients, whose mental health is undermined by issues that could be addressed with the right supported housing.

These new community models are all about wrapping support for people’s holistic needs around them, whether it’s clinical, practical or financial. That’s we why need non-health sectors to get involved as well – from housing organisations to employers to charities providing debt advice.

We need to see the wider social determinants of mental ill health being addressed, we all have a part to play in this.

In summary, there’s a huge amount to do, but also a lot to be excited about and I and all my colleagues at Rethink Mental Illness are really pleased to be working with NHS England and convening all sectors together to ensure ambitions are delivered. Only then will people severely affected by mental illness receive the right care at the right time.

Claire Murdoch

Claire Murdoch is NHS England’s National Mental Health Director.

She has been a registered mental health nurse for 34 years, and joined NHS England in April 2016.

She is also Chief Executive of Central and North West London NHS Foundation Trust. With a wealth of clinical and leadership experience she is leading delivery of the national mental health programme.