Mental stimulation: a level playing field for mental health

As a society, huge strides have been made in tackling the stigma associated with depression and other mental health problems. Yet the majority of NHS budgets are directed towards physical health, according to Former Care Minister Paul Burstow.

While there are powerful drivers in aspects of physical health, such as 18 week waiting time targets and national spending tariffs, mental health has long been excluded from major policies, indicating an institutional bias within the health service.

“Mental health is the poor relation when it comes to things like the development of tariffs, which enable more certainty and stability in the way physical health is commissioned and ultimately the way resources are allocated between physical and mental health,” Burstow told Editor Laura Ferguson at the Public Service Events Mental Health: From Strategy to Reality conference.

Despite government pledges to protect the NHS from spending cuts, recent figures from the Department of Health (DH) reveal a 1 per cent drop in mental health spending last year.1 With NHS reorganisation in progress and budgets now in the hands of locally GP-led CCGs, concerns are that mental health could fare even worse unless it is put on a par with physical healthcare.

“There’s a huge variation of spending from primary care trusts on mental health at the moment, with figures ranging from £315 per head to just £97.91 per head. That’s based on a weighted population and it gives a true comparison of the variation in spends across the country.”

With some areas of the country already spending up to three times less on mental health services, there is a need for CCGs to be made aware of the economic case for investing in mental health. Yet healthcare professionals remain unaware of the benefits associated with treating mental health, warned Burstow, who was the minister formerly responsible for the Mental Health Strategy at DH.

“If you have two or more health conditions then you are seven times more likely to have depression. Where depression isn’t treated, physical recovery suffers too,” he said, suggesting that a failure to address it was a false economy that “simply shunts costs along the care pathway and results in more people needing expensive acute care.”

“The impact of mental health on a person’s physical health and vice versa is huge. Yet it’s not embedded into the way services are commissioned, so people are being treated for their physical ailments and are then left to struggle with mental health problems,” explained Burstow. “This manifests itself in huge health inequalities, with people who have mental health problem dying 15-20 years earlier than their peers who don’t have mental illness.”

For parity to be realised, mental health needs to be backed by healthcare leaders when deciding their local spending priorities: “It’s about having a good lead on mental health at CCG and local authority level, someone really championing mental health,” Burstow added.

But management of the illness is not the only challenge. Today, 250,000 people will visit their doctor about a mental health problem and figures from Mind suggest mental illness is increasing in terms of incidence.2 Half of those with lifelong problems first experience symptoms by adolescence, implying that some of the foundations may have been laid in early childhood.

Burstow backed early intervention for its ability to “help build resilience within families”, which will in turn “reduce the number of children emerging with mental health problems in adolescence” and ultimately “change the flow so there are less people flowing into the mental health system from the outset.”

Translating the Mental Health Strategy into a reality will undoubtedly be tough against a backdrop of cuts, but Burstow is steadfast in his vision of ‘no health without mental health’. During the conference he announced he will be leading a year-long commission on mental health for the think-tank CentreForum, which will draw evidence from across the sector in order to “embed this vision as a parity of esteem between mental and physical health.”

NHS reforms offer the opportunity to revolutionise the way mental health services are delivered. But as physical health continues to take precedence it will be down to managers and health professionals alike to make a fresh economic case for investing in mental health.

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