The NHS must grasp the opportunity to ensure real parity of esteem for mental health, writes Dr. Alison Rose Quirie, Chair of the Independent Mental Health Services Alliance (IMHSA).
Mental health has arguably never had a higher profile in Westminster and Whitehall. We recently saw the first parliamentary debate on schizophrenia in over 20 years, along with Gavin Barwell MP’s landmark legislation to end discrimination against those with mental health conditions and allow them to hold public office. There were inspirational speeches from MPs such as Charles Walker, who spoke movingly about his own experiences of mental illness and the effect on his day to day life.
On paper, the government seems committed to ensuring mental health is given the attention it needs. The NHS Commissioning Board Mandate cements the legislative requirement for physical and mental health to be treated with parity of esteem. However, to turn the rhetoric into reality, a major culture shift is needed in the NHS. Funding disparities and integration of health services need to be addressed as a matter of urgency. Real choice, with shared decision-making between patients and health professionals, is yet to be delivered in practice in many cases.
The Department of Health’s own figures have found that while cash investment in mental health services has increased by 1.2% since 2010/2011, this actually amounts to a real term decrease of 1%. A report earlier in the year by the London School of Economics highlighted that mental health services are missing out on investment as the NHS struggles to meet its efficiency savings challenge.
In order to address this imbalance, patients need to be involved in their care, with real choices over where and how they are treated. As well as the choice of named consultant proposed by ministers, this should include a choice of setting from a field of high quality providers. Creating a system where money follows patients’ wishes will help ensure that mental health needs are fully addressed.
IMHSA members also fully support calls for the integration of health services. At the moment, many people with mental health problems do not have access to the treatments they need from other parts of the NHS and social care services. Better designed patient pathways, along with the personalised care plans proposed in the Mandate, will help break down existing funding and service silos, ensuring patients can access services from all parts of the NHS and social care system.
There is a risk that, with the separation of responsibilities between the central NHS Commissioning Board and local Clinical Commissioning Groups, that some complex conditions, such as severe and enduring eating disorders, may fall between the cracks. Care must be taken to ensure that local commissioners receive support from clinical experts to ensure they can provide excellent quality services for all patients, regardless of the complexity of their condition.
With the advent of the new NHS commissioning structures in April 2013, and the legal requirements to work towards parity of esteem, health professionals have a real opportunity to give mental health the support and attention it needs. The big challenge and question for 2013 is whether these ambitions can be realised in practice. If they can, an NHS that caters for every aspect of a patient’s mental and physical wellbeing will be the prize.