This post is from The King's Fund Blog
Gone are the days when mental health was a niche public concern. Over the past few years there have been many advocates for ‘parity of esteem’ – a commitment to putting support for mental health on a par with support for physical health. That mental health is prominent in each of the Conservative, Labour and Liberal Democrat manifestos is a testament to these voices, and reflects a shift in public opinion that considers equitable treatment of mental ill health as a key policy agenda.
Current NHS strategy is outlined in The five year forward view for mental health, an action plan for improving mental health outcomes by 2020/21. Components of that plan are evident in all three manifestos – for example, all three make commitments to ending out-of-area placements although with slightly different emphases – but are most prominent in the manifestos of the Conservative and Liberal Democrat parties, perhaps reflecting the roles of the coalition and current government as architects of the service developments currently under way.
This reflection of the plan is welcome as there is a general consensus that, if implemented effectively, many of these developments have the potential to deliver measurable improvements in access to timely and effective treatment for mental ill health.
This takes us on to what the parties propose to do in addition to, and beyond, the life of the current plan. It is here that the parties diverge. Theresa May’s personal commitment to mental health is clear from her time at the Home Office where she oversaw a drive to reduce the use of police custody as a ‘place of safety’ for people experiencing a mental health crisis and her first speech as Prime Minister which focused on mental health as a ‘burning injustice’. The Conservative manifesto continues this narrative, but it is the proposal to use legislation to enact change that is most notable. The proposed replacement of the Mental Health Act 2007 presents opportunities to start afresh and address legislation which still reflects the original 1959 Act, passed at a time when most people with mental health problems were housed in asylums. However, what this aims to achieve remains unclear and it is hard to forget that previous attempts to introduce a Mental Health Bill in 2006 had to be abandoned because of a lack of consensus on what changes in legislation could effectively achieve and on the balance between state intervention and individual rights.
The Liberal Democrat manifesto reinforces their commitment to using access standards as a means of driving improvement – an approach instigated by the coalition government – with the introduction of a new standard in A&E. However, there is also evidence of the approach adopted by the West Midlands Mental Health Commission, chaired by Norman Lamb which prioritises implementation of service improvements where there is a good evidence of impact, and development of longer-term solutions in areas of identified need. The Liberal Democrat manifesto commits to the roll-out of two evidence-based models of support for people with mental ill health, Individual Placement and Support in employment services and Liaison and Diversion in criminal justice settings, while developing work around supporting good practice among employers and a campaign to improve mental resilience.
Labour’s commitments focus on mental health in children and young people. This includes a commitment to increasing the proportion of the mental health budget spend on support for children and young people, funding for schools-based counselling, and the introduction of a mental health indicator for children. There is also a pledge to work towards ‘a new model of community care’ that brings together mental health with primary care and social care, although the manifesto puts little flesh on the bones of this commitment.
Having a plan is the first step, but if there’s a ‘burning issue’ in mental health, it’s funding. All three parties have tackled this, but in different ways. Both the Liberal Democrats and Labour have opted for ring-fenced funding for mental health, but where the ring-fence is applied varies. The Liberal Democrats plan to raise an additional £6 billion of funding for the NHS from which £1 billion will be ring-fenced for investment in mental health. In contrast, the Labour commitment is to ring-fence ‘mental health budgets’ to ensure allocated funding reaches the front line. Experience suggests this may prove challenging and risks placing undue restrictions on what is funded and how, particularly given the breadth of mental health commissioning and the move towards greater integration. The Conservative manifesto reiterates their commitment to delivering the funding increases set out in the Mental Health Forward View. It is assumed that new manifesto commitments will be met through the £8 billion increase in NHS spending pledged by the end of the parliament, but the challenge of getting funding to the front line where it is most needed remains.
Each party offers a different plan for delivering improvements and different ways of funding it, but we can be sure that whichever government is in place after 8 June, mental health will be part of the policy agenda. Yet while we remain long way from the reality of ‘parity of esteem’, one thing that government can be certain of is that the pressure to deliver improvement in mental health will be ever present.