False economies leave mentally ill vulnerable

Mental health services are facing serious financial pressures. From hospitals to community care, from children’s services to those for adults, budgets for mental health support are being cut across the country. And this is having an effect on a range of services, especially those that help people to stay well and to recover their lives.

In 2010-11, the last year for which we have reliable spending data, funding for adult mental health services fell in real terms for the first time in a decade. Freedom of information requests since then have unearthed evidence of further cuts in many places both for adults’ and children’s mental health services. In some areas, this means specialist community teams are being “merged” into generic services. In others, support is limited to those with the most urgent needs while cost-effective early interventions like school and parenting programs are scaled back. In such cases, short-term savings to balance the books could end up costing the public purse much more as people’s needs escalate and become more complex.

The NHS is now committed through its mandate from the government to work towards putting mental health on a par with physical health. At present we are a long way from achieving this. Mental ill health accounts for a quarter of all illness in the UK yet it gets just 13% of NHS funding. And specialist children’s mental health services get less than 1%.

Long-term under-investment and short-term cuts combine to put services under serious pressure. From the continued use of police stations as “places of safety” for people in a mental health emergency to inappropriate admission of children to adult psychiatric wards, these pressures affect some of the most vulnerable people at the most difficult times in their lives.

It is crucial that all mental health services, be they publicly or privately provided, are required to meet the same high standards we have of other NHS-funded hospitals and clinics. Local health and care commissioners need to assure themselves they know the needs of their local populations and that they are able to meet them using services that meet the standards of the quality regulator, the Care Quality Commission. This is especially the case for the steadily growing number of people who are detained in hospital under the Mental Health Act, whose rights and dignity must never be compromised.

Our children’s mental health cannot be left to chance. One child in 10 has a mental health problem. Three quarters never receive any treatment or support. Yet children with poor mental health go on to become adults with poor mental health. And those with the most common childhood mental health problem, conduct disorder, can look forward to dramatically harder, poorer and shorter lives than their classmates. We need to take action now to create a whole system of mental health support for children that boosts resilience and protects those who become unwell.

We need schools to become vigilant for the signs of mental ill health, supporting healthy child development, tackling bullying and teaching emotional wellbeing. We need to invest, too, in the mental health of parents, supporting those whose children are most at risk to develop positive parenting techniques.

We need to keep building on the government’s initiative to improve access to psychological therapies for children and young people (and their parents) to ensure that all who could benefit from proven cost-effective treatments are offered timely support from engaging and highly skilled workers.

And we need to ensure that care is there in a crisis for children who are at their most vulnerable. All services that work with children and families should be vigilant for the signs of stress that lead to a crisis. And in every area of the country the NHS should have to provide suitable beds for young people who need emergency mental health care, diversion services at the point of arrest for young people who get into trouble with the police, and on-call support and advice in A&E units from liaison psychiatry teams.