Opinion: Mental health is a hot topic again – and rightly so

Our Ministers have done much to rectify the shameful situation under Labour where mental health was a poor cousin to physical health – something Labour’s policies still haven’t addressed.

Last week, Norman Lamb announced we are looking to invest £500 million yearly in mental health. We’ve already invested £120 million for 2015/2016 to fund waiting time targets. We’ve pledged £150 million over 5 years to improve underage eating disorders services.

And profoundly, we’re looking at shifting from per-patient funding to outcomes-based funding.
What more could we do? Two ideas –

1. Mental health representation on CCG’s who commission mental health services

Last year, we learnt CCG’s were cutting mental health more than other services due to “NHS England’s advice on efficiency savings” – despite condemnation from Ministers.

Thankfully, NHS England has now asked CCG’s to increase mental health spending, following similar calls from Nick Clegg. But we could reinforce this by ensuring mental health presence on the commissioning bodies themselves.

NHS England could mandate mental health professional and even service user representation on CCG’s – alongside the GP’s, laypersons, and secondary care doctors and nurses already there. Currently, secondary care representatives can be psychiatrists, but often aren’t – despite their decisions impacting mental health provision. (Hospital doctors being on CCG’s shows conflicts of interest worries are easily resolved.)

There are still heavy pressures. As a psychiatrist, I’ve had days when I’ve been told there isn’t a single adolescent psychiatric bed available in the country – stranding children in A&E for days. The Royal College lead on under-18 mental health said: “This isn’t just about beds, it’s about community resources”.

And given the importance of underfunded community services in preventing acute admissions (especially adolescent crises), it is vital mental health is at the table where funding decisions are made.

2. Physical health of service users matters

It’s well known there are high rates of physical ill-health among service users.

The Schizophrenia Commission likened the poor physical health of those with schizophrenia to neglect. Smoking-related deaths are far higher in those with schizophrenia than in similar groups without.

We can cut this by improving diet, reducing smoking, and promoting exercise. But all too often, the needs – and existence! – of service users is an afterthought when designing public health campaigns and ensuring equitable access to services.

Even in psychiatric hospitals, physical health can be neglected. NICE has pushed hard to improve this – but one approach would be increasing the number of dual-trained nurses (whose numbers have fallen) with both physical and mental health experience.

A few Trusts have trialled brief physical health training for psychiatric nurses, but these nurses only occasionally visit wards. Dual-trained nurses need expanding across the sector, particularly in old-age wards.
The physical health of service users should be uppermost in the minds of not just doctors, but also nursing workforce planners, commissioners and those designing public health measures in both Public and Third Sectors.

* Dr Mohsin Khan is Vice-Chair of Lib Dem Campaign for Racial Equality. He is also a member of the Federal Policy Committee and Vice-Chair of the Lib Dem Health and Care Association.

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3 Comments

  • Mohsin Khan 3rd Feb '15 - 8:45am

    Updated bio blurb: “Dr Mohsin Khan is an NHS psychiatrist writing in his private capacity. He is also Chair of South Central Policy Committee, Vice-Chair of the Liberal Democrats Mental Health Association, and Secretary of Oxford East Liberal Democrats.”

  • Absolutely agree. With growing mental health problems in society, we need to develop policies that promote wellbeing, not just wealth creation. As a follow up piece to my article on LDV last November, “Should we take the Mental out of Mental Health?”, I am hoping to write an article on prevention soon. Just one example: according to the Nuffield Foundation, the number of young people aged 15-16 with depression nearly doubled between the mid-1980s and the mid-2000s. We have to start asking ourselves why this is happening and what we can do about it.

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