This morning saw the new health mission’s announcement from one of the UK’s largest political parties. Sir Keir Starmer spoke about Labour’s plan to build an NHS Fit for the Future at an event in Essex. The policies that Starmer announced in his speech focused on reforming the NHS through training, new technology, prevention, and early intervention and community care. In particular, Starmer set targets for three of the ‘biggest killers’: cancer, cardiovascular disease and suicide.
But what were the key takeaways? What are Labour’s plans to improve mental health care and have they grasped the importance of high-quality research when it comes to providing evidence-based care?
Why is this important?
Here in the UK there has been an undeniable decline in the nation’s mental health over the last decade.
The prevalence of mental health disorders in children has risen dramatically to 1 in 6. That’s 5 children in every classroom. Referrals to Children and Adolescent Mental Health Services (CAMHS) has more than doubled since 2019, with 733,000 children and young people in contact with mental health services in 2021/22.
Among adults, mental illness is also on the rise, with suicide as the leading cause of death in people aged under 34. Despite this, waiting lists for therapies are long. 1.81 million people were referred for talking therapies in 2021/22 with some having to wait for up to 229 days before being seen.
After a decline in the number of suicides since the early 1980’s, the figures have been steadily increasing since austerity policies were introduced in 2010.
More recently the COVID-19 pandemic and the cost-of-living crisis have both impacted the nation’s mental health. Groups who were already at the highest risk – people on low incomes, people who live in insecure housing and people who are marginalised or discriminated against, have seen a disproportionate impact on their mental health.
More than £2 billion is spent annually on social care for people with mental health problems, with the wider cost being estimated at over £117.9 billion across the UK through lost productivity and informal care costs. Mental health problems also add considerably to education, criminal and justice systems workloads.
While the individual, societal and economic burden is the consequence of mental health problems, there has been little investment in preventing these problems in the first place.
“One of the big issues in recent years in the field has been the rise in levels of self-harm, suicide attempts and suicide in young people,” says Professor Ann John from Swansea University and DATAMIND.
“It is estimated that for every person dying by suicide, at least six others experience intense grief. If this figure is correct at least 30,000 people are severely affected by suicide annually in the UK.
Most suicide deaths occur amongst people who are not in contact with mental health services, but, in the week before their death, almost a third of people who die by suicide were in contact with their GP….so the focus on primary care is important.
If the policies and changes we make are going to make a difference then they must be evidence-based. We know certain talking therapies can reduce the risk of repeat self-harm, improving access to them is key but practice and research in this area is underfunded.
Good quality suicide mortality data are essential to inform and evaluate suicide prevention strategies, as are consistent and reliable data relating to help-seeking and pathways of care from helplines to assessment to admissions.”
Is this decline surprising?
Years of austerity and lack of investment in mental health research and services have resulted in the knock-on effect we are seeing now, particularly in children. The current cost-of-living crisis is a public health emergency leaving many families having to choose between heating and eating.
Spending by local authorities on early intervention services for children and young people was cut by 50% between 2011 and 2021. These cuts have led to a generation of children growing up without adequate access to help when they first begin to show symptoms of mental illness or mental distress. Without early intervention, these can manifest into full blown mental disorders requiring much more expensive late interventions or even crisis interventions.
“As the incidence of mental health conditions continues to rise in children and adolescents, and these experiences can escalate and entrench over time without appropriate help, the need for early intervention in mental health care is vital. When working with children, play and arts in therapy offer the opportunity for symbolic expression through vivid and shifting metaphor. This can make all the difference to a child who is struggling to, or is afraid of, explicitly communicating their experiences. Access to earlier, effective and expert mental health interventions in the community and schools is central to addressing parity between physical and mental health and supporting the health of future generations.”
Sophia O’Neill, Research Writer Play Therapy UK, www.ChildMentalHealthCharter.com.
Lack of investment in the NHS has led not just to inadequate services. Poor working conditions and stagnating wages have led to over 10% of nursing roles being left vacant and even more shockingly, 18% of mental health nursing roles being left unfilled.
What MQ and many others working within mental health felt was required was a long-term approach to mental health investment from the government. Unfortunately, the long-anticipated 10-year mental health plan was scrapped in January this year and whilst a new ‘Major conditions strategy’ was announced as it’s replacement, the call for evidence for this has only just opened. Meaning there will be further delays before this is implemented.
But does today’s announcement address these issues?
In his speech today, Starmer recognised that more needs to be done to reduce suicide, the biggest cause of death in under 34’s. And whilst this recognition of the problem was welcomed, it remains to be seen whether any of Labours new policies will lead to real change.
The policies announced include:
Expanding the NHS workforce.
In particular, by recruiting 8500 mental health staff to cut waiting lists and provide access to talking therapies so that people can access help before they reach crisis. This focus on early intervention is welcomed, although we mustn’t allow any further decoupling of physical and mental health treatment. As identified in MQ’s recent Gone Too Soon paper, we should be actively reducing silos in healthcare, not building them into the fabric of the NHS.
They also plan to create community mental health hubs for children and young people with open access, as well as introduce professional support in every school.
This ‘prevention is better than cure’ approach rightly focuses on the need for an increase of preventative action and early interventions across the NHS.
Investment in new technology and life sciences to help improve the services delivered and their accessibility.
Harnessing data science, digital interventions and progress in technology has long been a focus of MQ so we welcome this approach.
The final key take away is a commitment to research.
Labour has pledged to make all health research, not just mental health, more competitive, more efficient and more accessible by embedding clinical trials within the NHS and increasing training within the workforce so that more research can be conducted in primary care settings.
Preventing people from being gone too soon
Recently MQ produced a new paper, published in the Lancet, which made 18 recommendations for reducing suicide and premature mortality among people with mental illnesses or with mental distress.
These recommendations included eliminating silos in health care and improving access, so that physical and mental health conditions could be treated holistically. Improving the screening and early identification of health problems, including early intervention measures. The paper also recommended more investment in mental health, including improving the training and capacity of the mental health workforce.
“I am delighted to see this prioritisation of suicide prevention,” says Professor Rory O’Connor, Director of the Suicidal Behaviour Research Laboratory at Glasgow University and co-lead author on the Gone Too Soon paper.
“Loss of any life to suicide is devastating but when young lives are cut short it seems especially heartbreaking. Too many young people are falling through the net; not enough is being done to protect the most vulnerable in society, so I welcome Labour’s focus on early intervention for children and young people.
Labour’s focus on primary care is also timely – and consistent with our call to action in Gone Too Soon. I hope they deliver more integration of healthcare delivery such that compassionate mental health care is delivered in general practices and that continuity of care is prioritised such that everyone gets the support they need it when they need it especially when in mental health crisis.”
MQ’s CEO Lea Milligan speaking to Keir Starmer after his speech.
Suicide is a difficult subject. if you feel like you need support then please visit our Get Help page for a list of organisation who can help.
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