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World Mental Health Day on October 10th took the theme of good mental health as a universal human right.
In the UK, despite over 75 years of universal healthcare via the NHS, attaining good mental health as a human right is getting ever harder to achieve following over a decade of underfunding and policies that have exacerbated the root causes of poor mental health, such as poverty. Good mental health is still too often dependent on the circumstances you are born into and your ethnicity.
Once diagnosed, treatment can be difficult to access, with long waiting lists, and not of a high enough standard.
Children from the poorest families are four times as likely to have a mental health problem by the age of 11 than the wealthiest children.
Black people in the UK are four times more likely to be sectioned under the Mental Health Act than white people. And people with severe mental illness face a 20-year shorter life expectancy than average in the UK.
The report – A Mentally Healthier Nation – published by the Centre for Mental Health on behalf of over 30 national charities, representing many thousands of people in the UK, calls for a long-term mental health plan that protects people’s mental health, reduces mental health inequalities, and improves mental health services nationwide.
The report asks for more investment in better and more equitable mental health services for treatment, but also for action to tackle the root causes of much poor mental health – poverty, racial injustice, and issues within the benefits and justice systems.
Back in February 2023, the government broke a promise to produce a new strategy focused on mental health and instead included it within a broader Major Conditions Strategy, along with chronic physical conditions, such as cancer and respiratory disease. At the time a coalition of charities in the mental health sector were concerned that this move would mean there will be no long-term mental health strategy to tackle the current crisis.
Centre for Mental Health chief executive Andy Bell said:
“The public’s mental health has deteriorated since the start of this decade. More and more people are seeking help for their mental health. Even with recent growth in NHS mental health services, care is being rationed because the system is overwhelmed. We have to turn this around. A comprehensive cross-government plan could help to improve the nation’s mental health while also boosting mental health services. It could tackle the causes of distress to protect people’s mental health, while also ensuring people living with a mental health difficulty are treated fairly in society. This cannot wait. We call on the Government to act now and on all political parties at the next General Election to commit to a long-term plan to create better mental health for all.”
And the country does have a crisis on its hands with NHS mental health services unable to cope with the level of help needed.
MIND reports there are currently 1.9 million people waiting for mental health treatment, with millions more struggling but not meeting the right clinical thresholds for treatment.
According to an analysis by the BMA, even before the COVID-19 pandemic, rates of mental illness in England had been slowly and steadily rising, from 17.5% in 2000 to 18.9% in 2014. But data due out in 2023/24 is expected to show a big increase.
The latest evidence for children and young people suggests that rates of mental illness may be growing at a faster rate than amongst adults. Between 2017 and 2022, rates of probable mental disorder increased from around 1 in 8 young people aged 7-16 to more than 1 in 6. For those aged 17-19, rates increased from 1 in 10 to 1 in 4.
The increase puts a major strain on services. The percentage of adults aged 16-74 with a common mental disorder, who were accessing mental health treatment has risen from 23.1% in 2000 to 39.4% in 2014.
Mental health services in England received a record 4.6 million referrals during 2022 (up 22% from 2019), with the number of people in contact with mental health services steadily rising.
The effect of underfunding by successive governments has been a reduction in hospital beds and insufficient community services, and the knock-on effect is that A&E visits have increased, with waits of up to 80 hours for some mental health patients. Health leaders warn that mental health services are “overwhelmed and at breaking point just as the NHS attempts to gear up for a very difficult winter.” Patients are not found suitable care, instead they are admitted into inappropriate acute hospital beds meant for physically ill patients.
The years of underfunding and resulting lack of capacity (beds and staff) in the NHS mental health services, means that it has become one of the most heavily-privatised services within the NHS. The NHS contracts out its work to private companies relying on them for hundreds of beds for patients.
According to NHS data, approximately 17% of people of all ages who were in contact with secondary mental health services between 2021 and 2022 were seen by a non-NHS provider. However, within inpatient services, the figure is higher, with market analysts Laing & Buisson estimating that over 30% of NHS mental health hospital capacity is now supplied by the private sector. These firms provide over half the NHS inpatient beds for children and teenagers with mental health problems, and almost all of the secure beds for adults.
The use of these private hospitals continues, as the NHS has no other option, despite repeated reports of poor and unsafe standards of care.
MIND, the UK’s largest mental health charity, has published previously unseen data from the Care Quality Commission (CQC), that shows the full scale of the crisis in mental healthcare services, with staff reporting 17,340 serious incidents in just 12 months.
The figures show mental healthcare staff across England reported an incident two times every hour in the last year, where people are treated for issues including self-harm, eating disorders and psychosis. Incidents included life-threatening injuries to patients and abuse.
Of the 17,340 serious incidents reported in hospital, community and residential mental healthcare settings between the beginning of April 2022 and the same time this year, 15,254 reported incidents related to care in private community and hospital settings, nearly 88%, and 2,086 related to NHS community and residential places of care.
Just a few weeks ago Cygnet Healthcare, a leading private provider of mental health services, was ordered to pay more than £1.53m after pleading guilty in a criminal prosecution brought by the CQC over an inpatient’s death.
The NHS will continue to have to rely on these private companies, however as current funding is nowhere near sufficient to improve capacity within the NHS.
Analysis by the BMA has found that funding for mental health services is far lower than it needs to be. If the government genuinely wants to meet mental health needs, the BMA notes, it must protect the funding from inflation and double the money from the £2.3bn currently promised for mental health services to £5.2bn. However, the BMA also calls for an increase in investment in primary care, public mental health, mental health research, and an increase in inpatient mental health beds.
Funding of mental health services needs to be fair, according to the report – A Mentally Healthier Nation – and the Government needs to make a long-term commitment to fund NHS mental health services and local authority social care at levels that enable them to expand the workforce sufficiently to meet rising levels of need. Plus sufficient resources for new access and waiting time standards to be implemented and achieved, mental health care in schools to be expanded, and the mental health estate to be modernised.
Links to poverty and discrimination
It is not just about NHS funding, however, in line with recent reports by public health organisations, A Mentally Healthier Nation calls for action on social determinants of health (like poverty and discrimination), with minimum income guarantees and reform of sick pay, and environmental factors (including housing and pollution), with an acceleration of a switch to cleaner energy, improved public transport, access to green space, and investing in public health infrastructure. It echoes the Association of Directors of Public Health’s call for a new Child Poverty Act to eradicate child poverty by 2030 and a restoration of the public health grant to its 2015 level.
Finally, a major issue in mental health is the role played by discrimination and disadvantage in our society. Certain groups have much higher rates of mental health problems plus people with mental health difficulties are often treated less well in society, including in the social security and justice systems.
A briefing from the Centre for Mental Health and King’s College London published on World Mental Health day discusses how parents’ experiences of racism affects their children’s mental health and vice versa. The briefing – A constant battle – finds that racism has “far-reaching impacts on parents, their children, and the relationships between them” and that “there is clear evidence that children of parents experiencing mental health difficulties are at a higher risk of experiencing those difficulties as well.”
Reform is also needed to remove the disadvantage those that suffer from mental health disorders experience. People with severe mental health conditions need to get fair access to health checks, vaccinations and all NHS services, so they do not die 20 years too soon. Added to this must be changes in how people with mental health conditions are treated in the social security system and the justice system.
As the report notes:
“Addressing these injustices must be at the heart of creating a mentally healthier nation.”