What next for mental health? It’s time to walk the talk

The last decade has seen immense progress on mental health, with pervasive stigma being challenged more openly and years of underfunding starting to be corrected. Services too were beginning to make real progress, with the solid foundations that the Five Year Forward View and NHS Long Term Plan laid.

But the pandemic has led to an enormous increase in demand on mental health services, and we know that the waiting list has now topped 1.5 million people. Mental health services are seeing more patients than ever before, but they are still far from able to keep up with the number of referrals now being made.

While Ministers have spoken at length about the mental health impact of the pandemic, last month’s spending review came as a disappointment. Talk comes cheap, and patients and those working on the frontline are concerned that they have been forgotten once again. And they’re quite right. The delivery of the NHS Long Term Plan commitments is now at risk as we face the prospect of undoing years of hard-won progress. As the system faces a new challenge, we cannot let leaders fall back into dangerous old habits of deprioritising or forgetting mental health altogether.

So, what next? First, NHS leaders will need to offer some reassurance that the as yet-unallocated elements of the new funding will be used to bolster mental health services. Announcements earlier this Autumn about new commitments to tackle the backlog and increase NHS budgets through the new health and care levy provided little insight on how these settlements will translate to mental health. Mental health has to be seen as a core part of the NHS’ COVID-19 response and recovery. Not doing so would represent a failure to deliver parity of esteem, after decades of grand promises to end the historical neglect of mental health. The Mental Health Investment Standard was introduced precisely because NHS leaders recognised that mental health was forgotten about far too often and there needed to be clear targets and national oversight to drive progress. It would be entirely counterintuitive to circumnavigate this vital mechanism during the biggest mental health crisis this country has faced since the second world war.

The spotlight will also be on the Secretary of State. Mr Javid has promised a new strategy on mental health. His recognition of the immense challenges faced is very welcome, but he must also recognise that it will make little difference if not backed up with an appropriate level of investment. Cross-government collaboration and investment in prevention and recovery will be vital. But reinforcing core NHS services struggling to keep up with unprecedented demand and workforce shortages is equally so. With the Mental Health Act Review and the Dame Carol Black Report, we have seen two government commissioned reports call for urgent investment, but no additional funding has been made available to date. He will need to work across Whitehall to ensure all Government Departments play their role to improve the nation’s mental health and crucially, make the case for investment to the Treasury.

In the short term, the Health and Care Bill currently passing through parliament offers some real opportunity to drive progress on parity, inequalities, and workforce. As does the next tranche of new hospital construction funding, set to be announced by Spring. The dilapidated mental health estate is well publicised — it stalls patients’ recovery and doesn’t meet current levels of need. It’s high time for Mr Javid to correct for the flagship health infrastructure plan’s neglect of mental health thus far.

With a new set of mental health standards due to be announced any minute, we can’t underestimate the cost of not getting this right. The Royal College of Psychiatrists has long supported the introduction of rigorous access standards in mental health to drive investment and progress towards parity of esteem. But clinicians are at their wits end, worried about another rod with which to reprimand and demand more with less. The government can’t continue promising patients more, while failing to support the delivery of those promises with appropriate resourcing, a deliverable plan to address workforce shortages and achievable timescales.

Doctors and patients alike know how urgently investment in mental health is needed, as they hear ministers and health system leaders promise progress. Colleagues working in acute and primary care will speak to the importance of responsive and effective mental health services as more patients with complex needs appear in their own services. Bolstering the NHS and levelling up requires additional investment in both physical and mental health, and the whole sector will need to pull together to ensure we stay on course. The spending review was a missed opportunity – we cannot miss another.