How can prevention work in mental health services without necessary staffing and resources?

One of the main tenants of Sajid Javid’s speech was prevention. Reflecting on the stark last two years under the shadow of the Covid-19 pandemic, he mentioned in his speech how “we lack resilience”. He commented on the “underlying health of our population” and noted that in the case of possible future “risks and shocks”, “we can’t honestly say that we’re well prepared to face them.”

To fight this, Javid said, we must “shift to a new mode of operating”, a mode he says will help the whole population to stay healthy, and isn’t simply reactive to those who come seeking help or treatment. This approach, one is forced to assume, encapsulates mental health. Especially because the mental health crisis in the wake of the pandemic has put one of the biggest strains on the NHS we have ever seen.

However, Javid did not specifically mention the mental health of the nation nor mental health services, instead electing to focus on physiological conditions such as cardiovascular disease.

When referencing to the NHS Long Term Plan, the Covid backlog and the proposed ‘Road to Recovery’, aside from vague suggestions of “as we look at every part of the NHS”, again mental health services are missing from the speech.

So, why are mental health services not being integrated into this preventative approach? For a public health approach to be truly preventative, it must be holistic: body and mind.

“For the 1.4 million people waiting for mental health treatment, the Health Secretary’s speech will be very disappointing. Waiting times for treatment are unacceptable. Urgent action is needed now.” Dr Adrian James, President of Royal College of Psychiatrists.

Primary care and mental health

A large part of the preventative care David spoke about in his speech was through the idea of empowering primary care services, especially GPs, to do more preventative work. In the section concluding prevention, David briefly mentions that preventable diseases “starting with cardiovascular disease” but, in time, “diabetes, cancer, and poor mental health” will be helped and targeted by preventative work within primary care.

However, it is with specialist NHS mental health services such as CAMHS, eating disorder services, complex trauma services and IAPT services where preventative work in mental health should be focused, none of which are mentioned in the speech. Although GPs are often most people’s first port of call when experiencing mental distress, inevitably a person will always be referred on to a specialist mental health service.

Personalisation in mental health care

Another of the main tenants Javid refers to extensively is the idea of personalisation. Which is of course, every patient’s ideal. Services that are generalised to a ‘one size fits all’ approach, especially within mental health, in attempting to be right for everyone, alienate and fail many people.

A good example of this is the NHS’s chosen therapy, Cognitive Behavioural Therapy (CBT), which is often delivered online when you first access a service such as IAPT. Although helpful for those experiencing a short-term bout of depression, for those with pre-existing long-term mental health conditions it often fails to get to the root of repeated dips in mental health.

One key way Javid talked about bringing this vision of personalised care to life, was through a new ‘Right to Choose’. Part of this will be through patients being able to decide whether they want to receive treatment from a “Trust next door” or farther away, so that long waiting times can be reduced. It is also reliant on “more active discussions between professionals and patients”.

Again, one can vaguely see and understand how this approach might be applied to mental health services, however they work in an entirely different way to general healthcare, and as such need a tailored approach within reform; unfortunately, this section on personalised care, also fails to include any action specifically designed for mental health services.

Head of Policy, Campaigns and Public Affairs at Mind, Vicki Nash has spoken about Sajid Javid’s speech. Speaking to the general aims the speech addresses, Nash said:

“We welcome the Secretary of State for Health and Social Care’s ambition to give people in England greater choice and control in their care. After years of chronic underfunding and a lack of fundamental reform, many find it impossible to get the support they need for their mental health, so today’s announcement is a step in the right direction.”

She also mentioned that they are hoping this reform will improve the 1.5 million people facing a long waiting list for mental health treatment, by expanding personal health care budgets.

She continued: “However, Mind and others across the mental health sector will need to work closely with the Department for Health and Social Care to make sure mental health remains at the forefront of this strategy, on an equal footing to physical health. It is also still essential, if people are to get the help they need, that mental health receives the proper funding it desperately requires, and that the Secretary of State urgently makes good on his commitment to implement a cross-Government strategy for mental health that recognises the social factors that can negatively affect our mental wellbeing, such as debt, unemployment, problems with benefits and housing.”

Here, Nash brings her statement back to where David’s speech was sadly lacking. Similarly, the Royal College of Psychiatrists’ (RcPsych) President, Dr Adrian James, highlighted the uneven treatment that mental health services got in the speech when compared to physical health services.

“Why was mental health largely forgotten, yet again, in the Health Secretary’s speech on healthcare reform?...We need a fully-funded mental health recovery plan to respond to the mental health crisis to expand services to meet unprecedented demand, train more psychiatrists, and replace crumbling facilities across the country.”

Reflecting on how workforce issues with NHS mental health services has, again, not been addressed, Dr James said:

“The nation’s mental health relies on long-term workforce planning. We look forward to engaging with Government to quickly progress a proper long-term workforce plan. But a plan without funding will not address chronic workforce shortages.”

As RcPsych mentioned in their statement, the upcoming cross-government strategy on mental health will hopefully raise all the issues that NHS mental health services are currently facing, as well as addressing the missed opportunities to include mental health services in this push for healthcare reform.