Mental health trusts have less money to spend on patient care than they did five years ago, according to a damning new analysis from the Royal College of Psychiatrists. This directly contradicts the Government’s repeated proclamations that mental health funding is at record levels, but will come as no surprise to patients, carers and mental health professionals.
The Royal College of Psychiatrists’ analysis compared mental health trusts’ income in 2011-12 to 2016-17, controlling for inflation. In England, 62 per cent of mental health trusts (34 out of 55) reported a lower income than five years ago. A similar picture was found in Wales, Scotland and Northern Ireland. While – after the 2012 Health and Social Care Act – these figures do not reflect the totality of mental health funding, the picture is bleak.
Mental health has always been the poor relative to physical health, seriously underfunded in the NHS. At a time when this discrepancy was supposed to be redressed, not only are mental health trusts receiving less funding, but psychiatric services are also facing massive increases in demand. This increase stems partly from the level of suffering caused by austerity measures and a society in free-fall, and partly from an increased tendency to view one’s problems through a mental health lens, meaning epidemic numbers of people are seeking help from mental health services.
This rush of interest in mental health has allowed the Government to make various smoke and mirror manoeuvres to appear to be at the forefront of change, while decimating funding for those most in need. Throwing £200,000 at schools to introduce mental health first aid makes for great headlines, but distracts from the more pressing need to adequately fund child and adolescent mental health services. Doubling the number of employment advisors in NHS Improving Access to Psychological Therapies services may appear a useful way to encourage people back to work, but it masks the fact that it is increasingly difficult to access life-saving therapy for other goals such as reducing symptoms or improving quality of life, especially for those with moderate to complex needs.
The pressure to appear to be doing better, with less funding in real terms, is having a devastating effect on patients, carers and staff. I am told, time and time again, of patients with complex needs discharged suddenly from community mental health teams without an adequate package of care after 10, 20 or 50 years of support. Under huge pressure to appear to be progressive, ideas such as that of recovery are put forward, while principles such as continuity of care from the same mental health professional or rehabilitation service are dismissed, despite being the bedrock of mental health care for decades.
Funding is now skewed to services for those with common mental health conditions, where large numbers of people can be seen, treated and discharged quickly, as opposed to prioritising those most in need (whose treatment costs more). Even in services like Improving Access to Psychological Therapies that serve those with milder mental health problems, therapists are intimidated into seeing patients for less than the number of sessions the evidence-base requires to mask unrealistic service contracts. These issues are producing record levels of burnout across NHS mental health services in staff members. Indeed the task for staff has now become performing, rather than providing care, a reversal that staff fight against each and every day.
The real casualties of the funding cuts, though, are not staff but those in deep pain – a pain often caused by a society that has let them down and looked away. The same responses come up repeatedly whenever a new government initiative is announced. Where exactly is it safe to talk when one’s community mental health team is discharging patients at the rate of knots? When people wait years and years for evidence-based therapy? When psychiatric beds are now often at 100 per cent occupancy, with patients treated hundreds of miles from home? When rates of self-harm and suicide are at a record high? When patients have to phone the Samaritans on acute wards because staff are too overstretched or undertrained to actually listen?
The Royal College of Psychiatrists’ report slices through the rhetoric-reality gap around mental health funding like a hot knife through butter, demanding ring-fenced money after five years of real-world cuts. It is time for the Government to actualise its own rhetoric, and adequately invest in mental health care.
Dr Jay Watts is a consultant clinical psychologist and psychotherapist, and honorary senior research fellow at Queen Mary, University of London
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