Alastair Whitington summarises highlights from the Westminster Health Forum on the next steps for mental health services in England
The Westminster Health Forum, Next steps for mental health services in England—prevention, specialised services and service user engagement, was held on Tuesday 23 July 2019 at The Royal Over-Seas League, London.
Sean Duggan, Chief Executive, Mental Health Network, NHS Confederation, outlined progress in implementing the NHS Long Term Plan for mental health services,1 building on the NHS Five Year Forward View.2 He explained that the mental health strategy was developed through ‘co‑production’—the collaboration of providers, commissioners, different professions, and NHS England—and will be supported by a ring-fenced investment of £2.3 billion (detailed in Claire Murdoch’s presentation) for mental health services for the next 5 years.
Delivery of improvements over the next 10 years will require the commitment of not only those involved in commissioning and providing mental health services, but also those outside of mental health services in fields such as criminal justice, employment, and social care. As with other areas of the health service, high vacancy rates of up to 20% in some specialist services need to be addressed.
… the mental health strategy … will be supported by a ring-fenced investment of £2.3 billion … for the next 5 years.
The importance of engagement with service users
Alison Faulkner, Mental Health Consultant, National Survivor User Network, and Judith Davey, Chief Executive Officer, The Advocacy Project, emphasised the need to engage with service users. Sometimes it is difficult for service users to attend or participate in structured discussion. In addition, organisations representing service users are in need of funding to continue their work. Meaningful engagement with socially deprived and marginalised communities takes time, and requires flexibility to enable inclusiveness. However, governance arrangements for transformation and service delivery must include the user voice.
… governance arrangements for transformation and service delivery must include the user voice.
Initiatives to improve care
Dr Jennifer Kilcoyne, Clinical Director and Deputy Chief Clinical Information Officer, Mersey Care NHS Foundation Trust, outlined work being undertaken in Merseyside to improve the care received by service users. The No Force First initiative, which aimed to reduce restrictive practice in mental health services, led to a reduction in the use of physical restraint of patients by 30% between January and December 2015, and a reduction in assaults on staff by 55% between April 2016 and March 2017.
Dr Kilcoyne also advised that the most common cause of death in men aged under 48 years is suicide. Mersey Care NHS Foundation Trust was a co‑founder of the Zero Suicide Alliance, a collaboration of 150 organisations, including NHS services, councils, transport, the police, and social services, with a role in reducing suicide across the country. Priority areas of work included sharing best practice, promoting a learning culture from past mistakes, raising awareness of mental health among the public and businesses, and developing a suicide‑prevention app.
Mental health in children and young people
Matt Blow, Policy and Government Affairs Manager for the charity YoungMinds, discussed the next steps for child and adolescent mental health services (CAMHS) around early intervention, integration of services, and involving children in their care. One in eight children and young people aged between 5 and 19 years have a diagnosable mental health condition, and many young people experience emotional distress or have subclinical mental health needs. In addition, self-harm rates are very high among young women aged 16 to 24 years. CAMHS referrals have increased by 26% over last 5 years, but at present, only one in three children and young people receive the appropriate NHS care, and waiting lists for access to CAMHS are very long in some areas of the country. To ensure that children and young people can access timely, age-appropriate mental health support, a green paper was published by the Department for Education and the Department for Health and Social Care highlighting the role of schools in promoting mental health.3
Increased funding for and access to CAMHS, alongside improved crisis care provision, are also outlined in the NHS Long Term Plan.1 Finally, the level of support offered by CAMHS is often quite different from that offered by adult mental health services, and many young people are lost at this transition. The NHS Long Term Plan aims to combat this by extending CAMHS to young people aged up to 25 years.1
… the level of support offered by CAMHS is often quite different from that offered by adult mental health services, and many young people are lost at this transition.
The future of mental health services in England
Claire Murdoch, National Mental Health Director, NHS England and Chief Executive, Central and North West London NHS Foundation Trust, provided an overview of the way mental health services have improved and the challenges that remain ahead. Although society is changing and people are much more open about mental health issues, greater emphasis on prevention, self-care, and education is necessary to empower patients to take charge of their mental health. Simultaneously, referrals between primary and secondary care, and collaboration with services with a significant impact on service users, such as third-sector organisations, volunteer groups, housing support services, and employers, are needed to provide integrated, holistic care to service users.
A funding settlement to the NHS of £20.5 billion was announced by the Government in 2018,4 but this did not include funding for vital social care services, or for recruitment and training of the workforce. Last year, a consultation took place to determine how to distribute the funding. At the end of the process, £2.3 billion was earmarked for mental health, split between three areas of service development:
- children and young people
- adults with moderate-to-severe mental illness
- perinatal mental health.
In terms of CAMHS, the funding will help an extra 345,000 children to be seen every year by 2023/24, doubling the number of children and young people currently seen.
A funding settlement … of £20.5 billion was announced … in 2018, but this did not include funding for vital social care services, or for recruitment and training
CAMHS services will also become available in schools to enable timely support. In adults, the transition to adult healthcare from CAMHS, community healthcare, and support services for those wishing to enter employment will be improved. Crisis care, addiction support, and suicide-prevention initiatives will also benefit from this funding. In this way, the NHS Long Term Plan1 will build upon the NHS Five Year Forward View2 to achieve better outcomes in mental health.
- NHS. Mental health. www.longtermplan.nhs.uk/areas-of-work/mental-health/ (accessed 28 August 2019).
- NHS England. NHS five year forward view. www.england.nhs.uk/five-year-forward-view/ (accessed 28 August 2019).
- HM Government. Transforming children and young people’s mental health provision: a green paper. London: HM Government, 2017. Available at: www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper
- HM Government. Prime Minister sets out 5-year NHS funding plan. www.gov.uk/government/news/prime-minister-sets-out-5-year-nhs-funding-plan (accessed 28 August 2019).