It is a little over half a century since the American physician Thomas Kuhn first popularised the term “paradigm shift” as a way of describing a revolutionary break in the ideas, practices and protocols governing scientific endeavour. Five years ago, when the government first legislated for “parity of esteem” between mental and physical health services across the NHS, we were reflecting a similar need to cast aside old assumptions and reimagine the way we plan for and prioritise mental health.
Since then, the NHS has embarked on one of the most ambitious plans for transforming and expanding access to mental health services anywhere in Europe, driven by a £1.4bn real-terms rise in funding compared to three years ago.
Of course, there remain many challenges in the delivery of mental health services and the services available to young people in particular are in need of major reform. But any fair assessment would also recognise today there are 120,000 more people receiving specialist care every year compared to just three years ago, including over 20,000 more children and young people.
At the heart of our strategy is to reduce the long waits for care which perhaps more than anything symbolise that there is still a way to go before we can truly claim “parity of esteem.” So two years ago we became the first country in the world to introduce waiting time standards for talking therapies and early intervention in psychosis.
And last year’s introduction of a new waiting time standard for eating disorders means that two thirds of children with anorexia or bulimia are now starting urgent treatment within a week – an achievement that has been described by the Royal College of Psychiatrists as “phenomenal”.
Others have started noticing. In July, the New York Times described our plans as “the world’s most ambitious effort to treat depression, anxiety and other common mental illnesses”.
Our flagship Improving Access to Psychological Therapies (IAPT) programme has inspired a similar initiative in Sweden. And suicide rates in England remain low by European standards as well as being the lowest in the UK.
So why, given all of this progress, does it still feel like mental health is continuing to fall behind? Why, in many commentators’ eyes, does the song remain the same? The answer is that the positive changes have to be set against the extraordinary rises in demand for mental health services.
Every day there are 1,400 more people accessing mental health services today compared to 2010 – but the growth in supply has still struggled to match the growth in demand. This extra demand is being met by services that continue to bear the effects of decades of underinvestment, with a clinical workforce that hasn’t been granted the same prestige and profile as those in other medical disciplines. Which means, in short, there is an enormous amount of work still to deliver the step change in service provision that we all want to see.
You need to start with workforce requirements. So over the summer, we set out a new workforce plan to create 21,000 new posts across the NHS. This amounts to one of the biggest expansions of mental health workforce across Europe – and an essential pre-condition for meeting the increased demand for mental health support.
There will be significant rises in the number of therapists, nurses and consultants working across child and adolescent mental health, adult talking therapies and crisis care settings, in particular – and key to this will be transforming the image of mental health as a profession, so that we can encourage more doctors, nurses and other health professionals to join.
Later this year, meanwhile, there will be a major Green Paper setting out how we will transform the quality of mental health support available to children and young people by strengthening the links between school, community and clinical-based services.
And a historic review of the Mental Health Act, led by the respected psychiatrist Professor Sir Simon Wessely, will reconfigure how we treat people with acute psychiatric disorders, and begin a much-needed public debate about issues such as detention and over-representation of certain groups in in-patient care.
At the heart of all this is a commitment to maintain a healthy flow of investment into mental health services. Last year, a record £11.6bn was spent on mental health, and by 2020 there will be an additional £1bn a year on top of that.
But not all of the answers come from government. If we want to build a more mentally resilient society, then there is only so much that can be achieved by public services. Good mental health depends upon what happens in the wider community and particularly the workplace – which is why we have asked Mind’s CEO Paul Farmer and the ex-HBOS chair Dennis Stevenson to lead a review of employer mental health.
It also depends upon the media and advertising industries operating with restraint and sensitivity in how they portray mental illness and related issues around body image, for example – and it is particularly important that major social media providers step up their efforts to confront the ambiguous role that technology plays in shaping the nation’s mental health.
We must also look at our own ability as individuals to change the story. One of the great advances of the decade is that people from all backgrounds – from establishment figures such as Prince Harry, to sporting icons such as Dame Kelly Holmes – are speaking out about their own experience of mental illness.
We must capitalise on this to give more people the skills throughout their lives to cope better with personal adversity and crucially, to recognise the signs of mental illness in others and help them through it.
Mental health has become one of the defining social issues of our time. And even as the NHS embarks on a huge expansion of services, we should acknowledge that perhaps the biggest opportunity is within us all: to become more aware, more knowledgeable and more equipped to support others.
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