The rise in children and young people with mental health problems makes this week’s announcement of a new network of community clinics in England particularly welcome. A&E departments have recorded an increase in difficult-to-manage symptoms including aggression and hallucinations. New specialist walk-in mental health services should take some of the pressure off. The bringing forward of a deadline for ending out-of-area acute placements, and a pledge to reduce waiting times for children, are also positive.
Declining mental health was among the key themes of Alan Milburn’s interim report on young people and work. It is a big factor behind the rise in claims for illness and disability benefits. Children’s anxiety and other psychological difficulties are also among the many challenges facing schools. Recent years have seen steep rises in emotionally based school avoidance, as well as in autism and neurodiversity.
But while concerns about mental health are shared across government, they have not been prominent in policies put forward by the department where you might expect them to feature most: health. Partly, that is due to other pressing issues including social care and enormous hospital waiting-lists. Partly, it is because ministers have been waiting for a review led by Prof Peter Fonagy into mental health conditions, ADHD and autism. Its recommendations are expected soon, and will feed into an upcoming strategy. In her first interview with the Guardian as health secretary, Yvette Cooper focused on maternity services and the need to prepare for future heatwaves. But the commitment to expand community mental health points to a welcome recognition that this should be an area of focus too.
Parity between mental and physical healthcare became a policy goal in 2011, with the launch of a No Health Without Mental Health initiative. Efforts to stress the importance of psychological wellbeing, and its interconnectedness with physical health, long predate that. The commitment made in last year’s 10-year health strategy to shift resources gradually away from acute hospitals and towards community services would seem to dovetail with this balanced, holistic outlook. But one year on from its launch, experts including Siva Anandaciva, of the King’s Fund, have raised doubts about “whether the NHS really will be committed to the fundamental shift away from hospital care that the health plan proposed”. This week it was revealed that one mental health trust, in east London, is planning to make £230m of cuts. Mental health is not ringfenced within NHS budgets, and as a proportion of overall health spending fell from 9.0% of the total in 2023/24 to 8.78% in 2024/25.
The reasons for the lower priority placed on mental health, compared with physical diseases and injuries, are complex, and reflect cultural as well as structural factors to do with the way that the NHS is organised. Socioeconomic determinants of poor mental health including incomes, work and housing, are outside Ms Cooper’s remit. But the disparities in access to treatment are irrational and unjust. Severe depression and anxiety are highly debilitating conditions. Expectations about waiting times and treatment options need to be clarified.
There are no easy fixes in a system as complicated as the NHS. It is not clear where the new neighbourhood centres fit in existing plans – or who will staff them. But providing that further details are produced in due course, the shift in focus that they signal should be supported.
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