Where is the promised parity for mental health care?

Promises to improve mental health services are likely to feature large in all manifestos, but who is most likely to deliver? Health Secretary Jeremy Hunt told Andrew Marr that the Conservatives would find another 10,000 ‘mental health workers’ but didn’t say what form they would take and whether this was an increase on the current figure, or the figure when the Tories took office (we have 6000 fewer mental health nurses in England since to 2010, and 170 fewer fully trained doctors specialising in psychiatry and psychotherapy). Hunt also refused to say if new money would pay for this, or whether it would be pinched from elsewhere.

Only the Lib Dems have thus far seemed prepared to back up pledges with transparent funding commitments. Some NHS staff will never forgive them for jumping into bed with Cameron and allowing Andrew Lansley’s disastrous Health and Social Care Act, but in now committing themselves to opposition, they can return to being an unelectable think tank. The Lib Dems have pledged an extra penny on income tax to raise £6 billion for the NHS and social care, have proposed a dedicated health and social care tax and an Office for Budget Responsibility for healthcare to link long-term NHS funding decisions to independent assessments. All very sensible and unlikely to happen.

Meanwhile, in parts of London, 20% of mental health nursing posts are unfilled, acutely ill patients are sent hundreds of miles for treatment due to bed shortages, or admitted to prisons. And those with life-long mental illness are having treatment withdrawn. Many trusts now use ‘short term recovery models’ for patients with long term problems. This is resulting in patients who are struggling with severe, and possibly drug-resistant mental illness, being discharged from community mental health teams, and often from consultants. The advice given is to apply for overburdened and underfunded adult social care – even when they do not need social care, and would not qualify for it. Failing that, to turn to the voluntary sector which is also overwhelmed by sheer numbers of people, many of whom need medical care, rather than what the voluntary sector offers – social inclusion, advice and some degree of support. Patients in rural areas are especially disadvantaged.

The alternative is to rely on overworked GPs to manage hugely complex conditions in 10 minutes. Recovery models rarely allow for long-term treatment, which used to be available where needed; even if re-referral by a GP is accepted (by no means always the case) it will be on a time-limited basis. One example of this method of delivering care is Cumbria Partnership NHS Trust. MD has been sent stories from three of their patients. One suffers from an uncommon psychiatric disorder and is unable to take medication following severe and incurable side-effects. She has managed, living alone, for many years with no medication but with regular treatment and support from community psychiatric nurses. Without warning she was informed she was to be discharged as the service no longer offers long term care. Her GP had not been informed that this was to happen. Her discharge letter stated she was at ‘high risk of self-harm and attempted suicide, likely to increase on discharge’. A GP re-referral has been refused and she has been left alone to reflect on her increased suicide risk.

The second patient has Bipolar Disorder with major depressive episodes. She is divorced, lives alone with no close family, but managed her life with long term CPN support. This has been withdrawn and she has to combat the mood swings of her illness with the added stress of a pattern or treatment-discharge-re-referral-treatment-discharge. This has had a seriously detrimental effect on her ability now to manage her life and cope with daily challenges. It would make far more sense to prevent her relapsing in the first place by providing long term support. The third patient has endogenous depression and an unsupportive family. Since discharge from long term care this patient’s illness has become extremely hard to manage. Many patients with mental health problems lose faith in NHS mental health care but are afraid to speak up and so suffer in silence.

There are some excellent examples of good mental health care, and NHS England’s snappy ‘Five Year Forward View for Mental Health – One Year on’ details how hard staff are working to improve the service. But without adequate staffing and funding, the mental health of the workforce itself is at crisis point. Staff simply can’t cope with the ever-rising demands of mental illness. Some patients fully recover but for those with life-long mental illness, a revolving door policy of referral, short term care, discharge, re-referral, short-term care, discharge etc is neither effective nor humane.