Pressures on the NHS are holding back progress on mental health

Are mental health services getting better or worse? The government repeatedly claims it is pumping money into rapid improvements, while a number of stories in recent days reinforces the impression that services are unravelling in the face of unparalleled demand.

The Education Policy Institute has revealed that more than a quarter of children referred to specialist mental health services in 2016-17 – tens of thousands – were turned away (pdf).

According to figures obtained by Labour MP and mental health campaigner Luciana Berger, for the third year running more than half of clinical commissioning groups (CCGs) are planning to either cut or freeze their mental health budgets, despite government pledges that funding will increase.

Researchers from the University College London (UCL) Institute of Education and the University of Liverpool have shown that 24% of 14-year-old girls and 9% of boys reported experiencing depression. The numbers indicate that mental health problems among girls rise sharply as they enter adolescence, and parents underestimate the problem.

A review of almost 300 case files by children’s charity Barnardo’s has shown that two-thirds of care leavers with mental health needs were not receiving any help from public services. It estimates that one in four care leavers suffer a mental health crisis.

Personal stories brutally expose the consequences of poor care. In August, senior family judge Sir James Munby said the nation would have blood on its hands if an NHS bed could not be found for an acutely suicidal teenage girl. In June, the Times Education Supplement revealed that treatment thresholds for children were so high that a growing number were driven to carry out mock suicide attempts – including taking overdoses – so they would get treated.

Yet around 120,000 more people are expected to receive mental health care in 2016-17 (pdf). There are now access standards and waiting time targets. The government aims to recruit an additional 21,000 mental health workers by 2021.

The Department for Education has committed £1.4bn over five years to improving children’s mental health services. Growing numbers of children are receiving treatment for illnesses such as eating disorders and psychosis.

NHS England’s mental health dashboard is bringing long overdue transparency to mental health services – and of course is exposing problems, such as more than half of CCGs missing their target for access to talking therapies.

The political and media convulsions around mental health are reminiscent of changing attitudes to child protection in recent decades. A hidden, little understood and desperately underestimated problem has now burst into the national consciousness. Claims of improvements are buried by data from the public sector, regulators, charities and academics exposing the scale of the problem, while growing understanding drives up demand for services.

Under intense pressure, the NHS is beset with contradictory signals – record funding and record deficits, growing staff numbers and increasing vacancies, growing productivity and falling performance scores. Now mental health services have never looked worse, just as they begin to show progress on a long journey of improvement.

A big part of the problem, as always, is translating national promises into local action. CCG figures obtained by Berger indicate that many parts of the country still regard mental health as a low priority, while others are hamstrung by the ceaseless financial demands of acute hospitals.

The workforce plan looks desperately optimistic, with little confidence among service providers (pdf) that the NHS will be able to recruit enough psychiatrists and mental health nurses. It depends on everything from creating new roles to changing retirement rules and improving the health of the workforce.

Ringfencing the extra money won’t help. It will simply exacerbate serious financial problems elsewhere in the system.

Mental health services are certainly improving, but parts of the country are falling behind. Parity of esteem with physical health is a myth in many places. Mental health workers are still not accorded the respect they deserve from other professionals.

The financial and workforce pressures across the NHS are a serious impediment to progress. It is fanciful to imagine that major advances in mental healthcare can be sustained without fixing the problems in primary care and hospitals.

• Richard Vize is a public policy commentator and analyst

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