Mental health: Promises, promises, promises....
by Sarima Mbata - July 2021
2019 - the year when the UK's political parties hastily prepared their shiny new manifestos, promising and launching a series of dramatic, eye-catching commitments. We, the electorate, cast our votes in the General Election with immense hope in our hearts that the policies we endorsed at the ballot box would come to fruition and the government would be one that we could truly believe in.
2021 - there remains a sizable gap between rhetoric and reality.
In January 2021, a survey conducted by Young Minds examined the impact of the pandemic on 2,438 young people aged 13-25. 67% of respondents believe the pandemic will have a long-term effect on their mental health. This is not just a UK phenomenon. A 2020 OECD policy response to coronavirus found 11% of 16-39 year olds reported having some form of depression from July 2019 to March 2020, this number has surged to 31% in June 2020.
In addition, it is not affecting all groups equally. NHS Digital’s annual statistics on how many people have been detained under the Mental Health Act in England shows that during 2019-20 there were 50,893 new detentions and highlighted a worrying trend that black and ethnic minority groups continue to be over-represented. Known rates for the detention of the ‘Black or Black British’ group (321.7 detentions per 100,000 population) were over four times those of the ‘White’ group (73.4 per 100,000 population). Seeing these horrifying statistics is yet another wake up call about the urgent need to reform mental health services amongst young people in the UK.
In 2019, the Conservative Party set out a series of mental health commitments towards young people in their manifesto, which include:
- Within the first three months of a Conservative Government, the NHS Long-Term Plan, which includes commitments on young people’s mental health would be made law.
- To treat mental health with the same urgency as physical health. This means introducing legislation so that patients suffering from mental health conditions have greater control over their treatment and receive the dignity and respect they deserve.
- To help teachers tackle bullying, including homophobic bullying.
- Introduce legislation to make the UK “the safest place in the world to be online” - protecting children from online abuse and harms.
THE NHS LONG TERM PLAN
The NHS Long-Term Plan was published a month into Conservative power (7 January 2019). In the Long-Term Plan the Conservative Government reasserted their commitment to mental health services. Beginning with a ring-fenced addition of £2.3 billion for mental health services by 2023/24. This led to the NHS Funding Bill being introduced to Parliament on 15th of January, thereby meeting the manifesto commitment for this to be on the statute book within 3-months. In contrast, in the March 2020 Budget an additional 6 billion pounds in NHS funding was announced, of which 5.4 billion pounds is new funding to help with the government manifesto commitments, but it’s unclear from the budget documents how the money will be distributed and how much of this will be ring-fenced for mental health.
The plan commits to a significant expansion of services for children and young people. Other commitments include:
- increasing the amount of mental health funding being spent for children and young people
- promising that all young people who need specialist care can access it by 2028/29
- improving access to talking therapies for people with anxiety,depression and other common mental health problems
- a promise that everyone will be able to access timely 24/7 mental health crisis support through NHS 111 by 2028/29
- an increase in the provision of alternative forms of crisis support, such as sanctuaries and crisis cafes; and
- more mental health support in the community for people with severe mental health problems, for example, increased access to psychological therapies and employment support.
The plan raises a number of big unanswered questions such as how something this ambitious can actually be delivered. According to an FOI, four in ten mental health trusts (41%) have staffing levels well below established benchmarks and mental health services rely hugely on qualified personnel. For example, there was an ambition to deliver 570 new psychiatrics, but two out of three of these posts remain unfilled. There needs to be detail of how the NHS will recruit and retain the necessary levels of appropriately qualified staff to deliver this plan, especially in the context of Brexit.
The plan also commits to a significant expansion of services for children and young people. However, most of the government’s proposals will only be rolled out to a quarter of the country over the next five years, which will be of little solace to the thousands of young people who are struggling to access support in other areas of the country.
Finally, the NHS is only one piece of the puzzle and no plans have been published for social care and public health, which have historically received little attention, both in terms of policy proposals and funding, despite their significant contribution to prevention.
Each year, secondary school pupils spend 714 hours at school and 18 years overall in education. This means that schools and colleges play a vital role in identifying mental health needs at early stages and helping young people develop the skills they need in today’s world. Yet, the Government has a major focus on behaviour management in school, including calls to make greater use of exclusion powers and alternative provisions. This is counterintuitive. Children who are excluded from school are both more likely to have had mental health difficulties before being excluded and face a range of disadvantages afterwards, including even higher rates of mental ill health.
There has also been little focus on mental health in further or higher education. There are unfortunately a number of factors hindering universities to support student mental health and wellbeing. In 2020 Randstad published ‘an investigation into the student well-being’. The 1800 responses are alarming.Over a quarter of UK students’ (37%) mental wellbeing has deteriorated since starting higher education. The increasing pressure on students needs to be taken into account and transforming student’s experience needs a joint effort from universities and the government. Therefore, a comprehensive cross-government strategy is needed to complement this plan and must include policies relating to education, which has an enormous impact on the day-to-day experiences of young people with mental health problems.
Moreover, bullying may have a reputation as a ‘playground’ problem, but it’s mental health effects go far beyond the school grounds. The Crime Survey for England and Wales shows that around one in five children aged 10 to 15 years in England and Wales (19%) experienced at least one type of online bullying behaviour in the year ending March 2020, equivalent to 764,000 children. The greater use of smartphones and social media means online bullying and its effects can follow a child everywhere they go and during the Coronavirus Pandemic, children’s isolation at home and increased time spent on the internet, has had a substantial impact on the split between the real world and cyber bullying.
Unfortunately, bullied children face an increased risk of social and emotional problems. Three out of four people who were bullied said it affected their mental health and nearly half became depressed as a result, according to a study by charity Ditch the Label. In the short-term, bullying can lead to anxiety, depression and self harm or suicidal thoughts and research increasingly shows children who experience bullying are at a higher risk of mental health problems as they grow into adulthood (long-term effects) including panic disorder, substance use, academic problems and violence later in life.
The Government has pledged to help teachers to tackle bullying. But, as yet, no detail has been given on what this will look like in practice. There has been a great deal of discussion about the UK’s proposed Online Harm Bill which refers to the government’s promise to make Britain ‘the safest place in the world’ to be online. The Bill includes a huge range of harms to which children might fall victim, including grooming, revenge porn, hate speech, images of child abuse and posts relating to suicide and eating disorders. However, DCMS Minister Caroline Dineage MP said because of Covid the Government ‘would not commit to bringing a draft bill to parliament before the end of 2021’. This means that the bill won’t become law much before 2023 or 2024. This could have dire consequences for children. As Lord Puttnam has said “Here's a bill the Government paraded as being very important but which they’ve managed to lose somehow”, he went on to say that a potential 2024 start date would be “seven years from conception. In the technology world that’s two lifetimes. In a child’s world it is also about two lifetimes. And that is unacceptable”.
Treating mental health with the same urgency as physical health.
‘Parity of esteem’ in the NHS means that patients should be able to access services which treat both mental and physical health conditions equally and to the same standard. The aim for equality between physical and mental health was something that was included in the Coalition’s Mental Health Strategy in 2011, recognised in the Health and Social Care Act 2012, and the NHS Constitution in 2015 after the Conservative Government came into office. But the idea is something that has been talked about for decades, and there have been efforts to achieve parity of esteem since the 1950s.
One major barrier is that the Mental Health Act doesn’t place patients' views to be at the centre of their care. The Act sets out that people can be sectioned and treated in hospital for their mental health against their will and many people who do end up getting sectioned under the Mental Health Act struggle to get the help they need when they ask for it and may be subject to coercion and control by mental health services and police.
Reading Antonio’s story which was published in Mind’s newsletter described how he was sectioned for two years at the age of 16, it made him feel like he was in prison, and he was being punished for something he was doing wrong. He was also tranquilized and put in an isolation room for six hours which he said added to the feeling of ‘being in a cold zoo’. Also at the age of 17, Colin was locked and beaten in a padded cell, subjected to ECT, ECG, a cocktail of medication, OT, discharge, and re-admission. Colin was locked on a ward and communicated to by nurses, social workers, and consultant psychiatrists as if he was inferior. We need alternatives to detention and they need to be rolled out equally.
The current law around mental health treatment is outdated and needs to be brought into the 21st century, it doesn’t consider the views of the individual enough.
The Government has not followed through on its commitment to the review of the Mental Health Act and reform the law in this area. The Queen’s Speech in 2021 laid out a programme of 30 legislations, which included a Health Care Bill with proposals to tackle obesity and improve mental health support, but there was no sign of a new mental health act.
COVID has made action even more urgent
In conclusion, the Conservative Party promised action for mental health services, yet in the midst of a health crisis that has separated many of us from our loved ones and support networks, they have been silent. The virus has exacerbated risk factors known to have an impact on mental health, like health concerns for ourselves and loved ones, potential loss of livelihood, or an instability to support one’s family. Not to mention the mental health impact of being isolated during lockdown, and separated from family and friends.When the Health Secretary and Mental Health Minister were asked how many mental health organisations they had met with between March and June last year an FOI revealed they had attended just two meetings at a time of great uncertainty and when our nation’s mental health was suffering immensely.
In conclusion, though the focus on mental health is highly welcome, we need to keep building the understanding of mental health through targeted public health programmes that prevent mental health from developing and being ignored, take a realistic assessment of the main barriers to delivery, and work across government.
Our government needs to fulfill their promises to give people the mental health support they need and deserve.