Back in 2016, giving mental health its own stage with Five Year Forward View was not only very promising but necessary. The goal of increasing access to mental health interventions and pledging to give parity to mental health was a major step forward in the way we cared for the nation's mental health and emotional wellbeing.
Since then it is welcome news that mental health has also been given a place in the NHS long-term plan, building on the work of the Five Year Forward View:
Increase access to treatment through accelerated funding - at least £2.3bn a year by 2023/24.
Make it easier and quicker for people of all ages to receive mental health crisis care, around the clock, 365 days a year, including through NHS 111.
Expand specialist peri-natal mental healthcare for mothers and partners.
Expand services, including through schools and colleges, so that an extra 345,000 children and young people aged 0-25 can get support when they need it, in ways that work better for them.
Continue to develop services in the community and hospitals, including talking therapies and mental health liaison teams.
My concern back in 2016 and now is that the plan is not innovative enough. It is offering a solution too similar to the way we have always delivered mental health interventions - primarily with talking therapies and medication at NHS, outpatients, clinics or hospital settings delivered by therapists, nurses, social workers, psychiatrists and operational managers.
It is estimated 25% of people with a mental health problem access ongoing treatment, leaving 75% left to cope by themselves or rely on informal support such as family or friends or non-mental health practitioners such as their GP, social workers, teachers, housing workers and probation officers.
More of the same is not going to reach ever higher proportions of the population with a mental health need and cover the early prevention and maintenance ends of the treatment spectrum.
This is not to say traditional mental healthcare needs to be scraped, but rather augmented with other promising approaches (most often not in the NHS), such as
task shifting, widely trialled in other countries in the world with a shortage of mental health practitioners
place-based co-location of mental health practitioners within community services
online therapies/counselling
peer support interventions
smartphone app (like Woebot) or avatar based self-help and support
mindfulness, yoga and normalising mental health conversations in schools, colleges and workplaces
drug treatments such as anti-inflammatory drugs and vitamin D supplements (e.g. for depression)
increasing positive awareness through popular television; e.g., with storylines in programmes such as Eastenders
use of personal health budgets so care is person-centric rather than provider-centric, giving back control and ownership of a person's mental wellbeing wherever possible.
In addition, we should bear in mind that before people can access mental health treatment they need the basics addressed - food, shelter/accommodation, a sense of safety in the environment and to be free of excessively stressful environments - whether the stress is due to deprivation, crime or other factors such as the culture at work or school. Traditional mental health treatments alone do not meet the population needs of people with mental health conditions.
The mental health implementation plan of the NHS FYFV and the Long-term Plan are promising and welcome but could it be a missed opportunity to be even more forward thinking and innovative?
Stuart John Chuan
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