The underfunding of mental health services is a political choice. There is an alternative.

Over the last few years, the subject of mental health services has increasingly made the news headlines.  A quick search engine query says it all:

‘Damning report finds serious failings in NHS mental health services’

‘NHS bosses warn of mental health crisis with long waits for treatment’

‘Police cannot continue to fill gaps left by mental health cuts’

‘Hundreds of mental health patients died after NHS care failures’

‘Mental health of pupils is at crisis point teachers warn’

‘Failings in mental health care are violating basic human rights’

The government has responded to the on-going crisis with many fine words about parity of esteem and promised additional funding to ensure that mental health services get the resources they need.  Covering a newly launched Jobs Scheme for mental health patients last week the Guardian quoted Theresa May as saying:

“The government is working hard to ensure genuine parity of esteem between physical and mental health conditions, and our long-term plan will make the NHS a world leader in the care and support we provide to those who need it.”

These well-meaning sounding words from the incumbent at Number 10 belie the realities of the extent of the crisis in mental health care services. The human stories about people’s treatment in an underfunded and under-resourced system reported almost daily in the media are no less than horrific at times. Vulnerable people being caught in the middle of destructive and unnecessary austerity and suffering serious harm as a consequence. Far too many families fobbed off and left trying to cope without appropriate professional support or living with the pain of losing a loved one to suicide because of failings in the system caused by unnecessary cuts to funding and too few staff unable to cope.

And it’s not just a question of vulnerable patients.  Nursing staff expected to work in increasingly pressurised environments as demand for support grows – again a direct consequence of austerity politics and public funding cuts.  Pay caps combined with poor working conditions are not conducive to recruitment or indeed to encourage nurses and doctors to continue working in mental health. The rose tinted, rainbow views expressed by government ministers bear no relationship at all to the experience of those delivering mental health services or those on the receiving end of a care system in crisis.  Telling a recently bereaved relative or sick patients who have been abandoned by the system that the government cares about delivering better mental health services is really a final insult.

Reporting of mental health services in the mainstream media often lays the finger of blame at the doorstep of the NHS itself as if it is simply a question of just needing to get services right.  There are repeated failures to make the links between government-imposed austerity and the quality of service provision. Between 2016/17 the budgets of mental health trusts rose by less than 2.5% whilst acute trusts received a 6% increase in their funding. In 2017/18 whilst 84% of mental health trusts had received increases the overall funding gap continued to rise.

Dr Mona Kamal, a Junior Doctor, writing for Keep Our NHS Public,  pointed out in a recent article that mental health services have suffered cuts in real terms of around 8% year on year since 2010, have lost almost a third of all NHS mental health beds over the past decade and 6800 (15%) of mental health nurse posts have gone.

She wrote:

‘This means a frequent struggle for staff to find beds to admit patients into and has extremely serious consequences for those in crisis and whose illness carries a risk to themselves or others. It means patients, including young children having to be moved hundreds of miles away from their homes and families to get to the nearest empty bed and it forces unacceptable practices where acutely unwell patients who are detained on section are having to wait for days or even weeks in busy A&E departments while a mental health bed becomes available.

Nowhere is this crisis more evident than in Child and Adolescent Mental Health where there have been years of negligent underfunding – most notably during the early years of the coalition government. By 2017 one third of children’s mental health services faced either downsizing or closure. This is causing completely needless suffering for young people who are not able to access care when they need it.

Figures from the NSPCC indicate that an average of 150 children a day are denied access to mental health treatment and what is most agonising about this is that treatment is being denied at a time in young people’s lives when intervention could be the most valuable. But among the most damning pieces of evidence surely is that in the past 5 years suicides amongst teenagers in London have doubled, rising by 107% most notably in the more socially deprived parts of the city.’

In a cash strapped environment, the solutions proposed by NHS England as part of its Five year/ten year Forward View Planning are an increasing reliance on community support, the voluntary sector, use of App technology along with a focus on social prescribing all of which put the responsibility for one’s mental health squarely on the shoulders of individuals. For example, Mid Essex CCG working in partnership with the charity Mind have recently launched a new self-help programme online with no need for GP referral. And only this week the Royal Horticultural Society announced that it was funding a mental health treatment pilot whereby patients can be referred to therapy gardens.

Of course, there is much to be said about promoting social inclusion, enjoyment of nature and exercise for those suffering for depression and anxiety and we should not knock it.  But this would seem to be more about shunting the responsibility for care into the community, funded charitably or on a voluntary basis simply to manage ever diminishing health budgets and to cut costs.  To deliver its privatising reforms NHS England is piggy-backing on the vogue for well-being and self-help through offering Mindfulness courses or even getting people back to work as catch all solutions to improving mental health. Mindfulness apps will not suit all, nor will gardening, mindful skiing or cold-water swimming. Replacing properly funded and professionally provided mental health services with self-help services will lead to more pain and suffering for many for whom such ‘treatments’ are neither suitable nor appropriate.

As in our ecosystem which depends on every part for its continuing health, so society too relies on the health of all its parts for its well-being. At a time when society needs to foster cooperation to bring about environmental, social and economic justice the government is continuing along its austerity path with the aim of dismantling publicly funded and delivered services to deliver an ideological agenda whilst ironically feathering the nests of big global corporations with public money.  It has done so on the back of the lie that they are no longer affordable and the consequences for the economy and citizens are increasingly laid bare. As publicly delivered mental health services are decimated, the private sector is increasingly called upon to provide beds and sometimes substandard care at public cost (for profit) and patients and their families, or at least those that can afford it, increasingly pay privately to be treated. The direction of travel must be becoming obvious to all.  An imported US framework, insurance-based health care service favouring those that can pay and leaving behind those that can’t.

But there is an alternative.

It begins with an understanding that:

• government as a currency issuer is in control and makes spending policy decisions based on its political agenda and not the state of the public finances (although at times with the household budget rhetoric which prevails at the Treasury or on Budget Day you might believe otherwise).
• it is the role of government through its spending choices and efficient use of finite resources to deliver public purpose for environmental, social and economic well-being.
• Government injects our currency into the wider economy as it funds public services. The NHS is the engine that drives the UK economy, as the wages and salaries of healthcare workers are spent in cycles into the real economy. Signs that the economy is stalling as the media report stores and factories closing, waiting lists for medical care and mental health reaches crisis levels, personal saving levels a record low, this is evidence that the fiscal deficit is too small. Yet we have a Chancellor of the Exchequer that boasts this week of his “balanced approach, getting debt falling…with borrowing for the last financial year at its lowest level for 17 years”. Neoliberal central.
• that all citizens have potential and can make valuable contributions to society’s good functioning and who deserve dignity and proper support whatever they are faced with whether it’s health or employment related. People don’t merit being dumped on the scrap heap of life and left to their own devices because government is serving corporate masters instead of those that elected them.
• a Job Guarantee for those that are seeking work combined with a basic income for those who can’t is the best mechanism for creating a balanced economy based on fairness and equity.

Let’s leave the final words to Dr Mona Kamal:

‘It has felt that the last six years have seen the NHS in perpetual crisis but there is now a real sense that the service is being irreversibly damaged, most importantly the impact on our patients is becoming painfully clear. As healthcare workers our priority is the patients we serve and we must ensure it is their care and their priorities that directs how the service is run, but this is not just a fight that concerns NHS staff. The NHS belongs to us all and we all have a responsibility to safeguard it.’

Events

Bill Mitchell, Warren Mosler and Martin J Watts to speak at GIMMS Seminar – Birmingham