This is an extended version of an article first published in One in Four Spring 2011
No health with mental health sets out government plans for mental health in England. Mark Brown sees what it has to say
February 2nd saw the publication of the new government mental health strategy No health without mental health, the replacement for the previous mental health strategy New Horizons, which was published in December 2009.
No health without mental health and its supporting hundreds of pages of documents sets out just how the government will seek to approach mental health, how it’ll measure if it’s being successful and what we, as people, should expect from the services we receive. Unlike the Health and Social Care Bill, the strategy isn’t something that has to be debated in Parliament or which has to pass a vote. It’s something that sets out the approach that the government wishes to take. Its important not only because it indicates what practical suggestions the government has in the area of mental health, but also because it shows how mental health will be considered.
So what’s in No health without mental health?
The first thing that’s noticeable about No health without mental health is its commitment to mainstreaming mental health. Indeed, the subtitle is ‘A cross-governmental mental health outcomes strategy for people of all ages’. Rather than suggesting that mental health is an issue only for mental healths services, the strategy is at pains to point out the fact that mental health and wellbeing is something to which most government departments can contribute. It states that it wishes to take a broader approach, tackling wider social determinants and consequences of mental health difficulties. It stresses very strongly that mental health is everyone’s business. It makes great stress upon Big Society ideas such as greater community involvement in helping everyone to to stay well. It is also very much weighted toward prevention. The strategy has six main objectives, which are worth looking at individually, alongside the suggestions for achieving them set out in the supporting paper No health without mental health: Delivering better mental health outcomes for people of all ages, also published in February.
- More people will have good mental health
The strategy describes this objective as more people from all ages and all backgrounds having better wellbeing and and good mental health and fewer people developing mental health problems. It divides plans for fewer people to develop mental health difficulties into the same five areas used in in the public health white paper Healthy Lives, Healthy People, published in November 2010. These are starting well, developing well, working well, living well and aging well.
The supporting paper makes a number of suggestions for how these changes might be made, mainly focused on helping families. Starting well focuses on children and suggests that interventions such home visiting, peer support and parenting programmes might help reduce maternal depression. It repeats a pledge to increase the health visitor workforce by 4,200 posts and a new model of practice including a stringer focus on maternal and infant mental health. It also states that the Department of Education has established a new cross-government programme to support families facing multiple, complex needs, introducing a new area-based Early Intervention Grant which will bring together a number of early intervention and prevention services.
This focus on parenting carries over into the developing well strand, which focuses on young adults. The strategy suggest that particular groups of young people are at risk of developing mental health difficulties; those who have experienced negative parenting, those who have experienced abuse and neglect, those in contact with youth and adult criminal justice systems, those under achieving at school, looked after children (those in care), early school leavers, young lesbian, gay and bisexual people and young homeless people. It claims that experiencing four or more of these situations leaves a young person at particular risk. To help young people with mental health problems the Department of Health is expanding access to talking therapies for children and young people and the paper mentions a forthcoming review of the model for school nursing. In a more general senses the government is looking to partnerships between the public, private and voluntary sectors to deliver better family outcomes, such as the family learning programmes funded by the Department of Business, Innovation and Skills, volunteering initiative The National Citizen Service, The Healthy Schools Programme and elements of the Department of Education’s national campaign to support families with multiple problems.
The working well strand carries on much of the thinking we are familiar with already, with much stress upon the benefits of being in work and of the Work Programme as a way of supporting people into work. it commits to more numbers of people with mental health difficulties being in work as a key indicator to measure success.
The living well strand focuses on promoting wellbeing by promoting things like volunteering, physical activity, getting involved in your community and similar. The government claims it will support stronger communities, try to reduce barriers to training and education, will promote better solutions to drug and alcohol dependency and support access to better financial advice.
The aging well strand focuses on how people get on in later life. The outcomes plan has few mental health specific governmental actions for this period of life.
- More people with mental health problems will recover
No health without mental health sees recovery as having a good quality of life after a period of mental ill health. It stresses that while some people experience “long-term and severely debilitating effects, many recover fully, including from severe mental health problems”. It says that for a good quality of life people need: “greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates, and a suitable and stable place to live.”
In general the strategy undertakes to find ways of intervening more quickly when someone becomes unwell to prevent their difficulties worsening and undertakes to provide services that are better. It stresses that providing a range of services in appropriate forms are important and also reiterates that the Coalition government is investing “around £400 million over four years to make sure a choice of psychological services are available for those who need them in all parts of England”. It states that people with severe mental health difficulties who need to spend time in hospital “require high quality care in the least restrictive environment”.
The outcomes paper suggests that there is need for more robust ways of measuring recovery across all of the kinds of mental health difficulty and that areas that might also be considered include measures of high-quality transition between services and improvement in older people that is not reliant on employment, for example non-paid work or learning.
It suggests local commissioners might be measuring number of inpatient stays by diagnostic category, proportion of those with first onset psychosis taken on by early intervention services and average level duration of untreated psychosis. It also says that quality standards are in development for amongst others, schizophrenia, depression in adults, long-term conditions/people with co-morbidities, bipolar in adults.
- More people with mental health problems will have good physical health
This area of the strategy is much the same as the plans for good physical health for everyone, though it does raise the issue of how many people with mental health difficulties smoke tobacco.
- More people will have a positive experience of care and support
No health without mental health makes clear the governments commitment to greater choice and personalisation in mental health, though things like being able to choose which people provide your services and through individual health budgets for long term conditions. In line with the NHS White Paper, it does not foresee that this will happen until 2013/14 and is sketchy on the details of what this will mean for people with mental health difficulties. Alongside this is a commitment to make sure that mental health services offer the same standards and outcomes to all people, recognising that some groups are more likely to have poor experience of services.
- Fewer people will suffer avoidable harm
The strategy states that; “People receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service.”
This aim covers the governments wish that fewer people will suffer avoidable harm from themselves, that fewer people will suffer harm from people with mental health difficulties and that fewer people will suffer avoidable harm from the care and support services they receive. It states that mental health services should protect people from further harm; have an honest and open culture that promotes the reporting of incidents and that they should learn from mistakes.
Notably it also calls for a greater recognition and understanding of self harming behaviour, the increase in the number of rape crisis centres and the development of a new national suicide prevention strategy
- Fewer people will experience stigma and discrimination
The strategy recognises that stigma and misunderstanding around mental health can stop people seeking help and can also lead to discrimination. It stresses that the government should lead by example and also commits it to working with anti-stigma campaigns like Time to Change to challenges and change attitudes.
This article appears in a slightly different form in the Spring 2011 edition of One in Four magazine. To subscribe to One in Four (£10.00GBP for 4 issues per year) or to purchase the full issue visit our subscriptions page.
