Helen Undy, Director, Money and Mental Health

What's next after the five year forward view - thinking sideways

12 October 2018

In policy terms, mental health hasn’t done badly over the last few years. While Brexit has forced some important issues off the agenda almost entirely, mental health has managed to cling on through a combination of public pressure, effective campaigning and political will.

And progress hasn’t been terrible. The Five Year Forward View for mental health was broadly welcomed, and although equal progress has not been made towards all of the goals within it, the goals themselves were encouraging. These included a recovery rate target for the main talking therapies programme, IAPT, and waiting times standards for mental health.

So while progress in the shorter term is certainly mixed, looking at progress in policy making for mental health services over a much longer trajectory, the last decade has been a period of comparative growth and improvement.

Looking beyond the Department for Health

But not everything has been rosy. Policy affecting the NHS and mental health services directly may have made progress, but those aren’t the only policies that affect our mental health. Policy shaping everything from benefits, to local government spending, school examinations and housing, has a profound impact on our mental health, and yet that impact is harder to quantify, and therefore harder to track.

It was almost exactly one year ago that the Prime Minister identified the need for ‘a comprehensive cross-government plan which transforms how we deal with mental illness’. With attention growing on ‘what’s next’ after the Five Year Forward View, it’s time for a renewed focus on what that really means.

Radical bureaucracy

It wasn’t that long ago that Prime Minister David Cameron stated:

Practical steps to ensure government focus are still exactly what is needed.

This won’t sound as exciting as calling for rapid investment, innovative new services or radical use of data, but it feels as though it’s time to introduce a Mental Health Impact Assessment for new government policy. When policies are developed, they are subject to privacy impact assessments, environmental impact assessments, equality assessments and even an assessment to consider the impact on families – but what could be more important than the impact on our mental health? There exists an ‘inter-ministerial group’ on mental health, but its aim is primarily to oversee the delivery of the government’s mental health policies, rather than to consider the mental health impacts of all policies.

Uncomfortable as it may be to suggest that more bureaucracy may be the answer, the civil service is what really creates policy, and bureaucracy is the world they inhabit. If we’re committed to mental health as a cross-cutting priority to inform all policy-making, it seems sensible that the associated bureaucratic hoops should be in place to jump through. And those bureaucratic hoops create a democratic tool – allowing MPs of all colours to properly scrutinise the mental health impacts of policies, good and bad.

Putting this into practice

You don’t have to look far to find instances where such a tool could provide valuable insight. Take the government’s proposals on gambling reform for example: if reducing the maximum stake on Fixed Odds Betting Terminals to £2 reduces problem debt, it’s a policy that will be having a positive impact on mental health. If capping energy prices helps consumers who struggle to switch to avoid paying over the odds, it’s going to be particularly reducing problem debt amongst people with mental health problems. And if ‘managed migration’ to Universal Credit is going to result in households missing out on benefits payments because they struggle with paperwork, the impact on mental health, and particularly people with mental health problems, is worrying and needs to be understood so that it can be addressed.

At the moment policy-makers are trying to address mental health in cross-government policy in a piecemeal way, and with only a fraction of the information they need. It’s time we took the job a bit more seriously.

Looking sideways

Impact assessments are only ever as good as the evidence that sits behind them and the reliability with which they are carried out, so this can’t just be a tick-box exercise. The What Works Centre for Wellbeing would be well-placed to build this sort of tool, and cross-government support would be needed to ensure that it is used effectively.

Given how far we’ve come in mental health policy-making, this doesn’t feel like too ambitious an ask – perhaps we’re ready for a little bit of radical bureaucracy. It would be fantastic if what’s next after the Five Year Forward View wasn’t as much of a ‘forward’ view, as sideways one, looking beyond the Department of Health, and right across government.