Katie Evans, Head of Research and Policy, Money and Mental Health

A Long Term Plan for mental health, not just mental health services

08 January 2019

Yesterday the government launched its Long Term Plan for the NHS, amid media headlines heralding both a welcome focus on preventing health problems, and a significant steps towards putting mental health on a par with physical health.

Mental health was given a level of focus and prioritisation that has too often been lacking. For a start, the plan includes a new guarantee that investment in primary, community and mental health care will grow faster than the overall NHS budget, as well as proposals to offer 24 access to crisis care through the NHS’s 111 service.

Beyond the headlines

These announcements rightly garnered column inches ahead of the launch, but there was also positive news in the body of the plan too. They include proposals to restructure community mental health services, to make them more place-based and better integrated with other services, including social care. This approach should create an opportunity to engage more broadly with the social determinants of mental health problems – potentially including financial difficulty. With the plan making a specific commitment to offering employment support for people receiving care for their mental health, there could also be an opportunity to integrate money advice too.

This kind of practical, joined up support could drastically improve the lives of those struggling to manage their money, particularly as a result of more severe mental health problems. It could also make things easier for mental health professionals, many of whom are currently spending valuable clinical time supporting patients with practical tasks like applying for benefits because specialist help simply isn’t available.

Mind the prevention gap

But while the plans outlined welcome moves towards parity of esteem between mental and physical healthcare when it comes to accessing services, unfortunately this commitment was not matched in terms of the focus on prevention. The second chapter of the plan outlines a number of measures to prevent physical health conditions – from reducing smoking and obesity, to lowering alcohol related A&E admissions and improving air pollution. However, there is little in the way of equivalent steps to support people in avoiding developing mental health problems.

This points to a wider problem with the government focus on prevention: that it just isn’t joining up the dots in terms of addressing the social determinants that can affect people’s mental health. Preventative care doesn’t just happen in the NHS. It requires adequate investment in social care and public health too, and for the government to consider the impact of all its policies on our health.

This is an issue which is explicitly recognised in the Long Term Plan, which calls for health considerations to be ‘hardwired into social and economic policy’. We hope to see something in the implementation plan about delivering this change to the policy-making process, as well as delivering changes to the health service itself.

One way the government could do this would be to revisit funding for public health in the Spending Review. As the Long Term Plan notes, NHS services can compliment, but not be a substitute for, the services provided by local authorities – a fact which is particularly true for mental health, which is so often influenced by our economic circumstances and surroundings. Yet spending on preventative public health services by councils was 8% lower in 2017/18 than in 2013/14 on a like-for-like basis, and further falls are expected over the next two years. This undermines local authorities’ ability to fund vital public health services, including advice services that can help people deal with financial, employment, housing and benefits problems which can seriously affect our mental health.

The opportunity

The Long Term Plan, with its integrated model of community mental health care, could offer a real opportunity to provide people experiencing mental health problems with holistic support that promotes recovery and improves people’s lives.

But, as ever, the proof will be in the implementation. There’s lots of work to do to make this holistic vision of mental health care a reality, and to make sure this thread flows through public health prevention, as well as treatment. As implementation plans are developed, we’ll continue working with government, NHS England and Public Health England to make sure the link between money and mental health is addressed, in and outside the NHS.