The other one in four
Turning positive words into practical action
Financial difficulty and mental health problems are inextricably linked. We have made that case consistently since our inception six months ago: the evidence is clear and so far we’ve yet to meet anyone in the health system who disagrees. In fact today, at the launch of our new research on the role of the health system in tackling this relationship, there was a consensus from key stakeholders across health, public health and social care. Attendees agreed that addressing financial difficulty is essential in order for mental health services to be successful in achieving their clinical goals, as well as to support wider holistic outcomes for their patients.
So if we all agree, what’s the problem?
Our new research has found that the mental health system’s response to financial difficulty is patchy at best. Everyone says they ‘get it’, but in practice, it’s not yet happening. We’d like to see every area systematically tackling the relationship between mental health problems and financial issues, from assessing local need to providing and evaluating a service. We found that only 4% of Clinical Commissioning Groups (CCGs), 10% of Scottish NHS Trusts and 33% of Northern Irish Health and Social Care Trusts are doing so. There’s clearly a gap between our understanding of what’s important and delivery on the ground. Yesterday’s event saw senior figures from mental health policy and practice respond to the research and explore why this might be happening.
Gregor Henderson, Director of Wellbeing and Mental Health at Public Health England welcomed the findings and called for the health system to respond by building skills in the NHS workforce to talk about these issues, for NICE to produce more holistic guidance on mental health and the CQC to inspect wider systems as well as individual services to gather a more accurate picture of what’s working and why. The ‘Prevention Concordat’, Public Health England’s new programme to support local public health teams with intelligence and data will be an opportunity to bridge that gap between good intentions and positive action, and Gregor committed to recommending that financial difficulty is collected as part of local needs assessments (JSNAs) in guidance to local areas.
Sarah Khan, Deputy Head of Mental Health at NHS England agreed that this needs tackling, and set out NHS England’s plans to develop detailed ‘community care pathways’ in 2017, identifying what good practice looks like. This should include tackling issues like financial difficulty that can both cause and result from poor mental health. Sarah said she’d like the Care Programme Approach to more consistently address finances and for joint service evaluations to look at how partnership working is achieved, as well as outcomes for patients, so that good practice can be replicated elsewhere.
Simi Ryatt, Chief Executive of Citizens Advice Hammersmith and Fulham added a very valuable practice perspective to the discussion. Simi explained that the issues people bring to Citizens Advice are more complex than twenty years ago, requiring a more holistic response. In particular, Simi made the point that it’s not enough to signpost people with mental health problems to advice services, a ‘warm handover’ is essential – whether that’s co-locating services, making a telephone appointment for them or transferring someone on the phone directly to support.
Finally, Dr. Tom Richardson spoke from both a personal and professional perspective. Tom is in the unusual position of being a clinical psychologist, an academic looking at the relationship between financial difficulties and mental health and a service user living with Bipolar Disorder. Tom argued that mental health problems and financial difficulties should not be treated as two separate problems. Many of the drivers of financial difficulty, including avoiding activities, negative thought patterns, and external stressors, are the same as the drivers of poor mental health – he argued that treating mental health problems without addressing financial difficulty is like treating lung cancer without asking about smoking.
Everybody’s business, nobody’s priority
The solution that repeatedly came up in the discussion, as so often when it comes to our complicated health system, was collaborative working. However worryingly, Tom Richardson argued that local budget cuts and rising demand are making integrated working harder than ever.
There’s a clear consensus that this issue needs addressing, but it needs addressing right across the system – from Health and Wellbeing Boards collecting the right data in their JSNA’s, to CCGs commissioning integrated support services and providers identifying the right people to use them. The challenge is that what’s everyone’s responsibility so often becomes no one’s, as accountability is difficult and competing demands on time and resources mean that anything that could be picked up elsewhere falls to the bottom of the priority list.
That’s why promising developments like new guidance on collecting financial data in JSNA’s and integrating financial difficulty into community care pathways in the health system are so important. As is keeping this conversation going and raising awareness and understanding of just how important tackling financial difficulty is – for clinical outcomes, for the NHS budget, and for the wider wellbeing of the population.