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The future of mental health –from strategy to reality

Authors: Karen Steadman Karen Steadman

19 March 2013

What does recovery mean for people with mental health conditions? And how can we help overcome the barriers to recovery? This was the focus of the 'Mental Health: from strategy to reality' conference in Manchester last week (14 March 2013). Tweets from the day can be found at #mh13.

Paul Farmer from Mind, reminded us of a stark fact– that one in four people will have a mental health condition in a year. Of these, the majority will take these concerns to their GP. In a given week, it is thought that 250,000 people will visit the doctor for mental health issues, 750,000 prescriptions will be issues for anti-depressants, and most worryingly of all, there will be 104 recorded suicides (with 5-25% more thought to go unreported).

It is therefore a cause for considerable concern that mental health services are expected to come under increased pressure in the next five years, as austerity measures and NHS service cuts continue. The likely impact of current Department of Health reforms on mental health service provision are also troubling. A GP audience member argued that the competitive nature of commissioning will do even more to break the links between mental and physical health services, and may undermine the government’s well-publicised commitment to achieving a parity of esteem between these services. 

Recovery from the perspective of the individual, and which services can best reflect this, was a key theme. Paul Burstow MP spoke about the importance of supporting personalised recovery based on individual goals. And Sean Duggan of the Centre for Mental Health called for Health and Wellbeing boards to support the commissioning of recovery-orientated services, highlighting the need for strategies that focus on the things that actually aid recovery - like housing, building relationships, and employment. In particular, he remarked that having a job is the best treatment for mental health conditions, yet many mental health service users are not in paid work despite this being desirable for many. In some areas of the UK, as few as 12% of mental health service users are in paid employment. For those with severe mental health conditions such as schizophrenia it might be as low as five percent. Sean Duggan stressed the importance of Individual Placement and Support services which, when well implemented, have proven to be incredibly effective at helping people with mental health conditions into employment.

What are the barriers to recovery and employment and how can we overcome them? Anne Beales representing the mental health consumer group Together UK raised concerns that people with mental health conditions were still not being listened to. For her organisation, recovery means services which ’connect you to yourself, connect you to your loved ones, and connect you to your community'.

Greater utility of Peer Support Workers was widely recommended, with the Implementing Recovery through Organisational Change (ImROC) project providing a positive example of activity in this area. This is supported by the growing body of evidence that involving people with lived experience of mental health and conditions and services is of huge value to mental health service users.

Stigma and discrimination experienced by people with mental health conditions were identified as ongoing issues during a Panel Debate featuring Sue Baker from ‘Time to Change’, Shahnaz Ali OBE Director of Equality, Inclusion and Human Rights at the NHS, Ruth Hunt from Stonewall as well as Anne Beale. We await the outcomes from the Time to Change project in April, which will provide evidence on where the problems are, and what can be done to address them. There was some discussion about whether the NHS itself was doing enough to eliminate stigma in its own workforce, and how issues of stigma and discrimination here might impact on the opportunities for people with mental health conditions to move towards recovery and employment.

Early intervention is critical for recovery, particularly for those with severe mental health conditions. Graham Allen MP mentioned the Early Intervention Foundation Consortium which seeks to create and share an evidence base for early intervention in mental health services. Poorer physical health outcomes for mental health service users were also high on the agenda, with some discussion about the reduced attention this is given by some health care services. We were told about the development of integrated care pathways to support mental and physical wellbeing being led by CLARHC Manchester. Paul Burstow MP told us the relationship between physical and mental health comorbidities would be on the agenda of the independent Mental Health Commission he is chairing with the Centre Forum think tank.

For me, the overriding message of the day was of the importance of linking up services and improving ‘joined-up’ working across government as the most effective way to make real progress in terms of mental health care provision and recovery. We watch and wait to see what impact of the current health reforms will have on this.