Mental Health: Out of the shadows
Mental illness is at last getting the attention, if not the money it needs.
Mental health care has long been the poor relation of its physical counterpart.
The stigma of mental illness remains heavy.
One in six adults in England has been diagnosed with a common mental disorder such as depression or anxiety.
Yet at least two-thirds of people diagnosed receive no treatment for their condition.
In 2012 the Health and Social Care Act created a legal responsibility for the government to give the same priority to mental health as it gives to physical health.
Now the prime minister, Theresa May, has added her voice.
In a speech on January 9th Mrs May warned that mental health had been “dangerously disregarded”.
She promised to transform attitudes to mental illness, including a special focus on children and young people. (Government figures show that three-quarters of mental-health problems start before the age of 18.)
This will include teachers in every school being offered mental health first-aid training, and better support in the workplace.
According to the Centre for Mental Health, a think-tank, the consequences of mental illness cost the British economy more than ￡100bn ($120bn) a year in health care and lost economic output from sickness or unemployment.
But the system is structured badly, with physical and mental care run and funded separately.
This means treatment is not integrated and money wasted.
Funding is a problem, too.
Though mental illness represents 28% of the national disease burden in Britain, it accounts for only 13% of spending by the National Health Service (NHS).
In 2011-12, for the first time in a decade, funding for mental health fell, says the King’s Fund, another think-tank.
Even though the NHS mandated that such funding should increase in 2015-16 alongside increases for acute care, about 40% of mental-health trusts continue to experience year-on-year cuts to their budgets.
Since government money for mental illness is not ring-fenced, it is often used to plug gaps in funding for emergency hospital care or other areas.
Mrs May spoke of the need for better accountability.
But “investment in mental health has been difficult to maintain when pressures on acute hospital care are so great,” says Helen Gilburt of the King’s Fund.
Those pressures have become even more evident in recent days.
On January 7th the Red Cross claimed there was a “humanitarian crisis” in Britain’s hospitals.
The NHS’s medical director for acute care denied this but admitted that staff were under “a level of pressure we haven’t seen before”.
According to leaked documents seen by the BBC, nearly a quarter of patients waited longer than four hours in accident and emergency (A&E) rooms in the first week of this year.
One in five patients admitted for further treatment endured a long wait on a trolley or in a hospital corridor—twice the rate normally seen.
With not enough mental-health care provided in the community, recent research has found that the number of people with mental illness coming to A&E doubled between 2011-12 and 2015-16.
The fact that the prime minister herself has chosen to highlight the issue marks an important step, says Graham Thornicroft of King’s College London.
Talking about mental health used to be seen as a vote loser.
Now, he says, not only are more celebrities unafraid to talk openly about their mental illness, but it appears to have entered the mainstream as a political issue.
“We now need to see if this policy priority is backed up by substantial extra resources to make sure these aspirations become reality,” he adds.
On that front, Mrs May is implementing a pledge made last year by her predecessor, David Cameron, to spend ￡1bn on adult mental health and ￡1.4bn on youth mental health during this parliament.
That money is being spent on both acute mental health care, such as specialists at every A&E unit, and on community care.
New rules limit how long a patient with acute mental illness should wait, just like the four-hour limits for physical maladies in A&E.
But this week’s announcements added up to additional funding of only ￡15m for community care, and ￡67m for digital services like online therapy—small beer considering the scale of the problems and of the prime minister’s avowed ambitions.
Demand is growing.
The NHS found that the proportion of people with anxiety and depression receiving treatment increased from 24% in 2007 to 37% in 2014.
This may show that people are feeling confident enough to seek help as the stigma of mental illness decreases, says Mr Thornicroft.
But the NHS also found that the proportion of the population reporting self-harm trebled between 2000 and 2014, to 6%, including one in five 16- to 24-year-old women.
With such a tide, money to match the great promises for mental health cannot come soon enough.