Professor Sue Bailey, the outgoing President of the Royal College of Psychiatry, has described mental health services in England as a ‘car crash’. Although the language may be alarmist Professor Bailey’s concerns deserve to be taken seriously by all those who care about mental health provision in our country.
The truth is that while politicians are much more comfortable talking about mental health than ever before, too often the ambitious rhetoric is ahead of the reality. Of most concern is the decision by NHS England, set against a background of pledged ‘parity of esteem’, to set the price deflator for mental health and community trusts at 1.8 per cent compared to 1.5 per cent for acute hospital trusts. These variations sound small but they make a considerable difference. Naturally, there are sound arguments for driving efficiencies into the NHS but, in common with the past thirty plus years, these are hitting mental health services harder, which are already starting from a lower funding base. Indeed, NHS England’s decision and the seeming impotence of government to challenge that decision is a perfect example of why we need more politics in the NHS and not less. It defies credibility that we in government and parliament think it is a good idea to abrogate responsibility for £100 billion of taxpayers’ money. Our elected representatives and democratic institutions are meant to ensure that publicly funded bodies are accountable to those that they serve; in the case of the NHS we have deliberately lost sight of this.
At a more granular level, the closure of mental health beds over the past decade is now giving cause for real concern. Looking after people in the community is a wholly desirable aspiration but there will always be occasions when someone is so ill that he or she will need to be cared for in a specialist setting, near their family and friends.