As the main parties publish their promises about how they would govern if handed power next month, mental health has emerged as a bigger talking point than in any previous election. In this post I will take a look through the manifestos of five main parties, and compare them. How might we expect the UK mental health system to look after May 7th? How much thought has gone into their plans, and how well do they stack up?
Overview: Mental Health as a talking point in 2015:
All of the parties include some mention of “tackling stigma”, though only the Liberal Democrats and the Greens have any detail in their plans for how to do this. All parties make promises about “improving training” in mental health for all healthcare professionals, though it’s rarely clear what this training will look like or who it’s really for. All parties also say that they prioritise, “parity of esteem” between mental and physical health, though none of them are able to define what parity of esteem would look like, or how we would know it when it’s achieved. Very few of these issues were being mentioned by any of the parties in 2010 and this undoubtedly positive shift may be the result of an increasingly prominent role played by mental health in the discussion since the last election. It is also likely due to a different economic climate, in 2010 the spectre of the deficit loomed larger in the discussion, making plans for public spending seem relatively controversial. After five years of austerity, perhaps there is a greater willingness to promise enhanced social provision alongside fiscal responsibility.
The Conservatives have run straight into controversy over mental health. Partly this is because one of their parliamentary candidates recently suggested that people with mental health problems could wear colour-coded wristbands. However, it is also a result of some alarmingly punitive language on the topic in their manifesto:
“People who might benefit from treatment should get the medical help they need so they can return to work. If they refuse a recommended treatment, we will review whether their benefits should be reduced.” [My emphasis]
It is unfortunate (but not insignificant) that the first mention of mental health in the Conservative manifesto contains an allusion to benefits sanctions, as though the only real purpose of mental health care is to make people productive again and that this makes it compulsory. This has prompted a letter from mental health professionals in The Independent, and a blog post in which psychiatrist Alex Langford called it vile. I might add vindictive, and it is at the very least extremely unfortunate that the party has so closely tied treatment to something like punishment.
However, the Conservatives make other promises too. One of these is that there should be “therapists in every part of the country” (a decidedly vague commitment) and another is to enforce “new access and waiting time standards for people experiencing mental ill-health“. The Conservatives also take up a theme which will be echoed by UKIP and the Liberal Democrats by pledging to “ensure that women have access to mental health support during and after pregnancy”. Like UKIP (see below), the Conservatives say they will honour the “military covenant”, with a promise of particularly good care to veterans suffering from mental health problems.
Overall the Conservative manifesto seems preoccupied with mental health problems as a “burden”; something to be curtailed as soon as possible, with a return to gainful employment as the ultimate goal. That is unless you happen to be a new mother or an ex-serviceman, in which case you are deemed worthy treatment in your own right.
In a word: Severe.
“There has been an alarming rise in mental health problems in recent years, especially among young people. According to NHS England, mental illness accounts for 28% of illness but only 13% of NHS spending. In the course of a year, one in four adults experiences some form of mental ill health. If you have diabetes there’s a 92% chance you’ll get treatment. If you have a mental illness, that chance goes down to 28%. Around 70% of prisoners have two or more mental health conditions. The government’s own Chief Medical Officer says mental health should be given greater priority.”
The Green Party sounds a strident note on mental health, calling it “the crisis of our time”. They cite statistics to highlight the social issues concerned, and are clearly attuned to the debates in the sector. The party promises to achieve parity of esteem by 2020, the only party to set a clear timeline on this goal. Like Labour they commit to access to talking therapies within 28 days. The Greens also commit to ensuring that “everyone who requires a mental health bed should be able to access one in their local NHS Trust [..] if specialist care is required, then this should be provided within a reasonable distance of where the patient lives”. This of course leaves open the definitions of “specialist” and “reasonable”, but the promise will resonate with many in the mental health sector, who watched with dismay as people were admitted to beds hundreds of miles away from home. Equally, the Greens promise to eliminate the use of police cells as ‘places of safety’ for children by 2016, and say that “by the end of the next Parliament” this should only occur for adults under “exceptional circumstances”.
- Ensuring that spending on mental health care rises within our overall commitment to increase real spending on health.
- Ensuring that everyone experiencing a mental health crisis, including children and young people, should have safe and speedy access to quality care, 24 hours a day, 7 days a week.
- Implementing a campaign to end the discrimination and stigma associated with mental health through supporting the Time for Change programme and offering employment support to those with mental health problems.
- Investing in dementia services, ensuring that support is available for all affected by this debilitating disease, including families and carers.
- Improving access to addiction services, including both drugs and alcohol addiction.
- Giving higher priority to the physical healthcare of those with mental health problems.
- Considering offering more personalised job-seeking support for people with mental health problems.
Many of the pledges the Greens are making will resonate with people interested in mental health. Like the Liberal Democrats (see below), they clearly know what matters in the sector, and they are the only party to refer to the fact that people of different ethnic backgrounds have different mental health needs. Nonetheless, however desirable their promises may be, the party’s record on saying how it will pay for them has so far been notably poor. Voters would be forgiven for thinking that however great their ideas might sound, they would rather trust a party who have a chance of actually delivering on them.
In a word: Ambitious
“The current system is too fragmented. It was not designed for the growing numbers of people living with chronic conditions or multiple needs. Rather than having three separate systems for dealing with physical, mental and social care, we will create a whole person approach: a single service to meet all of a person’s health and care needs”
Labour’s manifesto is one of the less detailed manifestos in terms of mental health, but many of their bigger, headline changes to the health system could be expected to impact mental health in significant way. The party expresses a clear plan to reverse some of the coalition’s broad healthcare reforms, including the controversial Health and Social Care Bill. There is a sense that Labour wants a more coherent health system, promising greater literacy “to help address the problem of undiagnosed mental illness”. However, the plan for this is a little feeble: “NHS staff training will include mental health”. Which of the staff not already receiving such training to Labour intend to provide?
Perhaps most significantly, the party plans to bring all services together into a single system (no more awkward funding turf wars between health and social care). This is a big and important idea, but the document is short on detail about how it would work. Given that there is much more private involvement in UK social care than health care, (and social care is not always free to service users, whereas health-care generally has been) what would be the implications of such a huge merger?
Other promises include access to talking therapies within 28 days (concrete and measurable) and a pledge to use techniques “like Mindfulness” to build resilience (much less so). This latter can be seen as a positive move, or (more cynically) as an empty ploy to cash in on a big name phenomenon which has gained enormous popularity in recent years. Labour’s focus is on presenting themselves as the party to save the NHS rather than on detailed smaller plans.
In a word: Disappointing
“One in four of us will experience mental health problems, but for decades mental health has been the last in the queue for funding and attention. Mental health problems cost the country as much as £100 billion each year yet less than a quarter of people with depression get the treatment they need. […] We have invested £400m in increasing access to talking therapies and £150m in help for people with eating disorders, but there is still a long way to go. That is why we will increase mental health spending in England’s NHS by £500m a year by 2016/17 – half of which we delivered in this year’s Budget – and provide the cash for similar investments in Scotland, Wales and Northern Ireland.”
The Liberal Democrats have something of a reputation as the most “wonkish” party, and they are true to form here, providing a list of promises which is both the longest and the most specific. The party promises a “waiting time standard from referral of no more than six weeks for therapy for depression or anxiety and a two-week wait standard for all young people experiencing a first episode of psychosis”. One intriguing plan involves the introduction of “care navigators” to help people in “finding their way around the system”. It’s not clear what else this new role would comprise, but may resonate with many of those who have been confronted bya complex and disorienting system. The Liberal Democrats also plan to “make the UK more mental health-friendly” by publishing a “national wellbeing strategy” to put “better health and wellbeing for all at the heart of government policy”. Rather more oddly, the party promises “a public health campaign promoting the steps people can take to improve their own mental resilience – the wellbeing equivalent of the ‘Five a Day’ campaign“. This sounds intriguing and makes me wonder what the equivalent of “five a day” would be in mental health. The party doesn’t elaborate.
- Increase access to clinically and cost-effective talking therapies so hundreds of thousands more people can get this support. Our long-term goal is to see everyone who can benefit being treated, but we will set an interim target of getting 25% of those suffering into treatment.
- Transform care for pregnant women, new mothers and those who have experienced miscarriage or stillbirth, and help them get the early care they need.
- Revolutionise children’s mental health services. With the £250m a year announced in this year’s Budget we will implement the proposals outlined in the report of the Government’s Children’s Mental Health Taskforce. This means building better links with schools, ensuring all children develop mental resilience, and getting support and care quickly to those who are struggling. Our investment will help ensure children can access high-quality care closer to home.
- Ensure no one in crisis is turned away, with new waiting time standards and better crisis care in Accident and Emergency (A&E), in the community and via phone lines. This will enable us to end the use of police cells for people facing a mental health crisis.
- Radically transform mental health services, extending the use of personal budgets, integrating care more fully with the rest of the NHS, introducing rigorous inspection and high-quality standards, comprehensive collection of data to monitor outcomes and waiting times and changing the way services are funded so they do not lose out in funding decisions in future.
- Establish a world-leading mental health research fund, investing £50m to further our understanding of mental illness and develop more effective treatments.
- Support community services and volunteers working to combat loneliness, particularly in later life.
The Liberal Democrats have the most concrete promises on offer. The 2015 manifesto promises bear the mark of a party with a much more serious commitment to (and knowledge) of mental health than most of the other parties. However, their time in government as a junior coalition member shows poor track record on delivering, and their their current poor polling is almost certainly due in part to aborted pledges, such as the promise to abolish tuition fees.
In a word: Geeky
“Patients with mental health problems frequently feel ignored and let down. UKIP takes a ‘whole person’ approach to health and that means giving mental health parity with physical health. We will introduce practical policies to improve delivery of mental health services”
To be honest I was surprised to see any mention of mental health in UKIP’s manifesto. This is still a party I associate with the EU and Immigration (and sausage rolls). However they want to be seen as a more serious political concern, and the 2015 manifesto bears evidence of this. Some degree of “vision” (to put it generously) on mental health is outlined, and clear promises are made to mental health service users (there is a clear financial promise to “invest 1.5 billion into mental health and dementia services” for example). Look closely though, and some of these pledges are less impressive than they seem.
UKIP promises that they will direct “patients diagnosed with a debilitating long-term condition or terminal illnesses to mental health professionals when appropriate”. This seems a reasonable proposal but does it amount to any more than the claim that when people need mental health services they should get them? We can all agree that it should be possible for people to access mental health services “when appropriate”. UKIP give no details about how they would enforce their promise. The next is similarly flat, UKIP say they will recognise “there is often a link between addiction and mental illness” and offer “appropriate treatment where this is the case”. Again, there is nothing wrong with this, but as someone who works in mental health, being told there is a link between “addiction and mental illness” is a bit like being told that we are no longer at war with Argentina. More useful would have been a specific statement of what UKIP feel comprises “appropriate treatment” and how they will ensure it is provided. More interesting is the party’s promise of a “Veterans Administration, along with a veteran card so former service-people can get fast track access to mental health care“. In the US, the VA is state run organisation, set up to offer benefits to veterans not necessarilyserved by a largely private healthcare system. In the UK the health system is almost entirely state provided, so its unclear why UKIP want to set up a whole new department when they could improve access to mental health services for anyone that needs them. One reason might be that, like the Conservatives, UKIP are playing to an implicit sense that some people are less deserving of high quality mental health care.
- Offering direct access to specialist mental health treatment for pregnant women and mothers of children under 12 months of age.
- Ending the postcode lottery for psychiatric liaison services in acute hospitals and A&E departments.
- Training 800 advisors to work in foodbanks.
In a word: Weird