A Political Football

A couple of months ago I wrote in my post Mental Health Matters about the way the Clinical Commissioning Groups (CCGs) were diverting the ring-fenced funding they had been given for mental health services into other treatments, against the express instruction of the government. To date, this post has received 38 ‘likes,’ the most for any of my posts, so this must have struck a chord with many people. Just for clarification, I’m using the phrase ‘many people’ in its true sense, not in the way Donald Trump uses it to tell the UK government that it should appoint a racist buffoon as its US Ambassador.

But I digress (it was too easy a target!). Last Friday The Times newspaper ran a front page story headed ‘Nine health secretaries attack government for failing mentally ill.’ The piece related to this letter which the paper carried on the same day:

Copyright Times Newspapers

Copyright Times Newspapers

It refers to this as ‘an unprecedented intervention,’ coming, as it did, from former Secretaries of State for Health from across the UK political spectrum. It goes on to say “the decision…to speak out reflects wider concern that people with mental illnesses are neglected in a way that would never be accepted for patients with cancer or other physical conditions.” I agree wholeheartedly with this, but nevertheless this letter causes me serious concern. Not so much in the letter itself which, taken at face value, is fine, but more in the motivation of those who signed it. In effect, the letter is challenging the government to deliver on promises made – it is making a political statement in a political game, and is using mental health as the football in that game.

But is the government really to blame in this case? Don’t get me wrong, I am not a supporter of our government and the direction it is taking, but as my previous post showed, they had been making the money available, but the CCGs were choosing to ignore its purpose and use it to commission other services instead. As I also said in that piece, the CCGs were created by the wholesale changes made by the government in 2010, despite the fact that this had not been mentioned in any election manifesto, as they would supposedly be a more informed group to commission services. The Health Secretary who brought in these changes was Andrew Lansley, who is one of the signatories of the letter to The Times. Either the man is totally lacking in self-awareness or he is now getting his revenge for being sacked from the job and being ‘promoted upstairs’ to the House of Lords when even the then Prime Minister could no longer make excuses for his monumental incompetence. This Times cartoon from that time sums him up perfectly:

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Blaming solely the government for the failure of support and funding for mental health services is wrong. The CCGs should also be in the firing line – arguably, at the front of it. The only thing letters like this will achieve is to provoke a political argument and, while that goes on, nothing will be done to give the additional support to mental health services that they so desperately need. It could be argued that the outcome of this letter might be that the government will tell the Department of Health to investigate how funds are being spent on the commissioning of services. For all I know they will already have done that after the report two months ago – and in any event, oversight of the CCGs and how they commission services is a regular part of the DoH’s responsibilities. Either way, we don’t need any more debate, and a letter from a bunch of people who can be too easily dismissed as being self-interested isn’t the answer. Mental health services in the UK have been under-funded for decades, and the CCGs need to recognise this. I don’t envy their decisions, as to allocate money to one service means taking it from another. But it is a question of priorities: they have been given money for mental health treatments and have chosen to use it for other services instead. This is wrong, and they should be called to account for it and required to invest in better mental health services.

The NHS in general, and mental health services in particular, have been kicked around for far too long. Turning them into a political football won’t do anything to improve that. As long as this situation continues, I fear for the future of mental health services in this country. We need someone in a position of influence to lead action on this, not write politically-motivated letters to newspapers.

 

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More bad news

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Copyright Times Newspapers – click to enlarge

Another week, another scary story in the newspaper about mental health. The statistics which lead to this headline are very worrying indeed. The high percentage of young women who suffer from a mental illness, and in particular the number of them who turn to self-harm, should be seen by all as a sign that we are failing our young people. As I mentioned last week in my post Mental Health Matters this issue does not appear to be being given the priority it deserves by the Clinical Commissioning Groups, who use the funding they are given to buy the services needed by the populations they serve. As always, they are treating mental health as being of lesser importance than physical health. Spending on Child and Adolescent Mental Health Services (CAMHS) is even worse: for some reason, CAMHS services are seen as some kind of poor relation within the context of mental health services. Surely, it isn’t rocket science to understand that if our children grow up with good mental health and are well supported in this, they will take that with them through their lives, is it? This survey was carried out on behalf of the NHS by the well respected National Council for Social Research, and it is to be hoped that everyone involved will take notice and take action as a result of these findings.

Apart from the headline and the story, what interests me about this piece in The Times is the focus they have taken to create their story: the full report runs to 405 pages, not including the data tables, so presumably there is much else in there which needs to be addressed? Tucked away towards the end of the article is mention of the fact that whilst men are much less likely to suffer from a mental illness or to have suicidal ideation, they are much more successful at taking this to its tragic conclusion. I’m not trying to downplay the importance of the situation in relation to young women – far from it! – but the fact that even in a brief report such as this The Times can draw some attention to the male suicide issue says to me that there is a huge amount that needs to be done in this country and, I suspect, elsewhere. I have downloaded the full report, which is freely available here to anyone who is interested.

I make no apology for writing this brief post which is, in effect, a continuation of where I left off last week. The more information that becomes available, the more widely it is shared, the greater the awareness of one of the major issues affecting society today. In these days of Brexit, immigration, racism, choosing the least bad of two undesirable Presidential candidates, international terrorism and many other important issues, it is easy for mental health to be lost in the tide of news. I, for one, don’t accept that this should be, and will add my own small voice to those who are trying to do something about this. We can only achieve acceptance of mental health as a major issue if we can widen the debate about it – this is the only way I can do this, but I know that I’m one among many who feels this way. Lots of you tell me that in response to my posts and the fact that I have had more new followers for this small blog in the past week, when I posted three times on mental health, than at any time since I began speaks volumes to me.

Mental Health Matters

At the risk of repeating myself, I started this blog to share my experience of depression in the hope that it would help others. I worked for more than 20 years in the NHS for a large mental health Trust and although I haven’t blogged much about it recently mental health is still a subject about which I care deeply. Last week there was a story in The Times which alarmed me about the way mental health is supported, and which I felt I had to share. This post is about the situation in England but I suspect that the issues are common to many other countries around the world.

A little bit of background: when the Tory-led coalition government came to power in 2010 they embarked on a major restructuring of the NHS. There had been no mention of this in their manifesto, but that’s another story. One of the key changes was the creation of Clinical Commissioning Groups (CCGs) which were intended to put the power in commissioning health services into the hands of health practitioners (largely, General Practitioners, i.e. GPs) as this would, in theory, mean that those who knew best would be commissioning the services needed by their local population. There is an ongoing debate about how effective this has been and a range of other issues too, but I’m not going there. What interests me at present is this:

Copyright Times Newspapers' Click to enlarge

Copyright Times Newspapers. Click to enlarge

Apart from the fact that they are going against Government policy and misusing their funding, I am horrified that so many CCGs fail to see the importance of providing good mental health services. These are supposed to be the experts, those who know best. It beggars belief that they can be so ignorant. The Times commented further on this in their editorial section:

Copyright Times Newspapers. Click to enlarge

Copyright Times Newspapers. Click to enlarge

I’m with them 100%. The figures speak volumes, both in terms of the abuse of power these CCGs are engaged in, and of the pressing need for more investment to be made in mental health services. I started working in mental health in 1993 and even then it was recognised by many to be a Cinderella service, pushed into a corner and under-supported. And children’s mental health services were seen as the poor relations within that! Finally, it seemed, we had a government that was doing more than say nice words about this, but they are being let down by the very people who they thought would be best qualified to enact their wishes.

There have been many studies which have shown how good mental health can be of benefit to physical health, and vice versa. One of the problems in these days of evidence-based treatment is in measuring the effectiveness of mental health care. With a physical illness it is relatively easy to assess, likewise with injuries, such as broken limbs: there is clearly visible evidence available in such cases. But this is not always true of mental illness. To use my own case as an example, the diagnosis I was given nearly five years ago was treated, I returned to work until I retired, and since then I have not felt any recurrence of the original symptoms. So, does that mean I am a successfully treated case? Probably, as I’m no longer costing my local CCG anything for treatment, but who is to say that I am ‘cured’ or whether that is even possible? And does that mean that my local CCG shouldn’t spend the money it has been given to treat people like me on people like me, that it can choose to use it for other treatments? I think not!

People with mental illnesses have for far too long been discriminated against and stigmatised. Whilst this may be recognised by some, far too little can be done, both in terms of treatment and education, as the funding just isn’t available to do all that is needed. I know that the NHS in general is underfunded and that CCGs are under severe pressure to balance their books, as are provider services, but to take money away from the most needy part of the service is totally unacceptable, particularly when that money is supposed to have been ring-fenced for those services. Are the CCGs deciding on their service commissioning on the basis of discrimination and stigmatisation? Who can say, but it could be argued that they are showing signs of doing this. If the supposed experts don’t take mental health seriously, what hope is there that the general population can come to recognise the need to do so?

(Footnote: I am having a week of mental health awareness posts. This is my second, after yesterday’s reblogging of It Asda Be from three years ago. More is to come.)