The coalition says the right things on mental health. But glossy-brochure commissioning threatens a long-term catastrophe
Recent announcements that the government is planning to invest �400m in mental healthcare are confusing. While it is encouraging that the government is explicitly prioritising mental healthcare, the announcements contrast starkly with simultaneous cuts to mental health and social care. Its intention also seems at odds with the likely results of proposed commissioning restructuring, which mean that mental health services, among others, will be bidding for tenders with GP consortiums, competing with private "willing providers".
The Department of Health's No Health Without Mental Health, published in February, recognises the importance of mental healthcare and cites the prevalence of mental illness: one in four people will experience a mental health problem and one in a hundred severe mental health difficulties. Mental health is a spectrum, and while we will probably all have times in our lives when we will experience extreme emotions and difficulties coping with the everyday, for some people these difficulties are longer term. I sometimes wonder whether the stigma around mental illness relates to just how near mental health problems can feel and a fear of thinking about these things because they are too close for comfort.
Child and adolescent mental health services are even less frequently discussed, but are, in my view, one of the most hopeful areas of provision. To get in early and help a family to think about and overcome problems before they become chronic and severe is an exciting opportunity, and one that results in savings longer term. The government report acknowledges the importance of child and adolescent mental healthcare, citing statistics that one in 10 children between five and 16 have a mental health problem and half of people with long-term mental health needs first experience these before the age of 14.
No Health Without Mental Health explains some of the related financial and societal costs of mental ill health. We know that mental health problems in childhood, for example conduct disorder, correlate with later offending: 90% of prisoners in the UK are estimated to have a diagnosable mental health and/or substance abuse problem. If we can target interventions to prevent longer-term behavioural difficulties, we are not only improving mental health and wellbeing but also potentially reducing criminality. Giving children coping strategies for managing their emotions and behaviours early on means fewer mental health difficulties as adults and a greater chance of engaging in meaningful interpersonal relationships and being able to enter the world of work. So far so good ? the government is saying all the right things.
However, the government seems to suggest that localising the commissioning of mental health services will help to improve services. I see little rationale for this. The proposed changes to commissioning structure mean that GPs will be responsible for choosing and buying services for their local area: this means a postcode lottery dependent on the expertise of the GP. Most GPs have not had specialist training in mental healthcare and do not necessarily know what services are available or helpful to their local communities; and this will involve time and money on marketing and selling their services that could be spent with and on patients.
While the private sector is familiar with this ? as their glossy brochures often show ? the NHS is relatively inexperienced in spin and sales. The shift to this type of tendering will mean a drive towards being able to generate short-term outcomes to prove a service's worth. While outcomes are important and are routinely produced by NHS audits, services often result in long-term positive outcomes, which are hard to quantify. Child and adolescent mental healthcare is a prime example of this. Without complex and costly economic modelling it is hard to estimate the long-term gains of, for example, parenting classes.
The report also totally omits any mention of the job losses and efficiency drives that have been affecting public services. Undoubtedly there are possibilities for savings and streamlining, but starting again and giving commissioning powers to physical healthcare professionals without specific training in either commissioning or mental health seems to be a huge error. The short-term effects of this will be messy, and it is likely that commissioned services will be the ones with the best sales pitch, but not necessarily the best experience, skills and ability to liaise with other services. Even more concerning are the longer-term effects, which could be catastrophic for subsequent generations.
The coalition is right to highlight the importance of mental health, but wrong to address it by a restructuring that seems based on an ideological shift towards a privatised healthcare system.
Source: http://www.guardian.co.uk/commentisfree/2011/mar/29/coalition-confusion-mental-health
Ron Paul Colin Powell Vladimir Putin Muammar Qaddafi Condoleezza Rice
No comments:
Post a Comment