How the Health and Social Care Act broke down mental health services

Jeremy Corbyn's creation of a ministerial post dedicated to mental health was welcome and long overdue. This week we're looking at some of the problems facing mental health services in the UK, and what can be done


At the mental health charity Mind’s conference event yesterday, the newly appointed shadow minister for mental health Luciana Berger described how the good will that UK mental health services have been running on for years is ebbing away.

Since the Health and Social Care Act introduced the concept of ‘parity of esteem’ between mental and physical health care in 2012, there has been a widening gap between the rhetoric and reality of this supposed equality.

This is because the very same legislation also fragmented all aspects of the health service to the point that access to mental health care is, as the panel put it, ‘almost nonexistent’ for many people.

Because there are now so many bodies involved in administrating healthcare, it is difficult for decisions or changes to be made expediently. The Health and Social Care Act disrupted what is known as the ‘patient pathway’ – the route a patient takes between first GP contact and the completion of their treatment in whichever department they need for their condition.

Because the HSC Act increased competitive tendering in the NHS, providers are more mixed than ever. This has led to the pathway becoming increasingly convoluted and made it difficult to trace accountability.

So while the National Commissioning Board is responsible for commissioning primary care, community and hospital services are commissioned by a variety of clinical commissioning groups (CCGs) supported by a commissioning support service. Sound confusing? It is, and it is damaging standards of care.

York Central MP Rachel Maskell gave the example yesterday of Bootham Park Psychiatric Hospital in York, which has just been ordered to close. In 2014 inspectors found a number of serious problems with the facilities, not least a prominent old sign reading ‘Lunatic Asylum’.

Inspectors found ligature points and doors which could be barred, presenting serious suicide risks. They inspectors ordered urgent improvements but when they returned earlier this month found these had not been made. According to Maskell this was partly because there are so many different bodies involved in the running of the hospital that the decision-making process slows to a halt.

Fragmentation also means that it is incredibly difficult for someone with a mental health problem to ‘get in’ to the system to begn treatment. GPs may be unsure which services are available locally, leading patients to ‘fall through’ the gaps, passed off as ‘too severe’, ‘not severe enough’, or not fitting age criteria.

Somebody in crisis – who has attempted suicide, for example, or been hospitalised for an eating disorder – will always be given the emergency treatment they need. But this will often be followed up by the news that there is a year-long waiting list to see a counsellor. This is hopeless. It puts people’s lives on hold, leading to relapses, job losses and worse.

The lack of integration of services also means that a  patient’s treatment is often left to the discretion of the first point of contact. Some GPs will put medication at the centre of treatment plans, whereas others will be more likely to prescribe a ‘talking cure’. There needs to be integration of these services so that nobody misses out on receiving the treatment most suitable for them.

Of course, long waiting lists are also down to a lack of funding. Under the coalition there was a £50 million cut to children’s mental health services, and a loss of 3,300 specialist mental health nurses and 1,500 mental health beds.

Research by the charity Young Minds found that over one in in five local authorities  have either frozen or cut their CAMHS budgets every year since 2010.

Despite a government pledge to increase spending on mental health, freedom of information requests made by Labour earlier this year suggested that 50 of the 130 CCGs who responded plan to reduce the proportion of the budget they spend on mental health for 2015/16.

The Conservatives have yet to practice the parity of esteem that they preached. This is an opportunity for Labour to step up and show that they still understand healthcare as a system that prioritises patients, not market competition.

Ruby Stockham is a staff writer at Left Foot Forward

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