Chief Executive of Mind, Paul Farmer CBE, discusses the current state of mental health within the UK, and the role Mind plays in driving change.
It’s a much-quoted statistic, but it remains true that one in four of us will experience a mental health problem this year. Over the past decade we’ve seen an overwhelming shift in how we think and talk about mental health as a society. Since Time to Change – the awareness-raising campaign run by Mind and Rethink Mental Illness – began in 2007, there has been a 9.6% improvement in public attitudes, which makes for 4.1 million people with more positive views on mental health.
Now that stigma is starting to shift, more and more people are coming forward to seek help and we are beginning to see the full and true scale of need for mental health support. But that increase in demand is putting further pressure on a system that has never been given the kind of resource that it needs. Mental health has been neglected for decades; by government, by public services and by society as a whole.
The impact of this sustained underinvestment means that for too long people with mental health problems have not had the same right to timely, high-quality treatment that we all expect if we have a physical health problem.
Five Year Forward View for Mental Health
In 2015 I was asked by NHS England’s chief executive, Simon Stevens, to chair the mental health taskforce. Made up of health and community leaders and experts in mental health, including doctors, charities, service users and their families, we were tasked with developing a new five-year national strategy for mental health in England.
Having consulted with over 20,000 people who live with a mental health problem or work in the mental health sector, we produced the Five Year Forward View for Mental Health and called for one million extra people to get access to support for their mental health problem by 2020/21. Our report also recommended, among other things, 24/7 care for people in a mental health crisis, for people’s mental and physical health to be treated equally, for all areas of society – such as schools, workplaces and community organisations – to promote good mental health and contribute to the prevention of mental health problems, and for urgent action to address the disparity in people’s experiences of mental health services based on ethnic background.
In accepting these recommendations, both the NHS and UK government marked a watershed moment for mental health in England – the first time that a strategy has encompassed all branches of mental healthcare and support, for all ages. With the promise of an additional £1bn (~€1.1bn) a year from the NHS, there is considerable momentum behind these plans to start building the mental health services we need to carry us in to the future.
We are almost two years in to the delivery of the Five Year Forward View for Mental Health and early signs of progress are positive. But we need to keep up the pressure to ensure promises are fulfilled, money reaches the front line and, ultimately, the day-to-day experiences of people accessing support for their mental health improve. However, it’s no secret that the NHS is under significant pressure at the moment. In November, Stevens raised genuine concerns regarding whether or not this plan could be delivered if significant investment in the NHS from government wasn’t forthcoming over the next few years.
Thankfully, the NHS has since stated clearly that “we need to protect the planned investment that we have in mental health”. It is, however, a timely reminder of the need to hold government and the NHS to account on the Five Year Forward View for Mental Health. While the NHS is faced with many difficult decisions, it is right to invest in mental health – the sooner people who are struggling get the help they need, the less likely it is that they will need more intensive and expensive support further down the line. It’s also important to remember from how much of a disadvantaged position we start. The Five Year Forward View for Mental Health will only bring mental health services up to a basic standard, to start the long road to achieving the ‘parity of esteem’ – equal priority with physical health – that both the government and the NHS have repeatedly said that they are committed to. It’s vital that this plan is delivered, but it will take decades more of sustained investment to get to a point where everyone gets the support they need, when they need it.
Thriving at Work
The Five Year Forward View makes clear that all areas of society have a responsibility to promote good mental health, as we know that preventing mental health problems in the first place is much more effective than having to pick up the pieces further down the line. Our experience in the workplace is, for many of us, a key component when it comes to managing our mental health and wellbeing. We also know that people perform better at work when they’re well-supported and feel valued by the people they work for.
Despite this, the importance of mental health at work has been overlooked at the expense not only of people, but also the companies we work for and the economy. The extent of the problem is stark; 300,000 people with a long-term mental health problem fall out of work every year, while issues relating to mental health in the workplace cost the UK economy up to £99bn each year.
This year the Prime Minister Theresa May commissioned Lord Dennis Stevenson – who was one of the first senior business leaders to speak openly about his own experiences of depression – and I to lead a review of employment and mental health. After working with business leaders from across the different sectors we produced the Thriving at Work report, which introduced six mental health core standards that we believe all employers should be putting in place:
- Produce, implement and communicate a mental health at work plan;
- Develop mental health awareness among employees;
- Encourage open conversations about mental health and the support available when employees are struggling;
- Provide employees with good working conditions and ensure they have a healthy work-life balance and opportunities for development;
- Promote effective people management through line managers and supervisors; and
- Routinely monitor employee mental health and wellbeing.
There are also further recommendations for large businesses, and specific recommendations for the NHS and public sector, which we are pleased have already been welcomed and agreed by government. We now need to see a real cultural change with a willingness from employers to properly address the mental health needs of the national workforce.
We know that lots of employers are open to improving mental health and wellbeing in their workplaces, but might have been unsure on where to start. Of course, the implementation of these standards will differ greatly from one employer to another and across sectors, but I believe that the mental health core standards, along with the ever-increasing awareness of mental health, lay the foundations for change that will transform people’s workplace experience across the country.
Mind’s role in driving change
Having chaired each of these independent reviews, at Mind we now have an important role to play in helping to drive these plans forward and support making them a reality wherever possible.
The Five Year Forward View for Mental Health has been accepted by the UK government, the NHS and all of the national bodies that deliver services and support. But it’s up to those who commission and deliver services in each area to make it happen, with national leadership and support. Every three months clinical commissioning groups publish extensive data to show whether they’re on track with the plan’s delivery, and this transparency allows us to hold the system to account at every level.
There is also a key role for our local Mind network, made up of more than 130 charities providing specialised mental health support in their communities, and others in the third sector. Given the significance of the local picture in delivering the Five Year Forward View for Mental Health, the voices of local Minds and others – as experts in the delivery of local high-quality services – are hugely important, and we have been supporting our network to play their part in delivering lasting local change.
On the subject of workplace mental health, at Mind we have been working with employers since 2010, supporting them to put in place better support for employees. We now have a dedicated Workplace Wellbeing Team, working with employers at whatever stage they’re at on a journey to a more mentally healthy workplace. We provide training and consultancy on everything from mental health awareness and line manager training to emotional intelligence and resilience. We have also launched our Workplace Wellbeing Index – a new benchmark of best policy and practice. With growing recognition of the importance of getting this right, we need to start embedding best practice into organisations of all shapes and sizes, and we’ll continue to use our experience to help employers achieve this.
While workplace mental health is a key part of the current landscape, not everyone is in work or in a position where they’re able to work. Almost two thirds of people with more severe mental health problems are unemployed and, while for many the right kind of work can have a positive impact on mental health, for some it simply is not an option.
Pressuring people to move closer to work when they’re simply too unwell is cruel and misguided, and that’s why we continue to campaign for a benefits system that truly reflects the needs of people with mental health problems. We need to ensure that anyone who requires it can access financial support from the welfare system to help manage the extra costs of having a mental health problem. The state should be there to support people to stay well and live independently, free from the fear of sanctions if they are too unwell to work.
We’re also campaigning to improve the state of primary care, helping people to find the words to talk to their GP about their mental health and get the support they need, while pushing for better and more rounded training on mental health for primary care staff. We’re also helping the people delivering primary care – GPs, nurses, pharmacists and their colleagues – with their own mental wellbeing. Only when primary care professionals are well and supported can they provide the best care for their patients.
Elsewhere, we continue to campaign on crisis care, both in relation to the Five Year Forward View for Mental Health commitments on crisis care and providing people with the information they need to know their rights and make informed decisions about their care. We also recognise the importance of care from outside the health sector, campaigning on issues such as housing and isolation that are so closely linked to mental health.
With all of the attention that mental health has been getting in recent years, you might think that we’ve got to where we need to be. But we need to see that increased awareness transformed into tangible change that will improve people’s day-to-day lives. We’re now at a tipping point with mental health – a once in a generation chance to get things right – and the next few years will be pivotal. We need to keep the pressure on to ensure that promises are kept. At Mind, we won’t give up until everyone experiencing a mental health problem gets support and respect, and there is still a long way to go.
Paul Farmer CBE
Mind, the mental health charity
This article will appear in Pan European Networks: Government 24, which will be published in January, 2018.