Today sees the latest in a series of major government and NHS announcements on mental health over the last few years. Since the passage of the Health and Social Care Act 2012, which wrote ‘parity of esteem’ for mental health (equal treatment with physical health) into law, there has been an increasing focus on how to make that equality a reality in the NHS.
Over the last year, an independent taskforce has been working to create a mental health strategy for the NHS in England. Chaired by Paul Farmer, Chief Executive of Mind, the taskforce brought together health and care leaders, experts by experience and clinicians, to set out a roadmap for improving services over the next five to ten years.
Today we see the culmination of all this work, with a commitment to an extra £1bn investment per year by 2020. CentreForum has established a commission on child and adolescent mental health, chaired by former minister Norman Lamb MP. So, in that context, what does today’s announcement mean for children and young people?
The taskforce has adopted a ‘life course’ approach to mental health, covering care for new families, through the early years, school, adulthood and older age. Nevertheless, given the focus on children in the last parliament, this report inevitably covers adult care in more detail. The taskforce endorses the findings of last year’s ‘Future in Mind’ report, which was announced alongside £1.25bn of investment for child and adolescent mental health services (known as CAMHS). For these services, the priority now is on implementation, rather than new policy.
There are, however, some new areas to highlight in today’s report. Most significantly, the taskforce calls for an access and waiting time standard to be developed for CAMHS in 2016/17. Given the long waiting times in some services and that an estimated 75% of children with mental health problems are not getting access to care, this is an important reform.
The taskforce also calls for mental health support in A&E departments to cover all ages. This is significant, as many of these services have previously been focused on adults. The opening hours of these services are also being extended, another positive move, given that a crisis can happen at any time. True equality in crisis care will only happen when these services are available 24/7 in every area and where there is ongoing support to refer people to. The taskforce therefore also recommends the development of appropriate community based crisis support for children and young people.
The taskforce calls for better perinatal mental health care for pregnant women and new mothers. This support will help ensure that these children have a healthy start in life. At the other end of children’s services, the report announces a trial of specialist inpatient care for those aged 16-25, recognising that this age group has often fallen through gaps in care in the past.
The taskforce calls for an end to ‘out of area placements’ where people are sent miles away from home for care. Given there were more than 50 days since last April when there were no inpatient beds available at all in the South West, it is vital that this practice is tackled for children as well as in adult care.
Other new proposals contained in the taskforce report include an expansion of evidence-based parenting programmes, the importance of which were highlighted in the Prime Minister’s recent speech on life chances, and a review of the particular mental health needs of vulnerable groups. There is strong evidence that certain life experiences (such as being in the care system) are risk factors for the development of mental health problems so a focus on these groups is a sensible priority, and the idea of personal budgets for these children is an interesting one.
The priority now will be implementation in local areas. The taskforce calls for the ‘Local Transformation Plans’ (which have been developed since the publication of ‘Future in Mind’) to be refreshed and rolled into the new five year plans which each local area is developing this year. This move will drive a continued focus on the transformation of care for children and young people and will ensure that this is integrated into the development of wider local strategies. This approach does, however, create the risk that the transformation of CAMHS will be sidelined alongside other key priorities (such as the sustainability of local hospitals). It will be necessary to keep a strong focus on this process of transformation at national and local levels in the years to come. Recommendations in the taskforce report on better metrics, waiting time standards, new payment mechanisms and transparency of expenditure should help the process of assurance. The taskforce also rightly calls for strong governance arrangements.
CentreForum’s commission aims to explore and understand progress in transformation of mental health care for children and young people across England. We will focus on analysing the process of implementation of this important policy: identifying the barriers to progress and developing solutions to address these concerns. The Commission will report on its findings this summer. The recommendations in ‘Future in Mind’ and today’s report are wide ranging and ambitious: the priority from now on will be successful implementation.