The Mental Health Network: fixing a Cinderella service

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The Mental Health Network: fixing a Cinderella service

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Chief executive of the Mental Health Network Sean Duggan took up post in November last year. He tells Mental Health Practice about the big issues in mental health.

‘Mental health has never been so high profile’, declares Sean Duggan – a man certainly qualified to know.

Mr Duggan, who has spent nearly 40 years in a career dedicated to mental healthcare and has worn many hats in and outside of the NHS, now occupies one of the nation’s key roles in this field.

A nurse by background, Mr Duggan took the helm of the Mental Health Network (MHN), the national body working diligently to boost the profile of mental health care, last November.

MHN membership is open to all mental health organisations offering NHS-funded services and as newly appointed chief executive, Mr Duggan is privy to every challenge and success out there.

‘There is never a day when there is not a story about mental health issues in the public domain and a lot of them are positive,’ says Mr Duggan.

Role models

‘It is fantastic when royals like Kate, William and Harry stand up and say “we are going to prioritise mental health issues, particularly for children and adolescents.”

‘And when MPs disclosed their own mental health issues a couple of years ago, it showed really good political leadership.’

But continued publicity is vital, because – as Mr Duggan would have it – mental health has always been the ‘Cinderella service.’

He says: ‘We are the service that doesn't get the investment, but we’re tackling that really well. Despite a degree of frustration, there is optimism and a real sense of motivation to change that.’

A package of reforms to tackle both ‘hidden injustice’ and the stigma of mental illness was unveiled by prime minister Theresa May in January, promising extra investment for mental health care.

Fresh opportunities

But the biggest change to the mental health landscape may prove to come from new, as yet untested, quarters.

Five-year sustainability and transformation plans (STPs) – discretely announced in NHS planning guidance in December 2015 – now need to cover all aspect of NHS spending.

The STPs require NHS organisations and local authorities in England to come together and develop ‘place-based’ plans for the future of health and care services in their area.

The plans also need to focus on better integration with social care and other local authority services.

However, STPs have prompted concerns from critics because they are being developed in an NHS environment which was designed for competition, not to support collaboration between organisations.

Greater good

Because of pressure from regulators for each organisation to improve its performance, NHS leaders may find it hard to work together for the greater good of the local population, rather than meeting the regulators’ requirements.

There has also been a lack of involvement from clinicians and front-line staff in developing the plans, according to research from health think tank the King’s Fund.

Despite these challenges, Mr Duggan says he has been encouraged to hear some chief executives remain positive about the untested approach that STPs offer.

He says that in some areas, the STPs were being chaired by mental health chief executives, or if not chaired by them, had a strong mental health voice.

‘They lost the forum where they could sit and talk to their really important partners – [through what were formerly local health authorities] – and STPs provide a new opportunity for that.

‘What they are saying is, the STP forum is actually a good [place] to get the mental health message across locally,’ Mr Duggan says.

‘Anecdotally, a number of chief executives are saying if it wasn't for the STPs, we would probably be in a worse position.

‘They give us the opportunity to speak with important partners about our plans for the future.’

Mr Duggan is also convinced that acute services – physical healthcare services –  are ‘beginning to understand’ mental health issues.

‘Putting psychiatric liaison services in cancer care clinics and long-term physical condition clinics can help outcomes and save money further down the line,’ Mr Duggan stresses.

‘We now know that mental health has got to be seen as a systemic, wider system.’

Investment

Mr Duggan welcomes funding to tackle specific areas such as perinatal mental health, crisis and improving access to psychological therapies (IAPT), but he says money is needed now.

‘The extra £4 billion in total cited in the implementation plan for the mental health Five Year Forward View won’t be enough alone,’ he says.

‘It’s going to help, but what I’m hearing very clearly from members is that this is a “five year” forward view.

‘What they desperately need now is some transformation development investment, which would come from that money, to start working on their plans with local partners on crisis.

‘To realise the Five Year Forward View, you need to start doing the planning and transformation now, it is an ideal time to sit down with STPs and say “you cannot ignore mental health”.’

Last month Mr Duggan co-signed a letter to The Times pointing out that extra money pledged for mental health services had not yet reached the ‘front line’.

He says that for areas where adequate mental health investment has not been forthcoming, providers should not sign contracts with commissioners.

‘They can’t sign – they need to re-negotiate and get the right amount of money for mental health services.

‘It’s okay for the government to say “you will have investment” but it is the local negotiations that will determine whether it is in there or not.’

Mr Duggan adds that some crucial plans, such as reducing the suicide rate, will not work without ‘basic investment’ in place.

And the picture is still one of variation.

Current contract negotiations between mental health providers and clinical commissioners are patchy across the country, according to Mr Duggan.

‘Some [providers] say they have done okay and some are worried – very worried. It varies across the country from about a £2 spend on an individual – up to £130 – a massive variation.’

Safe staffing

Mr Duggan also says the NHS Five Year Forward View plans for mental health revealed a need for 'thousands more in the workforce'.

He asks: 'Where are they going to come from? We have already got difficulties recruiting so we need to be thinking of the workforce of the future – will we require more peer support workers, more nurses, more doctors?

'The MHN – in partnership with Health Education England – has commissioned some work to look at what is the workforce of the future and this is due to be reported at the end of 2017.'

Mr Duggan says he cannot arrive at a specific number for safe staffing, but feels there are plenty of protocols to identify what safe staffing levels should be.

Mr Duggan adds that new routes into nursing, including nurse associates and nursing apprenticeship degrees, need closer examination.

'We have got to think about [these roles] and ask is it easier to attract [people] to those?'

Children and young people

Mr Duggan is keen to see local education authorities, schools and health services work together to get plans in place.

He says parenting programmes, anti-bullying programmes and group psychological therapies support for children were all proven to work well.

‘It will probably take five years to get that up and running and [by then] we would see it as standard that we have got mental health intervention in schools.’

The funding of child and adolescent mental health services (CAMHS) now can be compared with forensic secure services before they received investment, explains Mr Duggan.

‘Fifteen years ago, I was a director of mental health services and when I looked at my budget, the CAMHS service was way below the investment of all my other services, including acute inpatient units and community rehabilitation.

‘We had one psychiatrist and one community psychiatric nurse, and quite a lot of children on a long waiting list – we have brought that down to months, not years, so there has been some improvement.’

But beyond gaps in investment and workforce, Mr Duggan is keen to make sure that innovation, research and development are on the menu for his membership.

‘I’ve just come from being chief executive of the Centre for Mental Health, which has been working up the evidence as to what works well in mental health. We are very keen for the MHN to see some benefits from that and embrace the evidence.’