In the balance: austerity and its toll on mental health services

Loneliness to be highlighted at RCN congress 2019 as ‘a real problem for all NHS staff, not just mental health nurses’

Loneliness to be highlighted at RCN congress 2019 as ‘a real problem for all NHS staff, not just mental health nurses’

Picture: iStock

Since the financial crash more than ten years ago, living standards have been squeezed, financial insecurity has risen, and the government has overseen an austerity drive that has led to cuts in benefits and public services.

Now there is growing evidence that the effect of all these is being felt in mental health services.

 1 in 2

working age people receiving benefits has a mental health problem

(Source: Money and Mental Health Policy Institute)

Socio-economic drivers are playing a significant role in rising demand for care in England, according to the latest NHS Providers report, Addressing the Care Deficit.

Worrying picture

The report includes the findings of a survey of 35 mental health trust chairs and chief executives, who identify the following external factors as affecting increased demand:

  • 98% cited: financial hardship.
  • 92%: changes to benefits including universal credit.
  • 97%: increased loneliness and isolation.
  • 95%: homelessness.
  • 91%: cuts in local services.

The survey also presents what it calls a worrying picture of the healthcare workforce, with fewer than one in ten respondents saying they are confident they have enough staff.

More than two thirds say they are worried about maintaining the quality of the services their organisations provide over the next two years.

Pressure on services

NHS Providers deputy chief executive Saffron Cordery says it is clear that social and economic pressures are adversely affecting mental health and putting even more pressure on services. Demand is well and truly outstripping supply, she says.


of mental health leaders say financial hardship is increasing demand for care

(Source: NHS Providers)

Mental health charities are particularly critical of the roll out of universal credit, a welfare reform that merges six different benefits for people of working age into one monthly payment.

Universal credit was supposed to be up and running by 2017, but is not expected to be fully operational until 2023 due to delays while flaws in the system are ironed out.

Punitive and complicated

It has been criticised for running over budget, causing delays to people’s payments and in some cases making vulnerable people worse off.

Chief executive of the mental health charity, Mind, Paul Farmer says the impact has been devastating for people with mental health problems, and describes the system as punitive and complicated.

‘It’s clear that difficult life circumstances and mental health problems are closely linked, yet the relationship between them isn’t taken into account enough,’ says Mr Farmer.

‘Making changes could make a huge difference to millions of people across the country’

Helen Undy, chief executive of Money and Mental Health Policy Institute

A Money and Mental Health Policy Institute report, published in March around the same time as the NHS Providers report, found as many as half of working-age people receiving out-of-work benefits in England have a mental health problem.

The charity’s report states this is posing problems because claimants with mental health problems struggle to navigate the system due to difficulties such as increased impulsivity, reduced concentration and poor short-term memory.

‘The benefits process is cruel. I feel powerless’

Denise Martin used to work as a mental health nurse, but had to give up in 2011 due to mental and physical ill health.

She says she has struggled with her mental health since she was a teenager and was diagnosed with bipolar disorder when she was 25.

Denise Martin

Now 49, she says her problems have been exacerbated by financial worries and having to deal with the benefits system.

‘My mental health deteriorated when I was forced to give up work. I think it was a direct response to the loss of income, social contact and vocational enjoyment, and my personal sense of purpose.’

She currently receives employment support allowance and personal independence payments for her physical problems.

Constant worry

‘The first time I had to apply for benefits I found the whole process a huge source of anxiety. I felt lost. The staff were so rude and uncooperative. I found it extremely stressful.’

But the problems do not end even after people have been accepted, she says; there is a constant worry that the benefits may be taken away.

‘When you get a strongly worded letter in large type saying “If you do not get all the evidence in a month, your benefit will stop”, it throws everything off kilter and gives you a feeling of hopelessness. The whole process is cruel. I feel powerless.’


Benefits system anxiety

In a poll of 450 people with mental health problems using the benefits system, 94% said engaging with it caused them anxiety.

Money and Mental Health Policy Institute chief executive Helen Undy says the benefits system needs to make more allowances for people with mental health problems as they may be unable to meet all the requirements, including ongoing assessments and evidence of job hunting, to keep their out-of-work benefits.

‘Making changes could make a huge difference to millions of people across the country,’ she says.

RCN mental health forum chair Ed Freshwater agrees something must be done, saying that interruptions to benefits have cost lives.

‘As front-line nurses, we are pretty powerless to support people in this kind of socially induced crisis’

Ed Freshwater, chair of RCN mental health forum

‘Economic hardship is an obvious and serious problem facing those with mental illness. Mental health problems disproportionately affect those who are worst off, and the policy on austerity has compounded this,’ says Mr Freshwater.

Ability to help compromised

£10 million

is being invested in mental health Individual Placement and Support services over two years

(Source: NHS England)

The ability of nurses to help has been compromised because staffing numbers in mental health and wider public services have been cut, he says.

‘As front-line nurses, we are pretty powerless to support people in this kind of socially induced crisis. The time taken to liaise with other services obviously detracts from time that could otherwise be spent ameliorating symptoms and working therapeutically.’

The government, though, insists that measures are being put in place to address the issues. A cross-department statement coordinated by the Department of Health and Social Care acknowledges there have been challenges in reforming benefits, but promises that these will be tackled during the phased roll out of universal credit in the coming years.

Bigger share of budget

It states that mental healthcare is a priority, evidenced by the fact that an extra £2.3 billion is being invested in the service by 2023, increasing the proportion of the budget spent on mental health.

Part of this will go on further integrating mental healthcare with services, such as those provided by council housing and benefits teams, Jobcentre Plus, Citizens Advice and charities, that can offer wider support.

‘We need to develop much better partnerships with local government and the voluntary sector’

Zeba Arif, forensic psychiatric nurse

NHS England is backing a scheme, supported by the Centre for Mental Health charity and called Individual Placement and Support, which has seen employment officials providing help alongside any mental healthcare being given.

Zeba Arif

It is also championing social prescribing, which links NHS services with community activities such as befriending schemes and arts and dance classes to address problems such as loneliness.

Forensic psychiatric nurse Zeba Arif says progress is needed quickly. Ms Arif says she is ‘extremely worried’ about the effect of social isolation in particular and has put forward a motion on the issue for the college’s annual conference in May on behalf of the outer north west London branch.

‘It is not just something that is happening to older people; younger people are affected too. Loneliness eats away at your psyche and you are more likely to develop other risk behaviours, such as drinking,’ she says.

‘This is a real problem for all NHS staff, not just mental health nurses. But I don’t think we are equipped to help. The services that used to be available, such as day centres, are no longer there.

‘We need to develop much better partnerships with local government and the voluntary sector so we have clear services to refer patients on to. It needs a complete rethink; I hope the government is listening.’

Support twinned with help to find a job

Providing employment support to people with mental health problems has become a focus for mental health services.

There are 18 ‘centres of excellence’ that provide Individual Placement and Support (IPS) services.

Employment specialists work with patients while they are receiving mental healthcare. Anyone keen to find work is referred by mental health teams. The support they receive includes advice about finding a job, preparing for interviews and speaking on their behalf to potential employers to pave the way into work.

Work and treatment

It is based on the idea that finding work is part of their recovery alongside any treatment.

More than 2,000 patients with mental health problems a year are being helped into work.

One of the most successful schemes is run by Worcestershire Health and Care NHS Trust.

It has been praised by the Centre for Mental Health charity as ‘exemplary’ and its latest figures show that three quarters of those who receive help successfully return to employment for at least three months.

More funding for placements

Worcestershire Health and Care NHS Trust employment services coordinator Paul Wilcox says the key is that IPS is part of the mental health service.

He is proud of what his service has achieved, which he says is a testament to the hard work of everyone involved.

The success in Worcestershire has helped convinced NHS England to devote more funding to expand the use of IPS services.

A total of £10 million is being provided over two years to double access to these services by 2021.

Nick Evans is a health journalist

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