Analysis

NHS Long Term Plan: what it means for mental healthcare

Goals welcomed but leading healthcare figures share concerns about how ambitious plans will be realised

Goals welcomed but leading healthcare figures share concerns about how ambitious plans will be realised


Picture: Getty Images 

Mental health services are such a priority in The NHS Long Term Plan that prime minister Theresa May felt confident enough to predict the health service would become a ‘world leader’ off the back of it.

Unveiling the plan, she said it heralded the largest expansion of services in a generation and would deliver ‘true parity between physical and mental health’.

As had been widely trailed, the plan committed to spending £2.3 billion of the extra £20 billion the NHS is set to receive by 2023 on mental health services.

This money is being spread across new and expanded services for a range of groups: parents, children and young people, adults more generally.

£2.3 billion

extra funding pledged for mental health by 2023

What's in the plans?

But just how radical are the plans? It is clear there is a combination of new announcements and developing what was set out by The Five Year Forward View for Mental Health back in 2016.

In perinatal mental health, this means expanding the reach of specialist perinatal mental health services from 12 months after birth to 24 months, offering assessments to fathers whose partners are receiving support, investing in specialist mother-and-baby units and expanding outreach clinics that combine maternity support with psychological help.

For children and young people, the plan makes an explicit commitment to increase spending on their services more quickly than is being invested on adults.

It states that this will pay for school and college-based mental health support teams with the aim of ensuring up to one quarter of the UK has access to them by the end of 2023 and better access to eating disorder support and child and adolescent mental health services, for which a new four-week waiting time target will be piloted.

A new 18-to-25 service to support the transition of young people into adult care will also be developed.

Long overdue


Anne Longfield

Children’s commissioner for England Anne Longfield says all this is long overdue; currently fewer than one third of children and young people with a mental health condition have NHS support.

Research by Ms Longfield's office shows just £700 million of the budget goes on children and adolescent mental health services and eating disorders support; by comparison, services for adults receive 15 times more, even though children represent one fifth of the population.

The research suggests an extra £1.7 billion are needed to bring spending in line, which is clearly unfeasible in the next five years.

Ms Longfield predicts the plan will improve access, but says it will still leave ‘thousands of children missing out on treatment’.

‘The government must be more ambitious to ensure every child who needs support receives it, when they need it. That will require policies like an NHS-funded counsellor in every school to identify and tackle problems early.’

Community focus

For adults, it is a similar story. As announced previously, the reach of improving access to psychological therapies (IAPT) services is being expanded to 1.5 million by 2020-21, up from 1 million last year.

A four-week waiting time target for access to community mental health teams will also be trialled.

Meanwhile, the multidisciplinary community teams being created by the wider £4.5 billion investment in primary and community care are also expected to include input from mental health staff alongside district nurses, social care workers, physios and GPs.

Centre for Mental Health chief executive Sarah Hughes says the emphasis on the community is particularly welcome.


Sarah Hughes

‘For too many years, community services have been ignored in national strategy and policy and in many areas their capacity has fallen while demand for their help has gone up.’

She says this has led to too many people being admitted into hospital ‘far from home’.

But she says the plan has been undermined by applying only to the NHS.

‘Good mental health support relies on effective social care working. It requires good housing, fair income entitlements and reform in the criminal justice system. Without investment in public mental health, we will continue to miss opportunities every day to promote better mental health for all. Funding cuts to local authorities have held them back for too long.’

A comprehensive package of support was also set out for crisis care. By 2020-21, 24/7 community-based crisis care should be available across the country and all hospitals should have an all-age mental health liaison service, the latter becoming 24/7 in the following years.


Sean Duggan

Vital progress

Meanwhile, crisis support should also be made available through the 111 service by 2023-24.

Sean Duggan, chief executive of the Mental Health Network, which represents managers, says the plan will help ensure ‘vital progress’ is made.

But he says: ‘There are challenges to achieving this bright vision. The mental health sector has been stung particularly hard by the workforce shortages.’

Latest figures show 14% of mental health nurse posts are vacant.

The government has promised that a workforce plan will be published soon, and Health Education England and NHS Improvement have been tasked with developing a strategy.

Appointed too soon?

Primary memory nurse Kate Hendy fears the shortage of staff will lead to people being appointed to roles for which they are not ready.

‘I’ve worked in the NHS for nearly 40 years, in a range of jobs, and the thing that worries me is making sure the extra money we are getting is used wisely.

‘In areas that are particularly hard to recruit to, there is the risk that new services get created quickly and people get appointed without the right skills to do the job.

‘It looks good at first, but is not effective in the long term. You see some services that are really badly managed .’

Rotation schemes


Catherine Gamble

1 in 8

children in England aged 5-19 years has a mental health disorder

(NHS Digital 2018)

RCN mental health professional lead Catherine Gamble agrees staff shortages are a problem, saying that community posts will be particularly difficult to fill.

‘There is a need to think more creatively about how to make working in the community more attractive. We have to get past this outdated notion that nurses need to gain experience in inpatient settings before working in the community.   

‘Rotation schemes between hospital and community settings can hold the key to overcome this and to ensure nurses get the skill sets and experience to work in both.’

She would also have liked to see more on how to improve care for people with severe long-term mental health conditions, saying there was ‘insufficient detail’ on how to support them.

Her overall verdict? ‘The plan is very good on what it wants to achieve, but the challenge is how. That is missing.’

Investment in mental health services

Hospital psychiatric liasison

Birmingham and Solihull Mental Health NHS Foundation Trust’s psychiatric liaison service provides 24-hour support to five hospitals.

There are around 90 staff in the team and more than half of them are nurses. The service was launched in 2009 and now sees around 1,500 patients a month in emergency care, in clinical decision units and on wards.

This arrangement means a patient’s mental health needs can be dealt with alongside their physical health needs.

To help improve care, the service has set up a psychiatric decision unit. It is sited away from the emergency department at one of the trust’s mental health centres to help reduce admissions.

Patients are not kept there longer than 12 hours, and staff provide them with food and drinks while assessing what support they need.

Integrating employment and mental health support

Providing employment support is seen as a priority for mental health service providers because it can help prevent problems worsening.

Just over a year ago, Leicestershire and Rutland’s improving access to psychological therapies (IAPT) service launched an employment advisory scheme.

Patients who are judged to need help returning to work are referred to the team of employment advisers.

They are initially assessed by these advisers over the phone and then appointments, face-to-face or on the phone, are arranged.

The advisers can liaise with the individual’s employer to help discuss policies and enable a return to work. This support is carried out alongside talking therapy.

Senior employment adviser Ajay Maisuria says: ‘The principle aim is to create a culture of prevention and early intervention to make sure people get timely access to support to avoid long-term unemployment.’

Mother-and-baby mental health unit

One in five women will experience a mental health problem during their pregnancy or in the first year after birth.

As part of NHS England’s national investment in perinatal mental health services, Devon Partnership NHS Trust has been given funding to build a new mother-and-baby unit.

This is due to open later this year. In the meantime, the trust has repurposed space at one of its sites to create a temporary four-bed unit.

It is said to have transformed the care provided. Previously women with serious mental health problems had to travel hundreds of miles out of area to obtain care or had to be admitted into an inpatient mental health facility and accept being separated from their babies.

The unit has about 30 staff including doctors, nurses, nursery nurses, occupational therapists, psychologists and peer support workers.

Those admitted have experienced a range of serious mental health issues, including severe depression, anxiety, obsessive compulsive disorder and post-partum psychosis or relapses in pre-existing mental health illnesses.

The unit is supported by outreach practitioners. They cover Cornwall, Devon and Somerset to provide specialist support once women have been discharged.

 

Further information

NHS England (2019) The NHS Long Term Plan

NHS England (2016) The Five Year Forward View for Mental Health

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