Rhetoric is not enough: Prove parity of esteem with action

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Beyond manifestos that present unverified claims for investing in mental health, we need a party that will give us the next biggest innovation in mental health: improving access to psychological therapies super sized, says Melinda Rees and colleagues.

The mental health challenge for our next government will be increasing access to integrated services – services that will succeed will be truly integrated at an outcomes and contractual level.

People with mental health problems still experience disjointed pathways of care, long waiting times and rarely have the opportunity to have both body and mind treated as one.

We look at the three main parties’ manifestos to investigate whether any clear leader emerges for the mental health conscious voter.

Three ways

Labour pledges to bring together physical, mental and social care services with equal priority.

Psychological therapy will be put on a par with drugs and medical treatment, NHS staff training will include mental health, and an augmented budget will be assigned to children’s mental health.

Labour’s main quantifiable aim is to ensure most patients have access to talking therapies within 28 days.

The Conservatives also pledge that mental and physical health will be equal. As well as aiming for a general increase in the provision of talking therapy, the party commits to higher access and lower waiting times.

‘The Lib Dems include the most substantial detail on their support for mental health’

Priority groups include pregnant women, children and young people, veterans and those experiencing a mental health crisis – especially those that would historically end up being detained in police custody.

The Liberal Democrats centre their pledge of parity on accident and emergency department. Departments should have high quality, evidence based mental health crisis care provision for all ages.

Furthermore, the Lib Dems have figures: £500m a year is to be spent on mental health, and £250m on the care of pregnant women and new mums affected by perinatal mental illness.

Six weeks will be the maximum waiting time for individuals seeking treatment for depression and anxiety, and two weeks will be the maximum for young people experiencing a first episode of psychosis.

Finally, the Lib Dems highlight themes of greater access to talking therapies, augmented research funding and the removal of anti-transparency block contracting.

So while the parties are broadly aligned in their advocacy for increased access to talking therapy, shorter waiting times, and parity between physical and mental health, the Lib Dems include the most substantial detail. However, both the Conservatives and Liberal Democrats’ promises for reform after 7 May might be difficult to believe given their track record over the past five years.

The real change makers

So who are the change makers in real terms?

We all know vision and mission are not enough by themselves to make change happen. We must be concrete.

Which intervention will be the most successful in treating the lack of parity between physical and mental health in the UK?

What form should this change take? And how, at the ground level, do we operationalise a good vision for mental health in the UK?

‘Improving access to psychological therapies represent the biggest innovation and investment in mental health’

A recent exemplar of an attempt to operationalise vision is the success of improving access to psychological therapies, or IAPT.

This psychological service for mild to moderate mental illness has been claimed by Labour as their baby. More recently it has been adopted by the Conservatives.

Irrespective of ownership, the therapies represent both the biggest innovation and investment in mental health in recent years.

Established in 2008, it received £340m in funding by its sixth year. Its aim was to get support to 15 per cent of all people with a mild to moderate mental illness. IAPT has shown good outcomes, with national recovery rates for mental illness sitting at 50 per cent.

Despite the success of IAPT, it is not integrated with physical healthcare. Nevertheless, it represented a bold ambition for mental health – that increased access is possible at scale.

What needs to happen next?

The fact that mental health didn’t make it into all three political manifestos until 2010 indicates its underprivileged position to date.

Its economic position entrenches this: mental illness costs England some 7 per cent of national income, and we spend only 1 per cent of national income to reduce the economic burden of illness.

Beyond manifestos that present unquantifiable or unverified claims for investing in mental health, we look for the party that will give us the next biggest innovation in mental health: the next IAPT, super sized.