Mental Arithmetic

By Russell, Vivienne | Public Finance, September 28, 2007 | Go to article overview

Mental Arithmetic


Russell, Vivienne, Public Finance


The upmarket flats at Southdown Park on the edge of Haywards Heath in Sussex enjoy stunning views over the South Downs, but they are also a stark reminder of just how much mental health services have changed in England.

Housed in a large and eye-catching Victorian building, the complex was once St Francis Hospital, the 'lunatic asylum' for the county of Sussex. Opened in 1859, and accommodating at times more than 1,000 people, the asylum was eventually closed in 1995 and sold off for redevelopment.

Back in the nineteenth century, care was often confused with confinement and asylums were forbidding, remote places where patients - or inmates as they were called - were shut away, out of sight of society. Effective treatments and therapies were unheard of and there was little, if any, hope of discharge.

Modern mental health care is a far cry from the asylum system. In the postwar era, a series of enlightened reviews and legislative changes have shifted the focus from institutional to community care. More recently, services have evolved to become more proactive and responsive, intervening early to offer home-based support and treatment in an effort to keep people out of hospital. An early and striking move of the present government was to elevate mental health, along with cancer and heart disease, to one of its three clinical priorities in 1999. A ten-year National Service Framework was implemented and the following year psychiatrist Professor Louis Appleby was appointed national director for mental health services.

And the money has followed suit It might come as a surprise to some, but primary care trusts in England spend significantly more annually on mental health almost £8bn - than they do on the other two clinical priorities. Since 1999, an extra £1.5bn a year has been injected into mental health services. This has helped to fund an increase in the main staffing groups: there are now 1300 more consultant psychiatrists, 2,700 more clinical psychologists and almost 10,000 more mental health nurses. And there are new types of mental health professional: primary care therapists - graduates who have been trained to provide psychological therapies and 'support, time and recovery workers', who help and advise community patients and their families.

But there has been controversy, too. This summer, after eight years of trying, the government finally got its proposed changes to the 1983 Mental Health Act through Parliament While campaigners admit there have been some real breakthroughs - every patient will now have a right to an advocate, for example some proposals have proved extremely contentious. These include enforced treatment in the community and a change in the terms under which someone can be 'sectioned', ie, compulsorily detained under one of three sections of the Act.

Certainly, the government's actions mean that mental health is no longer the poor relation of the NHS, says Simon Lawton-Smith, senior fellow in mental health at the influential health think-tank the King's Fund. 'Five or six years ago, people were writing articles saying mental health has always been a Cinderella service. I would never say it is a Cinderella service now, and I think credit is due to the government for that.'

He warns, however, that standards could start to slip once the National Service Framework reaches the end of its life, particularly if it is not replaced with another mechanism to keep mental health as a priority.

Other voices are less upbeat Steve Shrubb, director of the NHS Confederation's Mental Health Network, believes the service continues to lose out compared with other areas of health care.

'If you look at the incidence and prevalence of mental illness I think you would probably still determine it to be a Cinderella,' he tells Public Finance.

"There's undoubtedly been an increase in funding, but I think, in proportion to other areas of health care, it isn't that great and we do constantly have to fight to keep mental health on the political agenda. …

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