Promises, promises: Is “Closing the Gap” going to help mental health services?

On Monday, Nick Clegg announced the government’s new mental health action plan, “Closing the Gap”.

In a document of broad scope, twenty five priorities are listed as targets for improvement in mental healthcare provision, including the commissioning of high quality services in all areas, easier access to talking therapies and the establishment of waiting list standards.

The acknowledgement of the need to improve mental health services by any politician is a clear positive step. For such a policy to attract the Deputy Prime Minister himself is even better. But the reaction from mental health professionals has been at best cautiously muted, and at worst dismissive.

This is because many of us have seen this all before. It’s been three years since the government’s last relevant policy, No Health Without Mental Health, which made simple promises like “more people with mental health problems will recover”. Since then, we’ve lost nearly 1 in 10 mental health beds, seen our wards packed to over 100% capacity and seen waiting lists for talking therapy climb to over a year in some areas.

Mental health funding, which was already barely 60% of what the morbidity burden of mental illness dictated it should’ve been, has been cut in real terms for the last two years. Staff from one Mental Health Trust have felt compelled to start a campaign against decimating cuts that they see as overtly dangerous to patients.

So as much as we crave change, we’ve learnt not to expect it, no matter how clear the message.

“Closing the Gap” in itself is well intentioned, but light on detail in places – particularly figures and timeframes. Although the pledge that “no-one experiencing a mental health crisis should ever be turned away from services” is a laudable one, it’s also easier said than planned and paid for. From the frontlines of mental health, where we often have to send patients over 200 miles to access something as straightforward as a hospital bed, it’s not hard to see how revolutionary the changes would have to be. We don’t even have the resources to see half of the people who come to A+E following an episode of self harm, let alone treat them thoroughly. To fix these problems in anything less than decades, with anything less than billions of pounds, would be akin to magic.

The promise of “an information revolution in mental health” seems a touch optimistic too, when the primary method of information transfer between mental health hospitals is still fax.

One action point – that mental health patients should be offered a choice of providers – resonated particularly sardonically. With so many people struggling to obtain an appointment to be seen by the sole local service, the political push to offer a choice seemed sadly out of touch to some. The difference in waiting times between mental and physical health is amongst the most prominent failings of our system, and though instituting waiting list standards is a positive step toward equality, reducing the size of the lists is a far pricier conundrum.

However, the focus of our doubt should not be the lack of clear funding promises accompanying the policy. The common denominator of success in mental health isn’t funding – it is caring. Wise investment would only serve as a means to employ more staff, to train them more comprehensively, and allow them more time to care for their patients. Such a process takes years, is not easy to legislate for, and has been consistently overlooked as a vital part of establishing high quality care. Yet again, the value of good staff with high morale has gone unnoticed.

It’s not that we aren’t grateful for the attention shown to mental health by Clegg. But politicians no longer have the right to expect commendation simply for showing an interest in us and making us promises. We’ve been fooled before, many times, and now we’re not so easily taken in. When we see results, we might begin to warm up.

About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

One Response to Promises, promises: Is “Closing the Gap” going to help mental health services?

  1. Judy says:

    It seemed long of words and short of concrete promises. Thought saying that money would go on successful treatments sounded as if it might repeat the ‘Time to Talk’ fiasco where lots of money is spent on the essentially ‘worried well’ while serious mental illness remains difficult to get treatment for.Talk about being able to choose a practitioner seemd like a sick joke when the current issue is getting any treatment.

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