The Psychiatry SHO*

An open letter to Alistair Burt, the new Minister of State for Health

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Dear Mr Burt,

Congratulations on your recent appointment as Minister of State for Health and for holding your seat as an MP in North East Bedfordshire.  I must admit, the majority your party obtained last week in the General Election was not the result I had personally wished for, but the result of a fair democratic election is not something to be sniffed at.

Forgive me if I’m wrong here, but a quick trawl of the internet suggests that this is the first time your brief has included mental health. In fact, it seems to be the first time you’ve been tasked with managing health policy of any kind. I was hoping, as a member of the mental health community that includes inordinate numbers of patients, carers and professionals who have spent their lives immersed in this complex area, that I might be able to offer you some advice.

As it turns out, you have big shoes to fill. Norman Lamb was well liked as a politician, which I am sure you’ll recognise as a rare attribute. As one of only a handful of Lib Dem MPs to survive the recent cull, the positive impact of his work over the last 5 years is beyond doubt.

How did he achieve this respect? By having the integrity and compassion to admit that the mental health system he was in charge of was critically inadequate, leading to the needless suffering of countless thousands. His Crisis Care Concordat and the Liberal Democrat’s Closing the Gap report were ample evidence of their commitment to make positive changes in mental health, and they were the only party to give a concrete funding promise (of £3.5bn over 5 years) in their manifesto.

And oh, how we needed that money. Though your colleague Mr Hunt has claimed that mental health funding went up in real terms over the last parliament, no figures in the public domain support that assertion. When corrected for inflation, official figures seem to show a minute fall. But these numbers don’t match our experience of services on the ground – Trusts have recently reported an 8% drop in funding over the last 5 years. Moreover, they expect their funding to keep on falling, by an additional 8% over the next 5 years.

The sad thing is, our services were on the ropes even before these cuts. Mental health problems account for 23% of the illness burden in the UK, but receive only 13% of the funding, an approximate annual shortfall from CCGs of £6.5bn. And during the cuts of the last 5 years, referrals to community teams actually rose by 17%, stretching us further. This pressure had to tell, and the result was agonising. We lost over 2,100 inpatient psychiatric beds. Community teams, the development of which is usually touted as an excuse for reductions in bed numbers, were cut too. Patients continue to be shipped up and down the country, away from their friends and family, just for the sake of finding a bed. Sometimes, even worse, they are sent home when a bed cannot be found or admitted to a ward but without a bed (!). At least seven patients have ended their lives by suicide as a result, just the tip of an iceberg shrouded by confidentiality and incomplete reporting. Those who somehow manage to stay alive receive a grossly and shamefully lower standard of care than their counterparts with physical health disorders. Despite the touting of increased overall nursing numbers in the pre-election period, here in mental health we’ve actually lost 3,300 nurses over the last 5 years.

As if this wasn’t hard enough to bear, the deep cuts to social care have hit people with mental health problems harder than any other group, with a staggering 48% fewer people claiming help in 2013 than they did in 2006. Because recovery in terms of mental health encompasses the whole person, this only serves to heighten the risk of needing more intensive input from mental health services, wasting money in one area by pinching pennies in another.

I could go on, detailing the desperate state of our services in detail. But that wouldn’t be as productive as telling you how to help. You see, you may have inherited nothing short of a national human rights issue, but it is a national human rights issue that you can go a seriously long way to fixing. Our services aren’t that complicated and they’re not even expensive in comparison to interventions in the rest of medicine – but the results can be incredible. Early intervention services, for example, were recently shown to be capable of saving £15 for every £1 invested. Similarly, though perinatal mental health problems costs society £8bn a year, over half the women in the UK don’t have access to a specialist perinatal mental health service. Providing cost-effective care consistent with NICE guidelines to the whole UK would set you back just £337m a year in comparison. I believe economists call this ‘low hanging fruit’. Instead of cutting your outgoings now, cut them in the future by funding these services, and save some lives to boot.

Here’s another tip. Listen to people who have lived experience of using the services that you are in charge of. Listen to them more than you listen to statistics or advisors. When they say that there is a problem, then trust me, there’s a problem. Mental health is fascinatingly complex and learning all its nuances takes years – I still learn something new every day. Genuinely hearing what these people have to say will win you supporters for life, but assumption and hubris will turn this crowd against you like no other.

As well as individuals, listen to the major organisations. They talk a lot of sense and are driven solely by wanting the best for people with mental health problems. Mind, Rethink and the Mental Health Foundation are just about as informed and influential as charities get. My own affiliation, the Royal College of Psychiatrists, regularly turns out lucid documents on topics like Parity of Esteem. They also asked for 6 things from the incoming government, including investment in (again, unbelievably cost-effective) parenting interventions and liaison psychiatry services.

As an additional note, could I implore you to bring a halt to the government’s flirtations both with putting online CBT into Job Centres and sanctioning people who refuse treatment for long term conditions. Both policies are in direct contradiction to the most basic principles of medical ethics (i.e. free consent), underestimate how difficult recovery is for people with these difficulties, discriminate against people with mental health problems and risk a dangerous conflation of unemployment with illness. The goal of recovering from a mental illness should be recovery itself, not employment. To be honest, in a general sense, I do not feel that the further fragmentation of our health services through privatisation, which brings with it the added clash of ideologies between profit and care, and a cumbersome and expensive tendering process, has any place in the NHS. But this is an issue for another day.

In summary, your new job may have more in store for you than you may have expected. You quite literally have the power to do more good, and to win more plaudits, than any other politician in the UK today. We will help you in any way we can, but only if you are eager to listen. I genuinely look forward to working with you in future.

Yours in collaboration,

Alex

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