Integrated care systems must now take the lead in delivering parity for people with mental health problems - Sophie Corlett, Mind Interim CEO
With 1.8 million people waiting for mental health treatment and no additional investment from the covid recovery funding this year, integrated care systems must now take the lead in delivering parity for people with mental health problems, writes Mind Interim chief executive, Sophie Corlett.
The pandemic took a huge toll on the population’s mental health and its impact will be felt for many years to come. We now face a long recession and a cost-of-living crisis which will further drive up need for mental health support, whilst eating into mental health budgets. In addition to an estimated 1.8 million people on waiting lists for mental health treatment, there are 8 million people who would benefit from treatment but do not currently meet clinical thresholds. Pre-pandemic, just over a third of adults with mental health problems and a quarter of children and young people got any treatment at all. As prevalence has grown, particularly amongst children and young people, NHS Long-Term Plan access targets are no longer in step with clinical need. Mind will continue to call for increased funding, including a share of the additional £3.3bn allocated to the NHS in the Autumn Statement. But in the meantime, integrated care systems can and must step up to support the mental health of the population.
We have some reasons to be optimistic. Several amendments were adopted in the final Health and Care Act 2022 that strengthen the hand for mental health. The Act contains an important symbolic commitment to explicitly define “health” to mean both mental and physical health, this decade’s updating of the famed 2012 “parity of esteem” clause. This amendment, first proposed by Lord Simon Stevens, will help to hold the Secretary of State for Health and Social Care accountable to Parliament for spending on mental health.
And, crucially, all integrated care boards are now expected to have a mental health voice at the top table. This is particularly pertinent as so many of the biggest challenges in the NHS right now have a mental health element, from 12-hour waits in accident and emergency departments, to pressures in primary care, to the emotional toll of long waits for elective care. Mental health must be hardwired into pathways across the system.
Early indications are that most of the mental health representatives on integrated care boards are from NHS trusts. This must not mean a focus only on the issues facing providers. ICSs offer an opportunity to finally implement the “radical upgrade in prevention and public health” promised in the Five Year Forward View. There is a strong and growing evidence base for investment to prevent1 those most at risk from developing potentially life-long mental health problems.
Where integrated care partnerships’ mental health strategies are being developed they should have a definitive focus on the wider determinants of mental health such as employment, education and training, housing, transport, and access to green spaces. People with mental health problems are more likely to smoke, misuse substances and to be overweight, so physical public health programmes won’t be effective without a tailored and integrated offer for this population group.
ICSs can use their new freedoms to go further faster where they see the most need, whether that’s scaling up support for children and young people by introducing community-based Early Support Hubs, partnering with the voluntary and community sector to better support racialised and marginalised groups, or working alongside local employers to build trusted partnerships that support people with mental health problems back into the workplace.
The move to a more localised system is not without its risks. Mental health has been neglected for decades and many of the improvements we’ve seen through the Five Year Forward View for Mental Health and the NHS Long-Term Plan have been driven from the centre. We are already hearing of ICS leaders looking to raid ring-fenced Mental Health Investment Standard funding to plug gaps in other parts of the system that have more political focus, such as urgent and emergency services and elective recovery.
Upgrading mental health services to achieve parity was always going to be the work of a generation. Progress is fragile and we cannot afford to slip back into bad habits, such as raising thresholds for mental health care to bail out other parts of the system when unmet need in mental health is so high.
Workforce remains the most pressing challenge. Having led the way in the shift to community-based services, mental health has continued to innovate, creating new roles such as peer support workers to support new models of care. ICS workforce planning is an opportunity to look at the workforce holistically across the NHS, social care and Voluntary, Community and Social Enterprise as well as to look at the best ways local areas can increase support and retain the existing workforce after the challenges of the last few years.
The VCSE is a crucial part of the mental health provider ecosystem, offering innovative and effective community-based services that help to keep people well and avoid hospital admissions. They often support communities that are not well served by statutory services, such as people from racialised communities. They are particularly important for the Community Mental Health Transformation Programme, providing holistic, integrated services that address the wider social determinants of mental health, as well as providing a clinical response.
Integrated Care Systems offer an opportunity to move away from short-term and non-recurrent funding which is difficult and resource intensive to utilise, mitigates against long-term strategic planning and often doesn’t help generate the system change that is needed.
The VCSE are currently under enormous pressure and are picking up the pieces where statutory services not able to offer timely support. They often support people with a high level of risk who can’t get help elsewhere. This is placing a huge strain on them and their staff.
Like all parts of the mental health system, they are facing difficulties with recruitment and retention as salaries are eroded by inflation. This is not helped by NHS commissioners not always passing on the inflation uplift they have received to their VCSE partners and attempts to reduce funding for management costs within contracts. The VCSE can access a different workforce from statutory providers, which is of particular value when there are big workforce challenges for the NHS.
There continue to be practical challenges, for example with the VCSE being able to access NHS data systems, something which risks the safety of service users because the service cannot see their patient records, as well as creating a lot of extra work for them.
The move to Integrated Care Systems has created instability and uncertainly in many areas, disrupting existing relationships and commissioning arrangements. It’s a really mixed picture in terms of how well ICSs are engaging with the VCSE and it can be difficult to know where decisions are being made. We want to see the VCSE treated as equal partners within ICSs. Systems need to consider how they’re engaging with the VCSE more strategically so that they are genuinely co-producing services and ensure they are resourcing this work properly. And simply funding a couple of VCSE engagement roles (recruited by the NHS) isn’t sufficient.
So while the landscape may have shifted again, the task remains the same: to ensure that people with mental health problems can access the help they need, when they need it. ICSs provide the change to get the whole system behind this goal. There is no time to waste.
Content provided by Sophie Corlett, Mind Interim CEO. For more information please visit www.mind.org.uk.
