David Cameron's brave new world of private mental health care
By Carl Walker
Carl Walker leads a European Community Psychology Association Task Force on Austerity and Mental health and is a member of the National Health Action Party.
Three out of four people with mental health problems get no help at all, we learned recently in a report from NHS England.
Like most people who’ve either cared for a loved one with mental health difficulties or experienced them themselves, I didn’t need to be sat down for the shock of this discovery.
The review revealed inadequate, underfunded care, leading to "thousands of tragic and unnecessary deaths".
David Cameron’s response? Extra cash in the budget?
No, a “call for the nation to focus on mental health”.
But ‘the nation’ is doing everything it can already.
To suggest to those who use the UK mental health system, either as service users, carers, volunteers or professionals, a need for a focus on mental health, was a predictably crass response from a prime minister who has overseen a drastic real terms cut to NHS funding generally and to mental health services in particular.
Budgets for mental health trusts fell by 2% from 2013/14 to 2014/15, a recent BBC Freedom of Information investigation found. The number of nurses working in psychiatric sectors between 2010-11 and 2014-15 fell by 1.4%. The dreadful baseline funding inequity is getting worse, not better.
But Cameron chooses to focus on the state of the nation and ignore his own catastrophic role in the demise of our national mental health institutions.
Years of negligent underfunding of mental health services and social care support have risked and cost countless lives. Mentally ill patients have been ferried hundreds of miles around the country for life-saving support due to a shortage of beds – and vulnerable children have been held in police cells overnight for the same reason. The mental health crisis is now taking up to 40% of police time - and a worrying number of mentally ill people are dying when they’re restrained by police, according to the police’s own watchdog.
Cameron is one of the great modern performers of blind idealism and political self-delusion. His tarnished ‘big society’ armour is always there to be picked up when he wants to shield himself and deflect onto society, the agonies inflicted by his ‘austerity’ dreamland.
Urging the nation to focus on mental health is more than just a lamentably vacuous attempt to avoid the concrete specifics of a given crisis. It is the emblematic defence of the neoliberal ideologue as they survey their crumbling architectures: “everyone else needs to try harder”.
Any money for mental health has to be found from the £8bn of ‘extra’ funding – that we now know to be only half what NHS boss Simon Stevens said was the minimum the NHS needed, even with huge ‘efficiency savings’. And that increasingly TARDIS-like £8bn also has to fund IT test beds, extra pension contributions and so forth.
So what should our response be? Should we demand that Cameron stops nagging ‘the nation’ and focuses on mental health himself? Should we assume that the last five years of underfunding arose merely through casual inattention? That if we highlight more the everyday challenges of living with a mental health problem, eventually the money will flow to where it needs to go, to NHS mental health services?
Or is something more systemic going on?
As a result of the NHS gaps, the increased NHS demand for private sector mental health beds now accounts for 87 per cent of independent mental health care providers’ revenue, according to a recent report in the Health Services Journal.
Private providers of mental health beds are “enjoying robust demand” with growth back up to an average of 4 per cent a year in the last three years, according to the report. The demand “tide” has been flowing in favour of private mental health hospitals in the last few years essentially because of constraints on NHS in-house capacity as a result of an NHS England moratorium on commissioning of new capacity (for centrally commissioned specialised services). Nursing and other staff shortages is also driving shift to private sector beds, as the NHS struggles under funding constraints to staff its own in-patient units adequately.
So while this administration continues to slowly strangle the NHS generally, and mental health services specifically, it has managed a sustained transfer of mental health activity from the staff and bed-depleted NHS to private sector providers.
The governments' blushes are only saved by a failure to collect information – meaning their ministers can’t answer basic questions in parliament, as revealed today by Labour’s shadow mental health minister.
We have a system that is on its knees by design. Recently a colleague who works to find beds for young people with mental health problems told me that recently they couldn’t find a single young person’s bed for her anywhere in the country at that given point of the day. She described the desperation of having a self-harming and suicidal teenage girl that they couldn’t find help for anywhere.
Exhausted professionals are increasingly bereft of options. Vulnerable, decent people’s lives continue to be lost. Carers continue to be driven to utter desperation. All casualties in the construction of this government’s brave new world of private health care.
For more information see these recent reports on the state of mental health treatment:
Lightning Review: Access to Child and Adolescent Mental Health Services May 2016, by The Children's Commissioner
Funding Mental Health at Local Level: Unpicking the Variation, by NHS Providers and published in partnership with the Healthcare Financial Management Association, May 9, 2016
Children and Young People’s Mental Health: State of the Nation, by the CentreForum, April 11, 2016
Mental Health TaskForce report, February 15, 2016
Mental Health Under Pressure, by The Kings Fund, November 2015