James Morris MP: ‘Stars are aligning’ for a revolution in mental health
Aden Simpson
| PoliticsHome
With the publication of an Independent Mental Health Task Force report, James Morris MP is leading a Whitehall debate to maintain its momentum.
Mental health has long been the ‘cinderella service’ within the NHS. Despite making up 23% of the disease burden and with an estimated overall economic cost of £105bn, it still only attracts around 9% of the total health spend. But for Mental Health All Party Parliamentary Group Chairman, James Morris, monumental change could be fast approaching.
In February NHS England published an independent report The Five Year Forward View for Mental Health aimed at closer parity between mental and physical health services, and offering 52 recommendations to this effect. The Conservative MP for Halesowen and Rowley Regis is leading a Whitehall Debate on Wednesday, to boost the profile of the report and ensure its findings are implemented.
“We’ve got a good quality public debate, a really good set of recommendations, and commitment at a senior level, both in the government and in NHS England to actually deliver them,” said Morris. “But now the challenge is to keep the momentum going, to sustain it and make sure it happens.”
While mental health services have undergone a transformation in the past 50 years, to some extent this improvement has been upstaged by rising demand. The report finds that one in four adults experiences at least one diagnosable mental health problem in any given year. Suicide is also rising rapidly, particularly amongst middle-aged men, and is now the leading cause of death for men between 15 and 49.
“We’ve also got more young people with eating disorders, depression and anxiety. There is more demand for services, that’s absolutely true,” he said.
“Over the next 15-20 years mental health is going to be the most important aspect of our health system, that’s why we need to change the system in order to cater for this rising demand.”
More data, and more transparency in decision-making are central to the recommendations:
“One of the challenges is that there’s a lot of variability about what Clinical Commissioning Groups (CCGs) are commissioning in the area of mental health. Some are spending more and some are spending less - there’s various reasons for that, but one of the issues is that we don’t really know, if truth be told.”
“We need better commissioning at a local level and we need more transparency as to what is being spent and where by CCGs.”
Currently acute hospitals receive most of the focus and finance. Morris argued that this is part due to stigma, but part also down to the payment systems and tariffs within the NHS, which actually incentivise and “support his lack of parity between physical and mental health.”
Another tenet of the report is that security in jobs and housing play a significant role in the wider context of prevention and lasting recovery, and that fostering this requires a cross-governmental approach above and beyond the remit of the health service.
Today only 43% of those with mental health problems are in work, compared to 73% of the general population, and 65% of those with physical health conditions.
“What we shouldn’t be doing is writing off people, and saying they’ll never be able to work,” he said. “I don’t think that’s a solution, I think work is very often a cure for many people.”
In a liberalised and competitive labour market, both the report and Morris advocate the NHS and DWP working together more closely on schemes such as Individual Placement and Support (IPS)- a more personalised approach than “the standard model of the Job Centre.”
Another finding is that psychosis is 15 times higher amongst those without housing, and it therefore recommends the NHS works with the Treasury, Local Government and the DWP to ensure the right levels of protection are in place for people who require specialist supported housing.
A final component is for more research into effective forms of intervention. There has been a trend in the past couple of decades towards drug-based interventions, for different reasons, possibly financial. But in terms of talking therapies, the go-to approach has typically been Cognitive Behavioural Therapy (CBT) - a quick, often 6 week, intervention with a strong evidence base for mild anxiety and depression, but one that “is not appropriate in every case.”
“The most important thing is about choice. There’s lot of evidence that if I’m given a choice about what kind of therapeutic intervention I want, the chances of me getting better are a lot higher.”
“I’ve been advocating for quite a long time that we need to have much more capacity for different forms of therapy available in the NHS. That’s why we need to have more research into what works and what doesn’t work.”
Access to talking therapies is currently only available to 15 percent of the demand, and in some areas the average waiting time is 124 days; this is despite the £500m funding allocated to the Access to Psychological Therapies Programme in the last parliament. Extending the length of therapy, from weeks to months, while increasing access and reducing waiting time, will require a substantial increase in funding.
For these reasons Morris remained sceptical that the £1bn deemed sufficient to implement the recommendations was correct, but “at least we’re having a conversation about what additional funding is required.”
“An additional £1bn goes a long way to achieving a lot of the things in this report,” he concluded. “We’ve got a historic opportunity - the stars are aligning - but we need to make sure that the implementation happens.”
