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Meltdown in mental health

We need more than fine words from our politicians to rescue a service in crisis, says JOHN LISTER

There can be no clearer illustration of the abject failure of the Tory-led coalition's competitive market in healthcare than the disaster facing mental health services.

Over the last few months the scale of the problem has been more fully revealed, not least the growing gap between the dwindling capacity of the system to deliver care and the growing need - worsened in many cases by this mean-spirited government's brutal cuts in benefits, the bedroom tax and refusal to tackle the problem of affordable housing, all of which take a toll on mental health.

Budgets for mental health in the NHS are not simply frozen, like budgets for physical health needs, but - for the first time in a decade - they are actually falling year by year as health bosses inflict cuts where they feel the media will not pay heed.

The government response has been to stop compiling the figures that have revealed the cuts.

NHS England, far from taking steps to address the problem of shrinking mental health budgets, has decided to cut the "tariff" - the standard fee paid to trusts for treatment - for mental health by 20 per cent more than the cut for other tariffs.

Health Minister Norman Lamb, speaking recently to the NHS Confederation's Mental Health Network, criticised the decision to impose a tariff reduction of 1.8 per cent in mental health contracts, compared with 1.5 per cent in acute care.

He told delegates the decision was "flawed, not based on evidence and cannot be defended."

But then he dumped the problem back onto the mental health trusts, saying they should "fight" with their commissioners over their contracts.

"Do not accept a proposed settlement which results in mental health losing out."

Since his Tory bosses have just forced through legislation that puts all of the financial control in the hands of commissioners and all of the problems in the court of the mental health trusts, this is a complete evasion.

We know that in the face of the government's cash squeeze all aspects of mental health have been hit - 1,700 beds have closed since 2010, leaving dire shortages in various parts of the country, not least for child and adolescent mental health, where young people are often transported for hundreds of miles to find a spare bed or even placed on adult wards.

One area facing especially severe problems is Norfolk and Suffolk, where the mental health trust is simultaneously cutting back on both beds and community mental health provision, while dispatching dozens of patients to beds many miles from their homes and families.

Protesters who marched 52 miles from Ipswich to Norwich last month to highlight these savage cuts showed clearly the injustice and the problems they cause.

"If someone had a stroke in Norfolk or Suffolk and had to be taken to Darlington, Somerset, Bradford, Manchester, Harrogate or Glasgow, MPs would be falling over themselves to call for urgent action. But this is the reality for people in Suffolk and Norfolk experiencing a psychiatric emergency."

These words are from one of the march leaders, Emma Corlett, a Norfolk councillor and Unison steward, who has been campaigning to stop the cutbacks.

In response the trust chief executive, interviewed by the BBC, desperately tried to deny that there was any crisis - before admitting that his trust, like many other mental health trusts, is facing a squeeze on funding and a shortage of beds.

Back in 2010 the Care Quality Commission (CQC) expressed concern at the excessive levels of occupancy of the majority of beds on acute mental health wards, with well over half the 486 acute wards in England running at or above 100 per cent occupancy levels and 35 reported to be running at levels above 125 per cent.

But last autumn consultants again spoke out on the dire shortage of acute beds - and nothing has been done. Instead more NHS trusts are once again using costly and low-quality private-sector beds, often many miles away, to take their "overspill."

Clinical commissioning groups seem, if anything, even more willing to cut mental health spending - even intensive care beds - than were the primary care trusts they replaced. But sadly their under-investment in mental health is not new.

Back in 2010, mental health charity Rethink published a report that showed many of the 1.5 million people suffering from severe mental health problems such as schizophrenia, bipolar disorder, personality disorder and severe depression were not receiving appropriate treatment.

As a result they die on average 10 years younger than the rest of the population, are more likely to wind up in prison or homeless and were much more likely to be unemployed and dependent on welfare benefits.

In 2012 a report by the London School of Economics found that only a quarter of the six million people suffering from mental illness were in treatment. Mental illness then accounted for 23 per cent of the total burden of disease, but received only 13 per cent of NHS expenditure - a share that is shrinking fast.

The problem is still unresolved.

Back in January Nick Clegg launched the Department of Health document Closing The Gap: Priorities For Essential Change In Mental Health.

Each of the report's 25 worthy proposals seems light years away from the actual situation in the NHS, especially in the last four austerity-squeezed years.

Proposal number one begins with the statement that "high-quality mental health services with an emphasis on recovery should be commissioned in all areas, reflecting local need."

Who would not agree? Apart, that is, from NHS England, which is forcing down the tariff for specialist services to unaffordable levels - and the local commissioners who have been spending less on mental health year by year for at least two years, with worse to come.

Number three promises to establish "clear waiting time limits for mental health services" - at a point where we know children and adolescents are waiting up to 18 months for treatment and many other services are hopelessly inadequate to deliver swift treatment.

Number four promises to tackle "inequalities around access to mental health services," with no serious explanation of how this might be done.

Number seven promises that the "most effective services will get the most funding," but we already know that's not what's happening either. Everything is being cut.

And so it goes on. The document has some good and necessary policies, but has no connection to the current, tightening resource squeeze that is set to run at least to 2021.

If words alone could fix mental health, there would be no crisis. But at present a small but growing private sector, with limited capacity, limited skills and no wish to take on any complex cases, is profiting from the gaps opened up in the NHS.

The gaps in social care are perhaps even greater, with massive cuts across the board, also hitting mental health the hardest.

A recent report shows that there has been a 48 per cent cut in numbers of people with mental health problems receiving social care since 2005. And one in three councils have cut their mental health services by 50 per cent or more.

The coalition government has set up a dysfunctional NHS that has fragmented services, divided drug addiction services from alcohol misuse and forced clinical commissioning groups to seek cost "savings" by opening up services to "any qualified provider" - whether this be cherry-picking voluntary sector organisations exploiting unpaid and untrained staff, or profit-hungry private companies.

For clinical commissioning groups and NHS England, the bottom line is short-term, often illusory cash savings, while quality takes a back seat.

This means the mental health trusts, with their superior skill mix, their staff training and their multidisciplinary teams, are facing deficits and loss of contracts, while cheap and cheerless services from less qualified providers win the day - and tens of thousands of patients lack the care they need.

In East Anglia, and recently in the west of Greater Manchester, there have now been small but important recent protests as a fight develops to defend mental health.

These protests need to be echoed loud and clear by any politicians claiming to stand up for the NHS this year or next.

It's not fine words we need from weasel politicians, but hard cash and commitment.


John Lister is director of Health Emergency


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