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Expert Comment: The crisis in mental health services

Mental health Wednesday 26 November 2014

A public meeting in Manchester last weekend examined ‘The Crisis in Mental Health Services’. Dr Rich Moth, Lecturer in Social Work, was invited to join the panel alongside Professor Sue Bailey (former President of the Royal College of Psychiatrists) and other practitioner, service user and carer representatives.

Mental health services in England are at breaking point. Earlier this year Professor Sue Bailey described the system as “a car crash”. For her successor, current President of the Royal College of Psychiatrists Sir Simon Wessely, services are “running dangerously close to collapse". The context for these unprecedented public statements is the Coalition government’s commitment to ‘austerity’ within a broader neoliberal policy framework. NHS Mental Health Trusts have seen over 2% cut from their funding in the last two years and as a result more than 1700 beds in mental health units, nearly 10% of the total, have been closed. During the same period the number of nurses employed in mental health services has fallen by 3640 and the number of doctors by 213.

As a consequence of the cuts some service users awaiting in-patient admission have been detained in police or prison cells, whilst others left without support have tragically taken their own lives. The government has tended to downplay concerns by suggesting that in-patient beds are being replaced by expanded community provision. However this narrative is undermined by NHS data showing practitioners’ contact with service users in the community has also dropped amidst evidence of widespread understaffing.

Last month Deputy Prime Minister Nick Clegg acknowledged concerns about mental health funding and announced this as a priority for his party. Yet his claim to be committed to parity of esteem between mental and physical health services seems hollow in the wake of a decision by his Coalition administration to reduce tariff payments for mental health providers by 20% more than those for the acute healthcare sector.

In addition to cuts statutory mental health services are undergoing neoliberal restructuring at an accelerating pace. The Health and Social Care Act 2012 requires NHS Foundation Trusts to compete for contracts in a healthcare market. Increasingly Trusts are losing out to companies like Virgin Care and Bupa, with figures released last week suggesting the private sector is on course to win NHS contracts worth an estimated £9billion this year. As a result an increasing proportion of scarce NHS funds are diverted into corporate profits.

When these developments are considered alongside a government welfare reform programme that is generating a “tsunami of fear” for mental health service users and other claimants through draconian elements such as the ‘bedroom tax’ and Work Capability Assessment, a characterisation of the mental health system as in crisis seems entirely justified. 

However in spite of the enormous challenges for mental health service users and practitioners resulting from these policy agendas, resources of hope are nonetheless visible. A number of local campaigns have emerged to oppose cuts, closures and outsourcing of mental health provision: from Salford and Liverpool in the North West, to Cambridge and Norfolk in the East of England.

These have been effective not only in drawing wider attention to the effects of ‘austerity’ on services but also winning important victories, for example in Liverpool where two mental health resource centres were recently saved from the threat of closure. Reflection on these at Saturday’s meeting acknowledged the importance of alliances between service users and mental health workers in achieving change as the Social Work Action Network (SWAN) has advocated in its Charter for Mental Health launched earlier this year.

Discussion at the meeting also engendered a renewed resolve to work together in this spirit to defend and extend vital mental health support.


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