Mental illness 'under-treated by NHS'

“The NHS is failing mental health patients,” The Independent informs us today. Meanwhile, BBC News warns that NHS managers have been accused of “shocking discrimination” in providing mental health services.

The news is based on an academic policy report on the state of mental health services in Britain. The report found that mental illness accounts for nearly half of all ill health in people younger than 65, and that only a quarter of people in need of treatment currently get it. The report concludes that money spent on treating physical conditions could be better spent on cost-effective psychological therapies, which are still not widely enough available.

This story is covered appropriately by The Independent and other news sources. However, it is important to note that terms such as "discrimination" and "horrific scale" come from a press release, rather than from the more cautiously-worded report, which describes "inequalities".

While the report makes several significant recommendations, it is worth bearing in mind that these are aimed at a national and local NHS policy level. They are not recommendations for the care of individuals with mental health problems.

How widespread and severe are mental health problems according to the report?

The report, from the London School of Economics Centre for Economic Performance Think Tank, was produced by a team of economists, psychologists, doctors and NHS managers. It says that mental illness is widespread and is generally more debilitating than most chronic physical conditions. The researchers report that a third of all families in Britain have a family member with mental illness. Additionally, nearly half of all ill health in those younger than 65 years is due to mental illness and only a quarter of those needing treatment receive it. The report estimates that 6 million adults have depression or anxiety and 700,000 children have a mental health disorder. The report also found that mental health problems account for nearly half of absenteeism at work and a similar proportion of people on incapacity benefits.

What criticisms of mental health care does the report have?

According to the report, mental illness accounts for only 13% of NHS spending on health despite the existence of cost-effective treatments. It offers the explanation that those in charge of planning NHS services (commissioners) are failing to fund the necessary mental health services or expansion of services and are, in some cases, cutting mental health provision, especially for children.

The report states that the under-treatment of people with mental illness is the most glaring case of health inequality in the country. The report goes on to say that mental illness can increase the scale of physical illness and that the extra physical healthcare caused by mental illness now costs the NHS £10 billion. It says that much of this money could be better spent on psychological therapies because the average improvement in physical symptoms is so great that the savings on NHS physical care outweigh the cost of the psychological therapy.

Why are mental health problems being under-treated?

In 2008, the government initiated a six-year programme called Improving Access to Psychological Therapy (IAPT). The report says that:

• as a result of the IAPT initiative, the situation has improved in some areas, while others are failing to meet the needs of those with mental illness
• many local NHS planners are not using their budgets for their intended purpose
• where effective psychological treatments do exist, they are sometimes not available widely enough
• the £400 million earmarked by the government for psychological therapy to local NHS planners was not always used for its intended purpose because there was no obligation to do so
• more expenditure on common mental disorders would almost certainly cost the NHS nothing overall. According to the report, therapies like cognitive behavioural therapy (CBT) lead to rapid recovery from depression or anxiety disorders in more than 40% of cases. If these therapies were more widely available, this would cost the NHS little or nothing due to the savings on physical healthcare and the savings on incapacity benefits and lost taxes.

What does the report recommend is done to improve mental health care?

The report recommends that:

• the government’s Improving Access to Psychological Therapies mental health policy is implemented in every local area and completed as planned. This will include using the £400 million provided to local NHS planners for 2011–2014 to fund services to treat 900,000 people with mental illness
• targets set by the government are included in the NHS Outcomes Framework document (the official list of government targets that NHS planners are supposed to achieve)
  mental health becomes a priority both locally and at a national level
• GP training is in keeping with government mental health policy, and recruitment to psychiatry is increased

The report states that beyond 2014 there should be another major expansion of mental health services, aimed especially at the millions of people who have mental illness as well as chronic physical conditions.

The report lead, Lord Layard, has called for the challenges of mental health to be placed at the heart of government. He said that NHS planners “should be expanding their provision of psychological therapy as it will save them so much on their physical healthcare budgets that the net cost will be little or nothing”. Lord Layard concluded that “mental health is so central to the health of individuals and of society that it needs its own cabinet minister”.