Comment / Taking the broader view on mental health

The government’s commitment to parity of esteem between physical and mental health services is currently underpinned by the mental health investment standard – requiring commissioners to increase spending on mental health by at least the increase of their overall allocation.

Understandably the focus has been on whether this increased investment is being met as this seems a straight forward way of checking on progress. But ticking the parity of esteem box is not that simple. The HFMA’s work in this area – involving both its Mental Health Finance and its Commissioning Finance faculties – has shown that the situation is far more complex.

There are ongoing debates about whether this standard is being met and at a local level, differences in opinion between commissioners and providers over what it means to meet the standard. Clinical commissioning groups (CCGs) believe they are meeting what is required of them with money spent across primary, secondary and continuing healthcare services; meanwhile many secondary care providers are unable to see positive changes to their contracts.

Our latest survey shows that while the national policy is encouraging local debate and welcome transparency around mental health funding, the financial challenge of implementing parity of esteem is difficult for 2017/18 and even harder for 2018/19.

When the money is challenging and health economies are working to make the most of what is available, we need to take a broader view.

Rather than focusing on CCGs spending more on mental health services (the money being put in), we need to focus on outcomes – asking what will have the greatest positive impact for patients and service users and thinking through what that means in terms of required investment. We need to be looking at whether we are delivering the goals set out in the Five-year forward view for mental health and what impact we are having on all important outcomes for service users.

In fact, looking at and measuring the impact that NHS services make on individuals is something that the mental health sector has a lead on. There is already a routine focus on an individual’s goals and how they can be achieved.  Indeed, one of the Forward view objectives is to implement 24/7 mental health liaison services in all emergency departments recognising that many patients attending A&E do so with multiple issues. Having these services in place helps people get to the right treatment quickly and improves longer term outcomes.

A focus on outcomes aligns well with the pursuit of value (measured in terms of outcomes and cost) and has been central to recent thinking by the HFMA’s Mental Health Steering Group. In fact, the focus must be on the wider perspective. Are there credible plans in place to deliver the Five-year forward view for mental health? And are these plans embedded within sustainability and transformation plans for local delivery?

To access the latest survey click here.

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