Clarity needed on assessment of mental health priorities

by Sarah Day

22 February 2019

Improving the mental health of the population is a key ambition in the NHS long-term plan. It promises to: accelerate investment in children and young people’s mental health services; provide 24/7 crisis care for those experiencing a crisis; and to continue to expand access to psychological therapies (IAPT). These ambitions are against a backdrop of increasing integration with the further development of place-based mental health services as part of multidisciplinary community teams, as well as expansion into the education sector.

The increased focus on improving mental health is welcomed by the HFMA’s members. But a recent survey has shown that there is some way to go to ensure that services are consistently funded to support the achievement of the associated targets.

The mental health investment standard (MHIS) requires clinical commissioning groups (CCGs) to invest in mental health services at a faster rate than their overall programme growth. Spend on continuing healthcare for mental health and related prescribing spend is currently counted towards achievement of the MHIS, meaning that investment in frontline services may not be increasing at the same rate.

The pressure of funding continuing healthcare spend means that finding the money to support other mental health services can be a challenge. Several CCGs have reduced investment in other sectors such as primary care and community services in order to meet the spending target. With the increased focus on these sectors in the NHS long-term plan it is unlikely that this option will be available to CCGs in the future. All those who responded to the survey said that greater clarity was needed around what should and should not be included in the assessment of the MHIS.

Implementing the five-year forward view for mental health sets out a number of areas for investment to improve access and outcomes for people using the services and these are built upon in the NHS long term plan.

Children and young people’s mental health is prioritised in the plan with an expectation that investment here will grow faster than other mental health investment. As the response to the use of the MHIS shows, any measurement tools introduced for this sector require clarity and transparency to be successful.

Workforce continues to be an issue in the achievement of mental health access targets, and this is recognised across both commissioners and providers in the sector. A scarcity of staff with the necessary specialist skills means that it can be difficult to meet targets even with a good level of investment in a service. This applies to the breadth of mental health provision where staff turnover can be high and trainee recruitment can be challenging.

The targets in Implementing the five-year forward view for mental health relate to specific priority areas, but all of these are supported by community mental health teams who work to keep people well and out of crisis. The plan states that community mental health services will be supported to redesign and reorganise their service to support place-based working and a new multidisciplinary service. The lack of investment in community mental health was cited by survey respondents as an obstacle in improving care in the specified areas, so support for these teams is to be welcomed.

Many mental health services have a high reliance on the community support offered by local authorities and the voluntary sector. Despite the financial pressures in the system, commissioners and providers who responded to the survey reported that there had not been a reduction in NHS support for local charities. They recognise that this would be counterproductive in supporting those that the statutory services sought to help.

The increased focus on improving mental health services for the population is to be welcomed, but the continued disparity between perceived investment and service transformation must be addressed in order to successfully achieve the changes required.

Mental health confidence survey – summary of results