A renewed commitment but inequalities persist

The prime minister Theresa May has restated a commitment made by her predecessor David Cameron to improve mental health care. Her statement was sandwiched between BBC headlines on psychiatric accident and emergency attendances and a disproportionate number of delayed discharges in mental health hospitals.

What underlies the renewed focus is the disparity in service provision and outcomes for people with mental health conditions compared to physical illness.

The BBC reported on data obtained by the Rt Hon Norman Lamb (former Minister of State in the coalition government) detailing the number of beds days lost through delayed discharges. This data is routinely provided to NHS England from English Trusts NHS.

A delayed discharge is when the patient occupies an NHS bed when it is deemed that they no longer need NHS treatment and are ready to leave. Delayed discharges have risen since November 2015 by 56% (17,509 bed days) for mental health trusts compared to 30% for acute health trusts. A leading reason for the delays is that patients are awaiting a care package in their own home.

There is unprecedented demand on health and social care services. Since the 1990s UK survey data has shown a general increase in the number of people with common mental health conditions with significantly more young women reporting mental health problems and overall more people seeking help from their GP or specialist services.

Demands on A&E may reflect awareness of mental health conditions but also pressures throughout the health and social care system. Constraints on social care and community NHS budgets are evident and consequently delay setting up care for people leaving hospital. But are the finances for mental health being squeezed unequally causing longer delays or leading to episodes of crisis?

A survey of NHS chief executives by NHS Employers indicates that acute services are being prioritised above mental health services with 63% of the executives not confident that mental health investment standards would be met this year. This is a continuance from last year even with substantial policy commitments prompted by the Mental Health Taskforce which highlighted a need to focus on young people’s mental health, improve access to help and reduce stigma and discrimination.

Stigma and discrimination is shown through poor health outcomes and social mobility, for example employment. Mental Health problems, particularly depression, are a leading cause of global disability. Whilst in England mental illness represents 28% of the disease burden it attracts 13% of NHS spending and only 5.8% of the total UK research spend.

The BBC articles illustrate how policy and funding intentions can be circumnavigated to perpetuate inequalities in mental health.