Mental health crisis support in all A&E departments, as the chancellor, Philip Hammond, set out in the budget, is critical. The almost fivefold increase in young people showing up at A&E with psychiatric problems in the past decade makes the case for this clearly.
But why should people with mental illness be able to access care only when they feel they have nowhere to turn but A&E? Lara Ferguson’s case proves this. Her case was highlighted in a report by the Centre for Mental Health, which revealed that young people are waiting for months, if not years, for help. When Lara was 15, she consulted her GP about depression but was told it was probably just a “normal teenage problem” and that she should visit self-help websites. Lara’s school tried to refer her to child and adolescent mental health services because she was self-harming, but was told the only way to access specialist services was through A&E.
She eventually received specialist mental health care six months later – after she tried to kill herself and ended up in A&E.
Having dedicated mental health teams responding to 111 calls should make a world of difference, with people experiencing mental distress directed to specialist teams.
Plans to reduce the numbers of people with mental illnesses being transported in police cars is also welcome. You wouldn’t expect a police car to pick up someone who had had a heart attack or broken a limb. So why should it be different if their illness isn’t a physical one? Expanding the use of specialist mental health ambulances won’t be easy, and will require a lot of extra resources and training for ambulance services. And if a second tier of “special” mental health ambulances emerges, will this create a different stigma?
And now comes the all-important but.
This focus on managing crises in mental health provision cannot continue. By overlooking early intervention support and ongoing services to keep people well, the overall crisis continues to feed and grow.
While the budget comes with a lot of small print, for the NHS the proof of the pudding will come in a plan for funding and delivering NHS services for the next decade, expected in November.
Core mental health services for adults are struggling, and have been neglected. These hard-to-define services, which don’t lend themselves to headlines, are often delivered in the community, and when they are available do a great job of keeping people with mental illnesses well, not in an A&E waiting room or in a police car (or ambulance if they are lucky).
The creation of school mental health teams, with links to clinical staff, is much needed to continue to grind down the stigma that persists around seeking help for problems and provide help to children early on. I’ve been buoyed by seeing job ads for these teams.
On the headline figure for mental health, £2bn sounds a princely figure. Who could possibly have the cheek to ask for more? But I am making an unashamed bid for more because £2bn is a smaller proportion of NHS spending than mental health services currently receive.
The government’s pledge to increase spending on mental health as a proportion of all NHS England spending will be broken without at least £2.5bn (we also need £800m for capital – that is to stop the crumbling hospitals we work in from falling on our patients’ heads).
The extra funding I am calling for would take mental health spending to just below 11% of NHS England spending (mental illness accounts for 23% of all illness). Otherwise the slice of funding I said was needed in July will be even smaller.
• Professor Wendy Burn is president of the Royal College of Psychiatrists