Some 15 years ago, the Mental Health Foundation set in motion a powerful and far-reaching annual mental health promoting week. The particular focus for this year’s week is mindfulness – in recent years it has focused on anxiety, physical illness and mental well-being, alcohol use, loneliness, and the experience of stigma.
Mental health had 44 mentions in the three main parties’ election manifestos, compared to just seven in the 2010 elections. A new majority Conservative Party has been elected, but in March, the previous coalition formed a mental health taskforce to bring together health and care leaders and experts in the field – including people using the services – to lead a programme of work to create a mental health five-year forward view for the NHS in England.
The new national mental health strategy is due to be published later this year and, in the opinion of many, simply cannot come soon enough.
Demand is still rising
The demand for mental health care continues to rise. We know for example, that in 2013 a million antidepressants a week were prescribed (twice as many as prescribed in 2003). During 2014, around 1.75m adults were receiving treatment for a diagnosed mental health illness, a 10% rise in service provision since 2012.
There are also just under 7.5m children and young people aged five to 16 living in the UK. Just fewer than 10% (720,000) of all children and young people will experience a mental health condition. While many of these problems are unrecognised and untreated, indicating that the true figure is likely to be higher, the number of children admitted to hospital for self-harm is at a five-year high. It is reported that one in 12 young people self-harms and, in 2014, 38,000 young people were admitted to hospital because of their injuries.
Some of the issues we are facing are concerns that are to be found across the globe. For example, we know that self-harming behaviour and depression is linked to feeling suicidal. Last year the WHO reported that a million people commit suicide each year around the world. This is a global mortality rate of 16 people per 100,000. The UK suicide rate i 2013 was 11.9 deaths per 100,000 population.
New targets around the provision of talking therapies require NHS mental health care service providers to provide face-to-face therapy to 75% of patients with six weeks of a referral and 95% of patients within 18 weeks. Although we are not great fans of targets per se, we recognise this as being a step forward, as it reinforces the need for healthcare services to treat mental illness in the same way as it treats physical health problems are provided for.
Mental health can no longer lose out
The authoritative How Mental Health Loses Out in the NHS study, published by the LSE in 2012, revealed that for people aged 65 or less, nearly half of all ill health was mental ill health. However, only 26% of adults with mental illness receive care compared, for example with diabetes, where 92% of people living with this condition receive treatment and care. Despite a huge investment by the UK government, only 24% of those people with an anxiety or depressive condition are in receipt of treatment. So we argue that six to 18 weeks is still a long time to wait if someone is feeling depressed.
In the week of raising mental health awareness, and the recognition of mindfulness as an easy-to-access, self-help method, it is perhaps also important to be aware that, inevitably, political imperatives and economic exigencies will result in some form of prioritisation of service provision – in other words, the continued downward pressure on public sector resources.
The prevalence of mental illness and demand for mental health care briefly illustrated here and the difficulties in being able to respond to such concerns in an age of political challenge and economic austerity should not be underestimated. Increasingly, it will become critical that politicians and mental health practitioners work together to use big data in understanding demand and outcome, capture the service user and carer voice in order to understand experience, harness new technologies to reshaping the therapeutic relationship, and perhaps most importantly, what the real costs might be of doing nothing.