The political parties are now in full-on campaigning mode in advance of the impending General Election. The transformation of mental health services appears to be a top priority, and quite rightly so. The situation with services and support for people of all ages is now shocking. Mental health services are in crisis and are crisis driven, despite the emphasis in policy on prevention, early intervention and improved access to psychological therapies for adults and young people.
The Liberal Democrat and Labour parties have set out important policy proposals in their Manifestos to address this crisis. The emphasis on achieving parity with physical health continues. The strong focus on meeting the needs of children and young people is essential. Far too many young people and their families are unable to access care and preventive community support. The risk of being subject to out of area placements when in acute distress is unacceptable, and the two parties recognise this. There are proposals to improve maternal mental health services and there is active support for the implementation of the recommendations from the Independent Review of the Mental Health Act. Stigma, inequality, suicide, NHS privatisation, mixed-sex wards, joined-up care, welfare benefits and housing are all tackled. There are promises of significantly increased spending on mental health care, but what will the much-needed funding be spent on?
Although social care, housing and community support are mentioned, an emphasis remains on illness, which means investment in NHS hospitals and the workforce – crucial, but only part of the picture. Social care services and the diverse infrastructure of mental health provide substantial support outside the NHS. Smaller local community and user-led organisations, independent peer support and advocacy initiatives and specialist support for people with protected characteristics all play a vital role in prevention, early intervention and social inclusion. These mental health services often operate to complement and supplement those provided by the NHS. They can address the social, emotional and cultural aspects of mental health and wellbeing for adults and young people. Investing in the social infrastructure of communities can help to build resilience in young people. Therefore building community capacity is still a mental health policy priority.
Over recent years this core social and community infrastructure has been undermined by disinvestment and public funding cuts. Large cuts to council funding have resulted in considerable reductions to the commissioning of local user-led, community and voluntary sector organisations. Competition for charitable funding is high. Smaller concerns are losing out to big national mental health charities that have higher profiles and greater capacity for fundraising. Analysis by Shaping Our Lives and the National Survivor User Network, both national networks of user-led organisations, shows that there has been an acceleration of closures in the sector. Just one example is the Liverpool Mental Health Consortium, which closed in April 2019, while Self Injury Support, the only national user-led organization providing advice and support for adults and young people who self-injure are on the brink of closure at time of writing. It is thought that community mental health organisations by and for Black, Asian and Minority Ethnic and Lesbian, Gay, Bisexual and Transgender people have been disproportionately affected by austerity. In effect, the destruction of this support infrastructure amounts to a reduction in support for everyone living with or at risk of mental health problems, so the promised investment in mental health needs to reach a lot further.