28% of the illness, 13% of the funding, the scandal of mental health 'provision'

The Chief Medical Officer for England has pointed out what many of us have been saying for years, that mental health gets the short (bordering on non-existent) straw in terms of funding and priority. Some snippets from the BBC report on this:

Dame Sally Davies said there were signs funding was being cut at a time when the cost to the economy was rising.

Her annual report said mental illness led to the loss of 70 million working days last year - up 24% since 2009.

She recommended they allowed people with mental health problems the option of flexible working to keep them in employment and maintaining regular contact during sickness leave.

Overall, mental illness costs the economy between £70bn and £100bn in lost productivity, benefit payments and absence from work.

In terms of NHS spending, it accounts for 13% of the budget despite causing 28% of illness.

Dame Sally said there were signs spending in real terms had been cut since 2011 - and called for this disinvestment to stop.

Not quoted by the Beeb, but just as stark, is the fact that 70% of people with a mental health condition get no treatment at all. And some of the treatment is itself pretty patchy - people with specialisms in other areas (e.g. general nursing, social work) are put through short courses to deliver Cognitive Behavoural Therapy, and that counts as 'treatment' even it's poorly done. 

The piece quotes Nick Clegg and Norman Lamb, all saying the right things, but who have comprehensively failed in this area. Clegg has spoken about the need for better mental health services in 2011, 2012, and earlier this year. The evidence quoted by the Chief Medical Officer shows that this is a monstrously ineffective talking therapy. On Cleggs watch, and Camerons, spending has fallen in real terms. Four and a half wasted years. 

The problem is getting worse, working days lost to mental illness have risen by a quarter in the last 5 years. The toll of the recession is not just an economic one. 

here's the official press release, and here is the full report. Some of the good recommendations include mandatory training for GPs in mental health (is this not in place already? if so, that's an absolute shocker), and waiting time targets for people with mental illness. I know people with fairly common mental illnesses who had 10-15 years of going to different GPs before their condition was correctly identified. 

What I can't see (it's a 300+ page report and I've just skimmed it, so I may be wrong) is a systematic attempt to listen to the experience and needs of patients. For example, the model of discharge which works for physical health (your broken leg is now working) doesn't work for mental health - there is often an ongoing vulnerability which ongoing, low level support can prevent from flaring up into a full blown episode. But that's not usually available - and a target based approach may make this worse: put more people through CBT, get more people off the books - that is not the same as a successful outcome for the patient. 

It's not glamourous, it's not a headline grabber, but any politician wanting to be taken seriously has to get a grip on this one, or they are failing 25%+ of the population before they've even started.