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.

Dying of Embarassment

Cancer survival rates would be much better if we were less embarrassed about going to see the doctor, or were afraid of wasting doctors time, according to a new report.  I can vouch for this; it's taken the repeated encouragement of my other half to get me to the doctor on a couple of occasions in recent years when, left to my own devices, I'd have tried to soldier on and hope things went away. Partly because I didn't want to bother the doctor, and partly because there were certain bits of my anatomy I didn't want exposed to the fresh air of a doctors waiting room.

"As a nation we are much more likely to say we are embarrassed about going to the doctor or we are worried that we will take up a doctor's time.

"We don't know why British people feel like that. It may be that we are more stoic and have a war-time mentality.

"We know that older people in particular can get a symptom and then wait for weeks or months before going to see their doctor."

I must admit, the fear of wasting doctors time is sometimes reinforced by booking in systems, which sometimes seem designed to keep people away from seeing the doctor unless it's absolutely necessary. I appreciate the need to make sure doctors time is well spent, but there is still quite an air of mystique and remoteness about UK doctors. My experience in hospital is often (not always) that the specialists whizz in and out on the basis of spending the absolute minimum of time with a patient, and it's quite hard work sometimes to get information out of people about your condition. I don't know how highly social and emotional skills are ranked in doctors recruitment, but wonder whether a more overtly approachable medical  culture would help.

Despite that, I'm sure a some of it is down to the peculiar British culture of being obsessed by sex, whilst at the same time very squeamish about our own bodies, especially our (insert embarassment-saving euphemism here). And lets face it, a prostate check at a GP surgery isn't a pleasant experience for either party.

More of the report findings here.