Special report: what does the future hold for mental health services?

A radical vision for a future mental health service focusing on wellbeing rather than ill health was published earlier this week.

The report proposes that by 2015 crisis houses and even hotels would be used instead of hospitals for people needing inpatient care. Direct payments and individual budgets would play an increasing role as those with the most serious problems could buy services they want. Service users would be aided by an “associate” who could provide advice on employment, benefits and housing as well as care.

People going to see their GP for help would be able to choose from a range of treatment options, including talking therapies. And schools would put “emotional literacy” on the timetable.

This idealistic vision was drawn up by the Sainsbury Centre for Mental Health, the Local Government Association, Association of Directors of Social Services and the NHS Confederation.

It is not the first report in recent times to propose a similar formula. Service users, expressing their views in November’s Future Perfect report, by severe mental health charity Rethink, imagined a world without inpatient beds. They called for small crisis houses with a therapeutic environment and more preventive drop-in services.

Future Perfect builds on a study published last June by the Institute of Public Policy Research which advocated developing a network of walk-in centres, where people could get advice on all aspects of healthy living and access mental health services by 2025.

Called Mental Health in the Mainstream it envisaged a future where mental health is taken as seriously as physical health and services are created which people feel comfortable accessing.

Rethink’s director of campaigns and communications Paul Corry, (pictured), believes a consensus is emerging among mental health groups about what the future should hold.

“The most fundamental point of convergence is we should be thinking more positively and hopefully about the future than we have been in the past,” he says.

Corry argues increasing numbers of people are recovering from even severe mental illness to live a meaningful life and while all the building blocks are in place for a positive mental health service they are scattered across different parts of the country.

“What we are saying is that some of those building blocks should be brought together to provide a comprehensive service for people.”

The Sainsbury Centre’s head of communications Andy Bell also feels there is a shared understanding of the necessary “direction of travel”.

“One thing that’s really clear is this is not about mental health services on their own any more, we need to focus on people’s lives as a whole. We’ve moved away from a time of people being closed up in asylums to living in the community. What we haven’t done is help them become part of those communities. It’s taking the next logical step and that’s why there is consensus.”

Of course it is all very well for mental health charities to enjoy a consensus but if it is to become reality is must also be shared by the government.

Responding to the Sainsbury report a Department of Health spokesperson says it broadly mirrors the government’s own mental health national service framework.

“We are trying as much as possible to divert people away from inpatient care to home treatment, crisis resolution and early intervention,” she explains.

Describing the idea to teach emotional wellbeing at school as “quite interesting” she adds: “We are not going to commit to introducing anything straight away but mental health is a top priority for us.”

Bell agrees the government is working towards the same goals in most areas, with the level of political priority, speed of change and amount of resources likely to determine how many of the aspirations are met.

But there is one issue in which campaigners fear the government is heading in the opposite direction to them – the proposed mental health bill.

Corry believes the bill’s onus on compulsion and dangerousness panders to prejudices rather than tackling the stigma which undermine attempts to integrate people with mental health problems into the community.

But the bill’s very unpopularity among mental health bodies may have contributed to the development of a shared agenda.

Royal College of Psychiatrists registrar Professor Sue Bailey says the Mental Health Alliance, set up to oppose the bill, has helped voluntary sector agencies, individuals and psychiatrists realise they can work together. Bailey welcomes the Sainsbury report but warns that inpatient beds will always be required for people with severe difficulties.

She remembers similar debates about mental health being held 30 years ago but believes the key to making progress this time round will be tackling society’s attitudes to mental health, particularly in the press, where negative stories currently add to discrimination and stigma.

Download The future of mental health: a vision for 2015