England’s chief medical officer has today called for mental health to be more of a priority with greater protection of funding for services.
Much in Dame Sally Davies’s comprehensive report on mental health services won’t surprise social workers. For example, it highlights real-terms funding cuts for services and problems accessing support for both children and adults.
However, the report also highlights where services are being cut. The figures below challenge some of the official narrative that services have been investing in preventive care in recent years. The chart below shows that total investment across three key services for crisis prevention – crisis resolution teams, assertive outreach and early intervention in psychosis – saw a 6% real-terms cut in funding in 2011-12.
All three of these ‘priority areas’ are supported by strong evidence of their effectiveness in keeping people out of hospital. They are the type of interventions that NHS trusts have often said will be invested in when they are justifying closing beds.
Here’s what the chief medical officer’s report had to say about the figures:
Between 2010-11 and 2011-12, investment across the three priority areas (crisis resolution, early intervention and assertive outreach) fell (for the first time) by £29.3 million, from £520 million to £490.7 million. This is significant given the evidence base for these services reducing admissions and the co-existing reduction in bed availability.
Funding for older people’s mental health services was also found to be under greater pressure, with a 1% fall in cash terms from the previous year to £2.83 billion in 2011-12. This represents a decrease in real terms of 3.1%. Some data suggest that service reductions may have been greater in London than in other areas of England.
The figures only cover up to 2011-12. In the two financial years since, we know that mental health trusts have faced further real-terms budget cuts. Data I obtained under FOI data from 32 trusts found that crisis resolution teams saw their budgets shrink by 1.7% in real-terms between 2011-12 and 2013-14.
So, what is the impact of this on services and patients? In the past I’ve spoken to social workers whose crisis resolution teams were disbanded and absorbed into community mental health teams due to cost pressures. The result, one social worker told me, is that staff with high community caseloads are left trying to combine care coordination work alongside intensive home treatment. The result is staff feeling overwhelmed and people being seen less. It is a situation, the social worker told me, that felt unsafe.
Research by the national confidential inquiry into suicide and homicide, based at the university of Manchester, have also warned about the risks of absorbing specialist crisis resolution and assertive outreach teams into generic services. Mental health charity Rethink produced a report earlier this year on the dangers of disinvestment in early intervention services.
With the chief medical officer’s wide-ranging report the case for greater investment has, once again, been made strongly. But will it lead to any meaningful action on the part of government and NHS commissioners?