NHS Confederation’s mental health director reveals plan to boost services

Steve Shrubb (pictured right) was appointed the director of the NHS Confederation’s new Mental Health Network, which represents mental health and learning disability providers, on 1 June. Before that, he was a regional director at the Care Services Improvement Partnership and had been chief executive of Newcastle, North Tyneside and Northumberland Mental Health NHS Trust for three years.

How has your first month as director been?

I’ve spent the bulk of it meeting various stakeholders – members, civil servants and service user groups – getting a sense of what they think the network should do. People are very keen to see commissioning improve. The future of successful services and care is about social services departments and primary care trusts commissioning better together. There’s also been interest about individual budgets and self-directed care, which is good to hear.

You said when you were appointed that mental health is often a Cinderella service in the NHS. How do you stop that being the case?

We need to get mental health onto the agenda of other bits of NHS policy. For example, there’s a continuing debate about health inequalities. Some of the biggest are in mental health, not just in the way people access services but their opportunities for work, education and good housing. Mental health needs to be as an important a public health issue as anything else.

How do you stop resources being diverted from mental health trusts to other trusts when they get into financial difficulties?

It’s happening less now but it’s still happening. The only way to deal with this is to have discussions with commissioners and PCTs to get them to understand the implications of reducing mental health services funding. We’re working with the director of the confederation’s PCT network to talk to commissioners about the right level of funding for mental health.

Are you happy with the Mental Health Bill?

We’ve taken a pragmatic approach. Due to the work of the Mental Health Alliance and others, the current bill is a lot better than it could have been. We have a new bill now let’s work together to influence how it’s implemented. That’s the next important focus of our energy. We can significantly improve how the new act is delivered.

Is it possible to make psychological therapies available to everyone who needs them and if so when will it happen?

The evidence is clear that we should be offering cognitive behavioural therapy for depression or anxiety. The government’s talking therapy pilots will demonstrate you can use less qualified people as long as they are well supervised. In the next three or four years there’s no reason why we cannot turn around access to these services in ways that happen elsewhere in NHS care.

Research suggests black and ethnic minority people have a bad experience of the mental health system. Is the mental health system institutionally racist?

I don’t think that’s accurate. People don’t go into work to provide poor services to any particular group or individual. But it’s a system that’s not understood the needs of the different groups that make up its target community. Services have often been very broad-based rather than designed to make it easier for certain groups to access and receive good treatment.

Are mental health in-patient units set up to help people get better or simply contain them?

Things have significantly improved. Most people now accept that acute in-patient care needs to be seen as part of an acute pathway. Seeing it as a disconnected part of the system leads to the units being seen as areas of containment. An acute pathway model means people go into acute in-patient units only when they need to be there, stay for the shortest possible time and are discharged back into a community system that can provide home treatment.

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Simeon Brody

This article appeared in the 26 July issue under the headline “Cinderella service finds its prince”

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