Supporting mental health services in the recession

Mental health services face the double whammy of higher demand and fewer resources, reports Jeremy Dunning

The impact of the recession on mental health services is already being felt but the belief among social care, NHS and voluntary sector organisations is that far worse is to come.

Many of the effects of recession – repossessions, money problems and unemployment – are well known triggers for mental health problems.

Research published by University College London in 2007 found that one in seven men developed depression within six months of losing their job.

Meanwhile unemployment has risen sharply – by 629,000 to 2.46 million between July to September 2008 and the same quarter in 2009 – and economists predict worse is to come.

The challenge for local authorities and the NHS will be meeting this demand amid cuts to public spending, particularly from 2011 onwards.

The evidence of increased demand is already available. Mental Health Helplines Partnership (MHHP), an umbrella charity that supports mental health helplines, says its members are receiving a higher number of calls relating to finance and job concerns through its virtual call centre, a national call handling system.

In the last six months of 2008 (July to December) members received 132,564 calls, while there were 158,827 in the first half of 2009, an increase of 20%.

In October, a survey by the Association of Directors of Adult Social Services found that 46% of councils had experienced rising demand for mental health and substance misuse services since October 2008.

The NHS Confederation’s Mental Health Network, which represents mental health trusts, is surveying members about the impact of the recession.

The results will not be completed until the middle of December but director Steve Shrubb says: “People who have responded are describing increases in activity across the board but most particularly in those areas you would link with the recession such as anxiety and depression.”

MHHP chief executive Fiona Kerr says there will be an increasing workload for helplines over the next few months and that health commissioners must commit to funding helplines now more than ever.

“What we are trying to do is to encourage the helplines to look at where the commissioning is happening and join forces either with each other or with other mental health providers in their area so they can complement the service provision,” she adds.

The government has already provided a £13m package to tackle the impact of the recession on mental health, including a faster roll-out of access to talking therapies for depression and anxiety.

It has also set up an NHS Credit Crunch Stressline to provide advice for people experiencing stress, though it is still in test period and has not been heavily promoted.

From 2011-14, public spending will fall to cope with the ballooning budget deficit.

Based on government figures, the Institute for Fiscal Studies has calculated that budgets across Whitehall will have to fall by 2.9% a year in real terms.

While the Conservatives have promised – and Labour has indicated – they would maintain NHS spending in real terms, this implies substantial cuts for local government. A real-terms freeze for the NHS would not help meet mounting demand.

In his annual report, published in May, NHS chief executive David Nicholson said the service needed to prepare for efficiency savings of £15bn-£20bn from 2011-14.

Shrubb says that not only will mental health have to play its role in meeting the reduction, it may also be more vulnerable to cuts than physical health services because it is subject to fewer targets.

A report published last month by the Mental Health Network, Royal College of Psychiatrists and the London School of Economics raised specific concerns about the future of the talking therapies programme, despite its focus on recession-fuelled conditions like depression.

Funding runs out in 2011, and the report, on mental health and the recession, warned that the programme’s focus on getting people back to work would make it vulnerable to cuts at a time of rising unemployment.

Shrubb says the key for mental health services will be to use resources more effectively.

Last month’s report made several proposals in this area (see box).

For example, it said the system for GPs referring patients into the mental health system was “undeniably complex” and risked duplicating costs.

Efficiencies could be made by enabling family doctors to refer people to a single point of access, where a team would carry out assessments and direct the patient to the appropriate service, it added.

Meanwhile, the sector awaits the government’s 10-year strategy for mental health in England, New Horizons, due this month, which is expected to set out ways of improving value for money by promoting innovation and joint working.

National director for mental health Professor Louis Appleby told the Mental Health Network’s annual conference last month that it would provide an opportunity to “recession-proof” the achievements of the past 10 years.

Mental health organisations will be hoping this is the case. If not, the twin pressures of reduced resources and increased demand will make the next few years torrid ones for mental health service users.

Short of resources?

How mental health services can tackle the effects of the recession

● Reduce pay bill through natural wastage and cutting agency staff use, not redundancy.

● Review out of area placements in order to bring patients back to local areas.

● Streamline referrals from GPs to mental health services.

● Acute hospitals should provide mental health services leading to fewer readmissions and earlier discharge.

Mental Health and the Economic Downturn

Case study: Richmond fellowship

There are still jobs available, says mental health care provider Richmond Fellowship, but the recession is making people doubt themselves.

Its Mid Surrey service, commissioned by Surrey Council in 2006, provides an employment advice service for people seeking paid work. It also offers a “Retain” programme to help people experiencing mental health problems stay in work, by providing support for individuals and employers.

From 2006-7 to 2008-9, 100 out of 187 clients supported by the service found work, with 67% of those working for 16 hours or more. A further 78 clients were supported into unpaid employment, training and education.

Manager Mike Munson says: “What our advisers are finding is that there’s more work to be done on self-belief. Our clients are looking at the market and seeing that there’s much more competition towards getting a job and as we know hope is essential towards recovery.

“History shows that people with severe and enduring mental health problems as a percentage in employment goes down in a recession. But there are still jobs out there and there are sectors doing better than others and that changes geographically.”

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