Care services minister Paul Burstow writes exclusively for Community Care on the link between poor mental health and deprivation
Writing earlier this summer, the prime minister made a powerful call to action on reducing deprivation in our society.
In a newspaper article, he wrote about “galvanising the whole of the public in fighting poverty”, and the “miserable chain of inevitability” linking family breakdown, worklessness, drug and alcohol abuse and crime with long-term poverty and exclusion.
But, in facing up to poverty, we must acknowledge another truth: that poor mental health is often a key link in that miserable chain.
The facts tell their own grim story. Being unemployed increases the risk of mental illness fourfold compared with those in employment – and once you have a diagnosed mental health problem, your chances of finding or keeping a job are drastically reduced.
This is a classic Catch 22 that has helped to fuel the massive rise in welfare spending over the past 10 years – 42% of the £12.5bn spent on benefits due to illness and disability now goes to people with diagnosed mental health problems.
Even if the deficit did not loom large, this figure should disturb us on a human level – because it shows how the previous government failed to tackle the deep-rooted effects of depression and stress-related illness on our communities.
Depression and other common mental health problems affect six million of us, and recent estimates put the economic cost of mental ill-health at a staggering £77bn a year. Yet this was treated as an afterthought by the last government.
It was only belatedly – and after much prodding by visionaries like Lord Layard [founder and director of the London Scool for Economics’ Centre for Economic Performance] – that it took any real action to prevent poor mental health.
The policies that do exist, most notably in the recent New Horizons strategy, are big on principles but short on detail. As a result, good intentions have foundered on the rocks of poor delivery.
Improving Access to Psychological Therapies (IAPT) is a case in point. This is making a tremendous difference in some places – health secretary Andrew Lansley and I visited patients at an IAPT centre in Berkshire last month and heard how cognitive behavioural therapy had changed people’s lives.
Yet slow take-up means many still face long waits for these treatments, and thousands of people around the country are therefore being consigned to months of anguish and uncertainty.
The coalition has already signalled its support for IAPT, committing £70m this financial year to establish more centres around the country.
But I know that’s only a small part of the solution. Because what we really need is a wholesale shift in emphasis to give mental health parity with physical health in the NHS.
Our NHS White Paper – with its plans to replace process targets with a new focus on patient outcomes – will help to achieve this.
Over this summer, we are discussing with patients and clinicians which “outcome” measures should be used to judge the health service in the future.
I passionately believe a person’s general well-being and overall mental health should form part of this assessment. There is no health without good mental health and certainly no well-being.
The fact is we can no longer accept that curing someone of cancer, then leaving them to struggle with depression afterwards is a true mark of success.
The NHS should deal with the full parameters of a patient’s recovery, including helping them return to work and get their life back after illness. That’s what the new outcomes framework should deliver.
We must also draw on a broader canvas in preventing people from developing mental illness in the first place. The new public health service and the health improvement role of local government will help, but this stretches far beyond just health. In fact, it covers all aspects of community life.
First, it involves other public services – from Jobcentre Plus and housing teams through to children’s services and environmental planning, we need to ensure the right support is there to help people stay on track and in control of their lives.
Second, it requires us to empower neighbourhoods, stimulating those active exchanges between people that can have such a healing effect on people and places.
And third, it means galvanising charities and grassroots community groups that can reach out to people on the cusp of depression and draw them back from the brink.
In the months ahead, ministers from the Department of Health and across government will reshape mental health strategy to set clear outcomes and offer a roadmap for delivering them.
Of course, all this has to be achieved in a difficult financial context. But even in these tough circumstances, we can move forward in mental health – and, by doing so, we can land a major blow against poverty and deprivation.
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