‘The beds crisis should make the NHS question whether it is spending enough on mental health’

Mental health accounts for 13% of NHS spending and a quarter of all ill-health. This gap must be bridged to create a system that prevents crisis, says Sean Duggan of the Centre for Mental Health

The pressures facing mental health crisis services highlighted by today’s Community Care investigation are of huge concern. Problems accessing beds for people in crisis means people are being placed in hospitals long distances from home and admissions are being delayed.

With recent reports of the continued use of police custody for people in mental health crisis and of growing pressure on A&E units, it’s clear that the “institutional bias against mental health” that the minister for care services says exists in the NHS can no longer be ignored.

Many of the personal accounts we have heard this morning of the human cost of pressures on mental health services have made the need for drastic improvements in care clearer than any statistic.

So what’s the answer? The truth is the pressure on hospital beds are a manifestation of problems across the health and care system, and beyond. Tackling the shortfalls in crisis care is going to demand a ‘whole system’ approach that recognises that.

Cuts to community services

Mental health services are facing the same austerity measures as every other public service. Community services – which play a vital role in preventing people ending up in crisis – are under pressure. Yet we have received reports that some community services we know to be hugely effective are being lost.

Early intervention in psychosis services, assertive outreach and 24/7 crisis resolution teams are not expensive luxuries but fundamental parts of any effective mental health service. Cutting them to save money will prove a false economy as pressures grow on hospital beds.

The whole system of mental health care needs to work better to prevent crises as well as responding to them quickly and appropriately. We know that services which focus on intervening early when people become unwell can reduce costs both to the NHS, local government and the wider economy.

We also know that supporting people with mental health conditions to recover their lives on their own terms is more cost effective than traditional mental health care.

So it is vital that a concern about pressures on beds does not divert us from developing better employment services, from setting up recovery colleges or from building up a peer support workforce that can enable people to take charge of their lives.

Spending levels

Today’s investigation should make all clinical commissioning groups examine how much they are spending on mental health care and what gaps exist in the services they commission. Mental health care accounts for 13% of NHS spending but about a quarter of all ill health. Bridging this gap will make the whole of the NHS more efficient by better meeting the needs of every community.

Pressure on mental health services is not, however, just a problem for the NHS and social care. For too many people, housing insecurity, unemployment, poverty and debt go hand in hand with mental ill health, each exacerbating the other. A system-wide response is needed.

Resolving these bigger pressures requires a strategic approach, led by government nationally to make real its cross-government mental health strategy and ensure that people living with mental illness are given a fair chance in every area of life.

And locally, councils now have a pivotal role in leading efforts to improve mental health and support equality for people with mental health problems.

Mental health must be regarded as core business for every health and wellbeing board. They can now provide the forum for a range of local services to come together and ensure people with mental health problems are involved in the design of timely, respectful support for all of their needs, not sent from pillar to post until they end up in a crisis.

Sean Duggan is chief executive of the Centre for Mental Health

More on Community Care and the BBC’s investigation into the crisis in psychiatric care

Patients at risk as ‘unsafe’ mental health services reach crisis point

10 ways the mental health crisis is hitting patient care

‘The beds crisis makes me embarrassed to be work in mental health’ – a social worker’s story


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