With the Mental Health Act dating back to 1984, the time for comprehensive reform is now, especially as highlighted by Lord Darzi’s review, which indicates a significant decline in mental health services. Written by HSR UK Board Trustee Dr Gemma McKenna, this blog delves into the multifaceted approach needed to rebuild and enhance population mental health support, examining key areas such as education, housing, prisons, and social care.
The King’s Speech 2024 pledged to modernise the Mental Health Act (House of Commons Library, 2024). First enacted in 1984, this crucial area of public health is long overdue a major policy reform. Moreover, the recent publication of Lord Darzi’s review (2024) highlighted that mental health services and population mental health is in significant decline, alongside gaps in both physical and mental health services for children. It is therefore both timely and crucial to start re-building the framework of population mental health support that is so desperately needed.
Addressing mental health in public services and across social policies will require a paradigm shift away from target driven measures and shaming individuals’ ill mental health (‘Butler and Mason, 2024). The pressures on services are demonstrable from the neglect of mental health and social care over decades with too much focus on the point of entry to the NHS for treatment, and not enough around prevention.
This requires a multifaceted approach. Prevention through early childhood support is needed, as well as early intervention strategies, and updated approaches for the current adult population who need person centred care. This all needs to be tailored in collaboration with allied health care professionals and carers too, so where should Labour start?
Education settings: early years and onwards
Previous governments have started key developments in this area. Most notably is funding the creation of mental health support teams (MSHTs) to work in and with schools. Teams work directly in schools and colleges, helping staff to promote emotional wellbeing for all pupils alongside supporting children and young people with mild to moderate mental health problems. Some MSHTs also provide more specialised therapeutic support for conditions such as for eating disorders and for specific groups including neuro-divergent children and black and ethnic minority groups (McKenna, Mays & Ellins, 2024). Research conducted by the University of Birmingham, London School of Hygiene and Tropical Medicine, RAND Europe, and the University of Cambridge found that staff felt more confident discussing mental health issues with children and young people. They also reported easier access to mental health advice and quicker support for young people experiencing certain mental health problems. However, staff spent more time supporting children with mental health problems rather than focusing on preventative work (Ellins et al, 2023). Preventative initiatives, such as developing whole school approaches to mental health and wellbeing in schools should be a key area of focus for the government going forward.
Housing and homelessness
The two are inextricably linked and have major impacts on physical and mental health (McKenna, 2013). The cost to the NHS of poor housing is high at around £1.4bn per year. A long-term national strategy to tackle the housing crisis is needed, without which the number of people experiencing homelessness is set to significantly increase, reaching 620,000 by 2045. (The National Housing Federation, 2024). Practical initiatives include building more affordable housing; the government have pledged to build 1.5million homes over the next 5 years (Georgieva & Reuben, 2024). Plans such at these are integral, and further still is the support required to treat and support children and adults in mental health services who present as either a cause or consequence of poor housing or homelessness experiences (McKenna, 2013).
Prisons
Prison overcrowding has been an early focus for the new government with an announcement in July 2024 to release prisoners early (McKiernan & Farley, 2024). We have the largest prison population in Western Europe but the least effective rate of reducing reoffending (The Psychologist, October 2024). We are at an impasse; reactive policy decisions, such as early release, may be necessary in the short-term but there is an opportunity for the government to build preventative approaches and for the research community to delve deeper into the people who make up the prison population. Around half of the adult prison population in England is estimated to be neurodivergent (The Joint Inspectorate Evidence Review, 2021). Neurodiverse people are more likely to experience comorbidity of neurodiversity and ill-mental health. The two can coexist, leaving individuals especially vulnerable (The Psychologist, 2024). Early diagnosis in education settings, early access to mental health support and access to diagnosis in prisons should form a key part of social policy developments going forward, alongside collaborative approaches between healthcare professionals, patients and carers, to treatment.
Social Care
Despite legislation to improve the relationship between health and social care via the Health and Social Care Act 2012, social care remains the poor cousin to the NHS and the focus is often on physical healthcare (Matthews, 2024). Yet social care is the home of innovation; due to these constrained resources, it is often required to be flexible and innovative. Allied health professionals, such as occupational therapists are paving the way for mental health support in general practice to free up GPs time (Chamberlain, 2019). They provide support for a wide range of needs, including complex cases that do not meet the criteria for specialist mental health services, as well as the mental health needs of children and young people that fall outside the criteria for secondary care services (Hawley, 2021). A key focus for the new government should be expanding this workforce. There are around 8,000 GP surgeries in the UK and only 300 occupational therapists working in them; research by the Royal College of Occupational Therapists (RCOT) suggests that therapists bring benefit to patients and GP surgeries through managing demand which is then extended to reduce the impact on secondary care (RCOT, 2023).
The role of Health Services Researchers: collaboration and policy innovation
The golden thread to weave these areas of social policy together is to ensure that mental health policies are at the heart of pre-emptive rather than reactive strategies and approaches. Health services researchers have a key part to play in this culture shift at the heart of government by coming together with social science disciplines, clinical researchers, the third sector, and collaborating with patients and carers to provide evidenced based policy solutions for these enduring social issues. Collaborations should also focus on working across government departments and with innovative partners such as the UK Government’s Policy Lab embedding design and innovation in people centred approaches. As a research community, we have a moral obligation to use our evidence to improve population health - so let’s elevate our work from research findings to have real impact through policy influencing and change.
Dr Gemma McKenna is an Assistant Professor at the University of Birmingham’s Health Services Management Centre, specialising in child and adolescent mental health and public access and usage of primary, urgent and emergency care services, with particular focus on vulnerable groups. She is also a trustee of HSR UK.
References:
Chamberlain, E. Truman, J. and Scallan, S (2019). Occupational Therapy in Primary Care: Exploring the Role of Occupational Therapy from a Primary Care Perspective. British Journal of General Practice, 575-576.
Ellins J, Hocking L, Al-Haboubi M, Newbould J, Fenton S, Daniel K, et al. Early evaluation of the Children and Young People's Mental Health Trailblazer programme: A Rapid Mixed-Methods Study. Health Social Care Delivery Research 2023;11(8), https://www.journalslibrary.nihr.ac.uk/hta/XQWU4117#/s10.
Garratt, K (2024). Reforming the Mental Health Act (2024). Accessed September: https://researchbriefings.files.parliament.uk/documents/CBP-9132/CBP-9132.pdf.
Georgieva, G and Reuben, A (2024). New Homes: What’s the New Government’s Housebuilding Target? BBC News. Accessed September 2024: https://www.bbc.co.uk/news/61407508#:~:text=New%20homes:%20What's%20the%20new%20government's%20housebuilding%20target?,-Published&text=The%20government%20aims%20to%20build,it%20will%20deliver%20more%20housing.
Hawley, R (2021) The Role of Occupational Therapy in Primary Care Mental Health Teams. Accessed, 25 September 2024 https://otalk.co.uk/2021/09/14/the-role-of-occupational-therapy-in-primary-care-mental-health-teams/.
Lord Darzi (2024). Independent investigation into the NHS in England. Accessed September 2024: https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england.
Mason, R and Butler, P (2024). Sunak to Cite Britain’s ‘sicknote culture’ in Bid to Overhaul Fit Note System. Accessed September 2024: https://www.theguardian.com/politics/2024/apr/19/sunak-to-cite-britains-sicknote-culture-in-bid-to-overhaul-fit-note-system.
https://commonslibrary.parliament.uk/research-briefings/cbp-9132/
Matthews, K (2024). Adult Social Care Sector Remains the ‘Poor Cousin’ to the NHS. Learning Disabilities Allies (2024). Accessed September 2024: https://www.hft.org.uk/press-releases/adult-social-care-sector-remains-the-poor-cousin-to-the-nhs-says-learning-disability-charity/.
McKenna, G, Mays, N & Ellins, J (2024). Access to Mental Health Support for Schools and Colleges for Children and Young People with Mild to Moderate Mental Health Concerns.
McKenna, G (2013). Tackling the Labour Market Exclusion of Homeless People: The Role of Social Enterprise. https://repository.mdx.ac.uk/item/8482w
McKiernan, J and Farley, H (2024). Thousands of Prisoners to be Released in September. BBC News. Accessed September 2024: https://www.bbc.co.uk/news/articles/crg5vp0296eo.
Ministry of Justice (2021). Neurodiversity in the Criminal Justice System. A Review of Evidence. Accessed September 2024: https://www.justiceinspectorates.gov.uk/cjji/inspections/neurodiversity-in-the-criminal-justice-system-a-review-of-evidence/.
Royal College of Occupational Therapists (2023). Summary of Evaluation of Occupational Therapy in Primary Care for Older Adults. Accessed September 2024: https://www.rcot.co.uk/primary-care-evaluation?hash=ZvSpdU7aq_vzzoSNewarmC9H93uyJwUPdygkOYOENHU.
Sutton, J (2024). The Psychologist Guide to Prisons. Accessed September 2024 (October edition). The Psychologist: The British Psychological Society.
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The Psychologist, January/February ed (2024). Neurodivergence: Change, Complexity and Challenge. Accessed September 2024. The Psychologist: The British Psychological Society.