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Peter Kinderman

53 million reasons

03 August 2017 | by Peter Kinderman

There are 53 million reasons to welcome the government’s announcement of a plan to spend £1.3bn on our mental health care.

The whole population of England (health is a devolved issue) will benefit from greater attention to our psychological health and wellbeing.

As the European Commission put it:

“Mental health is a resource which enables [citizens] to realise their intellectual and emotional potential and to find and fulfil their roles in social, school and working life. For societies, good mental health of citizens contributes to prosperity, solidarity and social justice” (click here for more info)

The government’s plan is ambitious. It includes proposals to recruit enough “nurses, therapists and consultants” (it doesn’t mention psychologists) to offer care to an extra one million people each year by 2020-21.

The government said an extra £1bn, money already promised for mental health services in England, rather than ‘new’ money, would fund the scheme. This money is to be spent, we now learn, on recruiting staff, with the main focus being on child and adolescent mental health services, early intervention services and crisis care. There is also a welcome emphasis on ‘talking therapies’.

The plans are challenging, with proposals for thousands of extra staff, including those with specific skills and extensive experience. And this is perhaps why critics such as the Royal College of Nursing have said the plans did not add up, and more "hard cash" would be needed if the new staff were to be trained in time.

This is perhaps also slightly ironic, as the present Government is responsible for caps to public service pay, an estimated £10bn annual shortfall in NHS funding by 2020, and the removal of the bursary for student nurses, already leading some to comment on threats to the provision of mental health nurses.

There also remains considerable uncertainty as to the future of training in my own profession of clinical psychology.

Therefore, like other professions, psychologists should – in my opinion – welcome this investment in mental health care, in prevention and early intervention, and in ‘talking therapies’, while also asking clear and assertive questions about the implications for training and employment, and in the case of psychologists, which means looking to ensure that a profession that serves the public extremely well is actively and practically supported.

We must also balance our welcome for these proposals with the recognition of the social origins of much of our psychological distress. Homeless people are 50-100 times more likely to be diagnosed with a psychotic disorder than the general population, and both poverty and social inequity are major determinants of our mental health.

Similarly, sexual abuse in childhood and an institutional upbringing are major risk factors.

More pertinently, the government’s own programme of reassessing disability benefits using the Work Capability Assessment has been associated with an increase in suicides, mental health problems, and prescribing of anti-depressants, and this pattern of anti-depressant prescription mirrors social disadvantage.

All this at the same time as we are seeing cuts to social care – an infrastructure that must underpin NHS care.

So I welcome this plan, and, for my part, I’ll work to implement it.

We need this kind of investment.

And we need these kinds of plans.

But we also need wider change too. We need the vision of the United Nations Special Rapporteur, which recently characterised mental health care:

“not as a crisis of individual conditions, but as a crisis of social obstacles which hinders individual rights” (p. 19)

This means re-thinking what we mean by ‘mental health’ – from a focus on the diagnosis of illness and the pursuit of aetiology. We should not look to medication to “cure” or even “manage” non-existent underlying “illnesses”, but instead identify and understand the causal mechanisms of operationally defined psychological phenomena.

And we need wider social change too.

If we are serious about preventing mental health problems from developing, and about promoting genuine psychological wellbeing, we must protect children and adults from emotional, physical or sexual abuse and neglect, and we should be working collectively to create a more humane society: to reduce or eliminate poverty, especially childhood poverty, and to reduce financial and social inequality.

And these are not, I’m afraid, changes of the kind recommended by the supporters of Trump, Brexit, and austerity politics.

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