Once upon a time, there was a girl who grew up to become a mental health researcher… No. Wait. Once upon a time? I’m not the Cinderella in this fairy tale… I am the girl who grew up to become a researcher though.
I’ve been working in mental health for a number of years now and have written a number of blogs in this time. The first of which was all about stigma. Since then, I have written about an inspirational doctor, who transformed care for many. I have written more directly about my work with a blog on the future of clinical trials, and I have written about microdosing — something which is very different to my own work but could have important implications for it. But my first — about stigma — is the one I want to emphasise.
It is my first one that hasn’t left me since, and most likely because of the prevalence of the issue.
Stigma is one of the biggest barriers to seeking help for mental health. Mental health isn’t seen in the same light as physical. You hurt your knee and you go to the doctors, but it’s not often the same for our taking action for our mental health.
I have grown up in a time where there has been a real focus on reducing this stigma, and these efforts are doing great things, but this isn’t the end of the story. There are further barriers.
Throughout this time working in research, two things have become abundantly clear to me: Firstly, an incredibly large proportion of us will experience mental illness at some point in our lifetime.
And secondly, mental health, has been a relatively underfunded sector in UK healthcare for a long time. When I say a long time, I don’t mean the last few years, I mean decades. But these seem like two contrasting issues to me — if we have a high demand for help and support and we are actively telling people to seek this, why isn’t the money pot being filled so that we can provide this?
Mental health services are the real Cinderella of this story, with an awful lot of work and very little credit (in this case, financial credit).
So, while stigma is just one barrier we are continuing to break down, I now find myself wondering about another: funding. More specifically I want to know why there appears to be such a difference between funding for mental and physical health. So I have decided to play detective and investigate the situation for myself.
I have started by asking — what is the current state of mental health funding in the UK? Is this truly a Cinderella story?
The statistics on mental health are hard to avoid if you have access to the internet, a TV or newspaper.
One in four of us will experience mental health problems — that equates to a whopping 792 million of us worldwide.
When it comes to our working lives, the cost of mental illness in England alone is estimated at £105 billion per year and as high as £99 billion per year worldwide.
Depression is one of the leading causes of disability (my fellow depression researchers will know this sentence inside out and back to front).
In 2013, approximately 8.2 million people in the UK experienced anxiety.
1 in 10 children between the ages of 5–16 will experience a mental illness.
Up to 725,000 people in England currently have an eating disorder.
And I could go on. The list of statistics is as endless as it is worrying, and it is clear that we need to provide support for a lot of people in need. Yet as it stands, the NHS does not currently seem to have enough funding to meet demand.
Campaigns such as Time to Change, one of the UK’s largest mental health awareness campaigns, and more recent examples such as the Royal’s Heads Together campaign, are making impressive strides in shifting the narrative on mental health: breaking down stigma and making awareness in the general population all the more better. These campaigns demonstrate the value of asking for help and this is so important.
Yet, alongside this, we are faced with another issue. More of us are coming forward for support, but despite our increasing demand, there doesn’t seem to be increasing funding for those services providing such support.
In January 2018, The Guardian published an article entitled ‘Mental health still losing out in NHS funding, report finds’. This article compared the disparity in the inflation of funding for NHS services. Between 2012–13, mental health services saw an increase in funding by around 5% whereas other services saw rises of up to 17%. From 2015–16, budgets for mental health rose only by 2% in comparison to a 6% increase for physical health services. The disparity is clear, and you can see why many people question the equality of money distribution, particularly given the prevalence of mental health problems experienced.
An article by NHS providers in 2017 shows that children and young people’s services (CAHMS) are particularly struggling, with over 50% of services not being able to meet the ever-increasing demand. In comparison, services for cancer are meeting up to 95% of demand and reaching specific target deadlines.
Don’t get me wrong this is wonderful news in cancer, but why can’t mental health services achieve the same standards?
Before I continue to dive into the specifics of funding for mental health specifically, it is also important to note that the NHS is in a difficult position when it comes to funding in general. Sadly, there is not limitless money floating around and with the majority of NHS funding (approx. 99%) coming from general taxes and national insurance, money available closely reflects the highs and lows of the economy. Sorry for mentioning this during our current situation…
But this does leave many sectors in need of a substantial cash injection so that NHS services are able to continue their incredible work providing the best care possible. The reality of funding is that growth in funding across the NHS has dramatically slowed since the 2008 recession.
Funding is always going to be a difficult conversation and in reviewing the equality of funding pumped into mental health, I am not saying that any sectors are more or less deserving. If I had it my way, there would be limitless funding for all sectors but sadly this is not realistic. The reality is far more complex.
What I am addressing here is the fact that mental health care has suffered disproportionately to its demand.
In truth, funding hasn’t just been an issue for services — mental health research is less invested in, in comparison to its physical health counterparts. MQ Mental Health, a leading mental health research charity, recently reported that mental health research has been receiving 25 times less funding per person affected than conditions such as cancer.
Research is funded in a number of ways but there is one particular example I would like to share as I feel it really emphasises the enormity of what I am trying to demonstrate: public donations for research into some physical illnesses is 900 times more than that donated to mental health research in the UK. We’re the Cinderella of research too.
The day-to-day consequences of the lack of funding is clear and the main examples of this are demonstrated with waiting list times and lack of staffing.
The state of waiting lists highlights this perfectly. A 2020 House of Commons Briefing Paper on mental health statistics for England reports that waiting times for NHS psychological therapy (IAPT — Improving Access to Psychological Therapies) can range from 4 days to 61.
61 days is a long time. Especially when you are desperate for that help.
61 days is a lot of time for things to worsen, things to go wrong.
When you’re put on a waiting list, your life is put on hold, waiting for your chance for support. Waiting times don’t just affect the individual either, strain is placed on whole families and support systems and not to mention leaving staff at the services frustrated.
During many occasions in my life, I have heard people rightly dismaying about the state of waiting times, but also incorrectly placing blame on the individual service providers. And I guess the most important thing I want to say is that no individuals, teams or services working in mental health want people to have to wait weeks, sometimes months, to get support.
Actually, it’s the opposite.
It is the financial system in place that fails these individuals, not the staff.
And while much of the content in this blog has come from research online, my last point is one that comes from experience working as an Assistant Psychologist in a service for people with psychosis in 2018. It was a busy service in an area of London with some of the highest rates of Psychosis, the waiting list was out of our hands, but it was hard to see patients disheartened hearing how long they may have to wait. But when they did get to the top of the list and had therapy, it was lovely to hear when they were doing a lot better. Maybe this experience is why I am interested in the topic.
Waiting list times are a direct consequence of a lack of resources — aka, a lack of staff. The staff who are employed still have to try and manage this high demand leaving many over-stretched and at risk of burnout. And it’s not just those providing the face-to-face support for patients, it has a knock-on effect on all, admin staff, housekeeping staff. All of these people trying to do amazing work are doing so under incredibly stressful conditions, yet still all doing their best.
A report by the King’s Fund described how all of the mental health trusts assessed in an Analysis of Care Quality Commission reported that a lack of staffing is putting patients at increased risk.
The importance and the drastic consequences that under-funding can, and is, having, is clear — without enough money, mental health services (or physical care sectors) cannot employ enough staff to provide the services needed, leaving many without help when needed and only causing further ill-health, with more intensive, and likely more expensive support needed for these individuals further down the line.
But it is not all bad news: many years of campaigning for these inequalities has led to a change in direction. The main change being seen after the UK governments strife for a ‘parity of esteem,’ first mentioned in 2011.
Parity of esteem in an approach to NHS treatment where a patients’ mental and physical health should be treated with equal importance. Research has shown us over and over that poor mental health can put you at higher risk of physical conditions, and/or poorer outcomes for these illnesses, not to mention mental health costs take up a fair amount of physical health spending and so this is a very good outlook to be pursuing.
So how is this translating into funding?
The strife to achieve parity led to the development of the ‘Mental Health Investment Standard’. This initiative ensures that Clinical Commissioning Groups (CCG’s) — who are responsible to distribution of NHS money within their local areas — must match increases in spending with increases in demand and add an additional percentage which reflects specific funding allocated for mental health. This is a strong step in insuring that mental health services aren’t ignored.But it is not all bad news: many years of campaigning for these inequalities has led to a change in direction. The main change being seen after the UK governments strife for a ‘parity of esteem,’ first mentioned in 2011.
Parity of esteem in an approach to NHS treatment where a patients’ mental and physical health should be treated with equal importance. Research has shown us over and over that poor mental health can put you at higher risk of physical conditions, and/or poorer outcomes for these illnesses, not to mention mental health costs take up a fair amount of physical health spending and so this is a very good outlook to be pursuing.
Further promise comes with the Governments ‘Five Year Forward View For Mental Health’. This came with changing attitudes in mental health and the reduction we have been seeing in stigma, and set out to invest an additional £1 billion by next year in order to improve mental health services. This should lead to an additional 1 million people receiving the correct care.
The NHS have described this as ‘a decisive and unprecedented step towards closing the treatment gap for mental health.’ Expansion to child and adolescent mental health specific services was a key objective of this, as well as perinatal mental health (pregnant women), and adult mental health in community and crisis care amongst others.
Initiatives and increases like this are also more important now than ever before. A quick search on google will show you that the demand for mental health services is inevitably increasing and more substantially with COVID-19. In response, the Government’s Department of Health and Social Care have provided an additional £5 million of support offering grants to mental health projects particularly led by service users and small communities that will need the extra support now.
So, while our attention the last few months has rightly focused on COVID-19, as we begin to make a move back to normal life, we can’t ignore that mental health services have been struggling for some time now. And with many of us having experienced the detriment of the virus and having to put life on hold in lock down, the pandemic has brought the importance of support for mental health to the surface, and shown yet again that not only are mental and physical health intertwined, they should be treated as equal.
So, let’s really work for a focus on providing the right support for as many people as we can. It cannot be ignored.
While it is probably unfair to just demand more money, knowing where the NHS budget comes from and how strapped for cash we are in general, what is significant is to adjust the balance. Considering the funding available, we need to do all we can to emphasise the importance of providing a fair share of what is available to mental health.
Change is beginning to become evident, but we still have a long way to go and we can all but hope that these initial steps are the start of a new era for mental health.
“Let’s make mental health part of the NHS and not the Cinderella service.” — Susan Highton
There’s still hope for a fairy tale ending.
