Access to mental health care is a problem around the world, with mental illness accounting for “10.5% of the global burden of disease.” A study from the British Journal of General Practice reports the number of people in the UK afflicted by common mental health problems such as anxiety and depression as greater than the number of people in the UK afflicted by heart disease, breast cancer, and diabetes combined. The number of people struggling with their mental health is estimated only to have grown in the past five years, with the COVID-19 pandemic exacerbating mental health struggles especially for young people and frontline workers.
Despite the clear need for accessible, effective mental health care, obtaining care through the NHS can be challenging. The modern model for mental health care services has been developing in its current iteration only for the past few decades, and there’s a pressing need to train and employ more professionals in the mental health care sector in order to fulfill demand. There are a myriad of ongoing government initiatives to this end, by way of expansive funding and legislative reform.
NHS services, broadly speaking, are organized into primary, secondary, and tertiary care. Primary care is “often the first point of contact for people in need of health care.” It includes networks of GP practices, which often work with “social care, pharmacies, hospitals and voluntary services.” Secondary care refers to hospital care, which can either be elective or emergency services. Tertiary care refers “to highly specialized treatments”, which could include specialties such as neurosurgery, for example.
Mental health care is primarily accessed through primary care. The GP can refer patients to psychiatric care, if the patient seeks or requires medication for treatment, or therapeutic services. If patients are minors, however, they will be referred to Children and Adolescent Mental Health Services.
The same study from the British Journal of General Practice argues that until very recently, the role of primary care in mental health care in the UK has been “one of gatekeeping for specialist secondary mental health service.” These secondary services would be psychiatric care, for example. Thus, the primary care referral model can sometimes act as a barrier for necessary treatment strategies, sequestering treatments to the limited jurisdiction of GPs. A study from the Royal College of General Practitioners reports that “90% of people with mental health problems are cared for entirely within primary care.”
Primary care is inadequate for meeting the needs of mental health care because in addition to “significant time and workload pressures”, primary care staff, in general, is highly undertrained to deal with mental health cases. According to the British Journal of General Practice Study, “fewer than 35% of GPs have undertaken any continuing education relevant to primary mental health” and “98% of practice nurses have had no specific mental health training.” The study further characterizes the primary care field as not a “neat high ground of well-defined symptoms, but [rather] a messy swamp of experiences and interpretations that rarely conform to… case definitions.” Primary care also suffers from a “lack of clarity around roles and responsibilities for the care of patients with chronic, complex, and disabling non-psychotic mental health problems”, according to the Royal College of General Practitioners Study.
Addressing the systemic issues in mental health services requires the intervention and initiative of the NHS’s ruling body, the British government. The government and the prime minister determine funding allocation for the NHS as well as set top level priorities. There have recently been monumental gains for mental health care budgeting. In June 2023, the Department of Health and Social Care announced a £2.3 billion investment to “expand” and “transform mental NHS services” by March 2024. £400 million was also allocated to the improvement of mental health facilities, and an additional £150 million will be invested in the construction of new mental health and urgent care facilities.
Important legislative movements have developed in the past decade to reform mental health services executed by the NHS. In 2018, an independent review of the 1983 Mental Health Act—which outlines how people who are in a mental health crisis can be detained for treatment—was undertaken to “address the rising number of people detained [under the act], especially Black British people.”
The independent review found that the processes presented in the 1983 Act are “out of step with a modern mental health care system.” In response, the House of Lords and House of Commons established a joint committee on the Draft Bill that developed based on the findings of the 2018 study. According to The Royal College of Psychiatrists, among the many wide-ranging aims, key policies of the draft bill include:
removing learning disability and autism from the civil parts of the…?
amending detention criteria so people can only be detained if serious harm may be caused to the health or safety of the patient or of another person, and secondly, that the decision maker must consider the nature, degree and likelihood of the harm and how soon it would occur
amending detention criteria in both civil and criminal parts of the act so that treatment provides a therapeutic benefit
adding additional safeguards around the administration of urgent electroconvulsive therapy
“We believe stronger measures are needed to bring about change, in particular to tackle racial disparity in the use of the Mental Health Act,” Chair of the Joint Committee on the draft of the Mental Health Bill, Baroness Buscombe, said. “The existing shortfall in community care must also be addressed or these reforms risk being derailed, with worse outcomes for those that the Bill is intended to help.”
The NHS 10 Year Plan also tackles the development of mental health services. The Ten Year Plan seeks to ensure that the NHS continues to match the changing health needs and medical advancements in society. A sub plan of the 10 Year Plan is the Mental Health Implementation Plan, which propagates a “new framework [to transform] mental health care at the local level.”
Further government initiatives to address mental health services reform include the Suicide prevention strategy for England: 2023 to 2028, the plan to increase training places for mental health nursing by 93% through the NHS Long Term Workforce Plan, and the strategy to “ensure mental health conditions are considered alongside physical health conditions.”
While there certainly have been strides in funding and legislative efforts, their efficacy remains to be seen. Despite the cross party support of the Draft Bill for the Mental Health Act, the Draft Bill “has been shelved” and appears to have been relegated to legislative purgatory. Further, the Health and Social Care Committee Expert Panel and the National Audit Office have raised concerns that the target goals for closing the mental health care gap, even if successfully completed, may be insufficient to meet demand for mental health services in the wake of the pandemic. A concerted effort to monitor the state of mental health care availability must be undertaken to ensure equitable access for all.