Monday, 8 May 2017

GE2017: Reflecting on Mental Health Political Policies

Mental Health (MH) is fast becoming one of the most important issues for political parties to discuss in the UK. 1 in 4 of us in the UK will have a MH condition in our lives. A recent MH report conducted by the Mental Health Foundation, which had more than 2,000 respondents found that 78% of 18-34 year olds saying "they have experienced a MH problem" compared to 58% of over 55 year olds. The Mental Health Foundation report has also found that 42% of respondents had suffered from depression and around 25% had a panic attack. 85% of respondents who were out of work said they had experienced a MH problem, compared to 66% in employment and 53% of retired people (see more here: https://www.theguardian.com/society/2017/may/08/two-thirds-of-britons-have-had-mental-health-problems-survey?CMP=share_btn_tw). The MH Crisis costs the UK as much as £100bn a year, yet only 25% of people end up receiving treatment for depression. It's important that we begin challenge the stigma that surrounds MH, which includes breaking down stereotypes and encouraging men and non-binary people as well as women to discuss and talk through their concerns and to ask for professional help.  Many voters feel that MH service provision in the UK has been sketchy at best and political parties have realised that voters want to see sufficient, positive changes made in this policy area. I've checked out a few policies on MH from the Conservatives, Labour, the Lib Dems and the Greens and offer some of my thoughts below:

Conservatives:
PM Theresa May has talked over the past few months of the need to end the stigma associated with MH. In January she delivered a keynote speech on the Tory vision for Britain, a "Shared Society" where every person feels valued and receives the help and support they need to live a positive, healthy life. The speech was full of warm, fuzzy sound bites and did contain some policy ideas (most of them based on the recommendations made in the Five Year Forward View For MH.. see my January blogpost:.http://sassysvensknorsk.blogspot.co.uk/2017/01/my-response-to-theresa-mays-mental.html). Yesterday PM May announced a number of new policies in a bid to attract centre and centre-left voters who particularly want to see the Cons address inequalities in the healthcare and education systems and also reduce barriers in the workplace for employees and workers with mental health issues.

The number 1 "headline grabbing" policy announcement was that the Cons have committed themselves to scrapping the Mental Health Act 1983 and introducing a new Mental Health Treatment Bill which would see changes to detention procedures. Currently the police have the right to detain you in a public place under Section 136 of the MH Act (or Section 135 if at home) if they believe you have a MH condition and need immediate care to prevent you from causing harm to yourself or others. Conditions include schizophrenia, obsessive compulsive disorder (OCD), bipolar disorder and dementia. It can also include learning disabilities such as dyspraxia (but only when "abnormally aggressive" or "seriously irresponsible"). The police officer(s) in question will have a conversation with a MH professional (such as a MH nurse) before using a Section 136. Police officers can detain you in a cell where you will be examined by a MH professional. The police can hold you up to 24 hours but can get this extended if further time is needed for MH assessment. After this time you'll either be released or taken to a MH clinic to receive treatment or referred to community services depending on the outcome of your assessment. You do still have the right to ask why you have been detained under Section 136 and for appropriate legal assistance. MH and wellbeing campaigners and charities have called for an end to routine police cell detentions and a new MH Treatment Act which reforms the detention protocol for years but the Cons seemed unwilling to amend or scrap the MH Act during the Coalition Government and during the first months of May's tenure as PM. The Cons have promised that MH professionals would be consulted on plans before the MH Treatment Bill would be presented to Parliament so that it would be truly "fit for purpose".
The MH Treatment Bill would introduce:
    • "Revised thresholds for detention" so that people cannot be detained unless they are deemed a risk to themselves and others (very rare)
    • A new code of practice that aims to address the disproportionate use of MH detention for minority groups (hopefully challenging race and gender stereotyping....The Guardian reported that "black people are detained at 56.9 per 100 patients compared with a rate of 37.5 per 100 patients amongst white people" https://www.theguardian.com/politics/2017/may/07/theresa-may-pledges-mental-health-revolution-will-reduce-detentions) 
    • A new set of safeguards so that individuals who have been deemed to have the capacity to refuse or consent to treatment can do so without fear of being "treated against their will" (unless they have been deemed a danger to themselves or others). 
As a result of passing a MH Treatment Act in the future, there is a hope that people with MH issues would be treated with the dignity and compassion they need and truly deserve. Reducing the number of police cell detentions and increasing the bed capacity in Mental Health clinics and wards is certainly the way forward. 

The Tories also want to:
  • Ensure 10,000 more MH professionals are employed in the NHS by 2020 (an ambitious target considering that trusts would need to increase recruitment and retention rates against a backdrop of Brexit and NHS pay cap)
  • Improve Mental Health provision in schools by training staff on MH First Aid and appointing a staff member as a point of contact to liaise with local MH services  (reaffirming a previous policy commitment made during the "Shared Society" keynote speech)
  • Introduce cyberbulling and online safety training into schools for all students (something that Labour's Shadow Secretary for Equalities, Sarah Champion, has been advocating for with her Dare2Care strategy)
  • Funding the Samaritans helpline for the next 5 years (good but could imagine every other party making this commitment too)
  • No more charges for people in debt when they provide proof of their mental health condition (no commitment to scrap the Doctor's Note fee though...people are being charged up to £150 for this and creditors will not help debtors without it) 
  • Amend the Equality Act to make "mental health" a protected characteristic and giving employees who have short term mental health conditions (less than 1 year) the same protection as those suffering from long-term mental health conditions (conditions that last more than 1 year). This could benefit employees who suffer from anxiety/depression caused as a result of family bereavement or being in a traumatic accident
  • HR staff in large companies would also be mandated to access MH training to act as "first responders"; this would help HR staff to develop strategies to better support employees with MH conditions. 
The Conservatives' policies look good on paper. I think that very few MH campaigners would argue against strengthening protections to reduce levels of discrimination in the workplace or improving resilience training for students who use social media on a daily basis. However, there is no indication as to how the Tories would pay for 10,000 more MH professionals to help improve MH service provision in England (as health is already a devolved issue). Community Care's 2015 report found that funding for MH services had reduced by 8.25% in real terms during the Con-LibDem Coalition Government. Also it has been shown that MH professional numbers in the NHS has reduced. 6,110 nurses have been cut since 2010 and 23 doctors have gone too (according to the BBC's own Reality Check system). It's perfectly understandable that there is a high level of skepticism as to whether the Cons really will deliver on their promises given that local NHS trusts are struggling to deliver appropriate services. 

Labour:
Labour have a comprehensive approach to MH which I've already explained in some depth in this blogpost: http://sassysvensknorsk.blogspot.co.uk/2017/03/labours-approach-to-mental-health.html. The question now is how many of these previous policy ideas will pop up in Corbyn's manifesto and whether Labour would be willing to adopt policy suggestions put forward by the Conservatives that would actually help improve MH service provision, especially amending or scrapping the MH Act and scrapping charges for people in debt who have MH conditions, including the Doctor's Note fee.

One great Labour party proposal is to help improve children's and young people's MH services across the UK as part of an overall Child Health Strategy (http://press.labour.org.uk/post/160434638224/labours-new-manifesto-ambition-to-make-britains).
 The strategy would include:
  • Introducing a new Index to measure improvements in Child Health provision against international standards which would be collected and collated into a report on an annual basis. The measures are "obesity, dental health, under 5's and mental health". This would provide much needed data and ensure that the Government can be held up to account for failures to address problems. Any areas that require improvement would be delivered on during the following year. 
  • Creating Governmental departmental strategies for Child Health (interesting that Labour mandates this for every department...I wonder how the Department for International Trade or Exiting the EU would contribute here)
  • Providing funding for counsellors to be available to go into every school in England
  • Setting up a £250m annual Child Health Fund to support the delivery of the strategy, which would come from efficiency savings gained from reducing management consultancy costs (sounds great on paper but how practical would this be to deliver on, on an annual basis?)
  • Ringfencing the Public Health budget over the next 5 years, allowing councils to deliver targeted health awareness campaigns and invest more in leisure activities (my local Labour council in Lincoln has announced a £1.4m investment in Birchwood Leisure Centre but it means the loss of a much loved social club and closing of sports facilities, which Labour councillors have suggested could have been avoided had the Council had a pot of funding from central Government to revamp). 
There's also other policy announcements from Labour that would have an impact on MH service provision:
  • Scrapping the public pay cap could help NHS managers to attract and retain talent 
  • Reintroducing the training Nursing Bursary may help to encourage more nurses to enter the NHS and specialise in MH
  • Scrapping the car parking charges will help MH patients and their families spend more time together
  • Not restricting immigration of medical professionals could encourage more MH professionals to consider working in England.
I do like the idea of improving children's and young people's MH services and ensuring there is central funding in place to be able to help deliver those service improvements. However, we need to hear a lot more about how adult MH services will be improved and a firm commitment to addressing MH provision in prisons, including recruiting counsellors and MH nurses and training prison officers as to how to treat inmates with MH conditions appropriately, something MP Luciana Berger has been actively campaigning for over the past few years.

Lib Dems:
The Lib Dems have not shied away from laying out the challenges the UK currently faces when it comes to the NHS and social care. They have admitted that funding needs to be increased urgently and the best way to provide this funding would be to raise Income Tax by 1p in every £1 for everyone that currently pays Income Tax (30 million would pay this). In England, this would mean an extra £4.9bn would be raised (but Scotland has powers to set its own Income Tax). Nobody likes to pay extra taxes but if the money is specifically going towards helping pay for improved NHS and social care services, it does seem justifiable. Lib Dem MH policies include:
  • Establishing a "cross-party health and care convention" which will consult with NHS professionals, patients and care workers to make sure that systems, including in MH are sustainable; this would be very sensible and allow service users to shape future MH policies
  • Establish an Independent Office of Health and Care Funding that would monitor budgets and produce a report every 3 years which would provide recommendations as to where funding would need to be increased in the future, including on MH
  • Providing £250m for the next 5 years to help pregnant women and mothers suffering from depression (strengthening protections in the workplace so that employers cannot discriminate against pregnant women and mothers who suffer from discrimination would help too)
  • Improving access to talking therapies on the NHS for "hundreds of thousands" more anxiety and depression sufferers (as long as access would improved in every NHS trust in England and not just in the South East this is a good idea and to re-commit to ensure that most MH patients can start their talking therapy treatment within 28 days, a commitment that was also in the Labour and Green 2015 General Election manifestos) 
  • Reducing use of physical restraint to an absolute minimum with a view to banning the practice in future (Lib Dem found that there had been an average of 183 restraints a day between 2013 and 2016, with "1,548 injuries to patients and 2,789 injuries to staff" reported over the three year period....http://www.libdems.org.uk/shocking-levels-force-mental-health-patients)
  • Ensuring that homeless people have access to MH counselling, especially to help MH conditions related to drug-use and sex work 
  • Expand the Access To Work programme to properly support potential and current employees with disabilities who may also develop a MH condition.
I'd like to see the Lib Dem proposals for amending or abolishing the MH Act to reduce instances of police cell detentions and a firm commitment to improving MH education in schools across the UK. Having previously read the Lib Dem education policy, it's safe for me to assume that there would be plans to introduce online resilience training and some sort of commitment to provide teaching staff with MH training delivered by MH professionals and campaigners so teachers can develop practical methods to help fully support students in their class who may have a short-term or long-term MH condition.

Greens:
The Greens have often mentioned the need to ensure that MH service provision is fit for purpose for all service users, especially those from minority groups. In the LGBTQIA+ manifesto released in April 2017, the Greens called for funding to be in place to help provide services to LGBTQIA+ asylum seekers, including giving them access to counsellors on the NHS. In the past the Greens have been focussed on improving MH service provision in local communities, such as encouraging the appointment of local mental health champions who would be able to offer their views as to how to improve MH service provision directly to their local NHS trust management. MH champions could also help to advise and support people in their communities on issues such as housing and employment and be invited to deliver MH training to local businesses and organisations. The Greens have also expressed a desire to improve MH bed capacity so that every patient can be treated in their local area unless they require specialist treatment and care. The Greens also want to end police cell detention under the MH Act for adults wherever possible.

An interesting commitment was made by co-leader Jonathan Bartley on Andrew Marr's BBC 1 political analysis show Marr to introduce a 3-day weekend in the UK. Bartley believed that by reducing working hours for employees to allow them to spend more time with friends and family, there would be an overall reduction in stress levels generally amongst the population. The clear issue with the proposal is that it may only benefit a small percentage of the population on full-time contracts who still work on a Monday to Friday 9am-5pm pattern. Business leaders remain vigorously opposed to any proposals that would mandatorily reduce working hours for employees on this working pattern as they believe productivity levels would fall. Mind you, those same business leaders are opposed to the idea of 4 extra bank holidays anyways! However, there is a need to introduce more flexibility into employment, so that it becomes more acceptable for employees with MH conditions to be able to take the time off they need to recover or reduce their working hours to reduce their stress levels so as to reduce the likelihood of them developing a long-term MH condition. Reasonable adjustments should also become routine in workplaces -e.g. allowing an employee with a diagnosed MH condition to take time off at short notice to see their counsellor and ensuring that all employees have time off to visit GPs for initial diagnosis free from discrimination. Flexible working and other reasonable adjustments may also make employees with MH conditions more productive over the long term too.

Conclusion:
Based on current policy proposals, I'd be very tempted to say that no one-party has an edge because they each seem to be addressing different aspects of the MH crisis. Labour seems to focus heavily on funding issues rather than proposing the legislative changes needed to the MH Act to make it fit for purpose in the 21st century. The Conservatives have suggested improving resilience training in schools for teaching staff and students but haven't really set out any extra funding or proposals to help improve recruitment and retention rates of MH professionals in the NHS. It's all well and good reforming detention procedures but there still needs to be improvements to local bed capacity so that people who are detained by police officers can receive assessment in a NHS clinic rather than in a police cell. After all, most people who have a MH condition who may have been "deemed a danger to themselves or others" will not have committed a criminal offence. So why treat them like criminals? The Lib Dems have been very astute in recognising the need to offer a long-term solution for funding the NHS and Social Care in the UK and the Income Tax increase will go a bit of the way to providing funding for MH services. Yet they haven't been clear on whether the £250m to tackle pregnancy and post-natal depression would come from existing funding or from the tax increase. Voters may also be unhappy at having to pay a council tax precept in addition to an Income Tax increase so the Lib Dem proposal to create an all encompassing Health and Social Care Tax that would negate the need for the council tax precept in the future seems to be a good way forward. The Greens have pointed out the need to ensure that MH services are accessible to all and that local MH champions can help in this respect but the 3 day weekend seems impracticable from a business viewpoint and there is still a question as to how they would fund any MH improvements.

What is a clear is that a comprehensive, wide-ranging, intersectional approach is needed to ensure that MH improvements are delivered that benefit the majority of MH service users in the NHS and those who choose not to seek professional help too. That means being bold enough to offer ringfenced funding to pay for an increase the number of MH professionals and encouraging recruitment and retention by scrapping the public sector pay cap and reintroducing the Nurses Training Bursary. Funding needs to be sustainable and there must be a review into how best to provide funding streams in the long-term. The MH Act needs to be either amended or abolished so that detention procedures can be reformed and there should be an end to routine detention in police cells. School staff need training to help them support students and colleagues who may develop a MH condition. Students definitely need to be given online resilience training, given that they are most likely to access social media on a daily basis. HR staff in companies should develop policies that are designed to provide reasonable adjustments such as flexible working patterns to employees who have a short-term or long-term MH condition. There must also be considerations made for MH patients in prison, including training for prison officers to help support inmates in their charge and routine drug-use counselling. I can't wait to see what extra policies are unveiled in the election manifestos over the next few weeks; perhaps a frontrunner will emerge for me then. At the moment, it's all to play for.