Victory of rhetoric over substance

The Coalition’s mental health strategy, launched in early February, looked on the face of it like a piece of joined-up thinking. We asked Professor Peter Beresford to scratch below the surface.

The truest thing about the Coalition’s new strategy for mental health, is its title No Health without Mental Health. And that’s the trouble. Mental health policy and provision are still far from fit for purpose. Instead they are chronically underfunded and inadequate, frequently inappropriate, risk-ridden and stuck in a medicalised past. It is now exactly 50 years since Enoch Powell’s famous “Water Tower” speech, when he sought to announce the end of institutionalization in mental health.

This is still as strong as ever, even if today’s thousands of long term service users are to be found in prison cells, forensic services, tower block bedsits or on the street, rather than asylums.

So the challenge facing politicians and policymakers is an enormous one. This Strategy includes all the right words, like “recovery”, “well-being’ and “outcomes”. There are grand goals: “good mental health for more people…from all backgrounds”, “more will recover”, “more people will have a positive experience of care and support” and the report explicitly addresses children and young people’s mental health.

But talk’s cheap. Has the Strategy got the wherewithal to achieve its goals? Key figures in the field are already saying there is no new money here. What money is mentioned isn’t ring-fenced.

The Strategy’s rhetoric is largely the same as the last government’s and likely to be as ineffectual as Labour’s “New Horizons” proposals before it. There seems to be a grim cross-party political consensus about mental health policy and provision – back of the queue and always associated with threat and danger. Nor can this Strategy be considered in isolation. It must be set next to the massive cuts in mainstream services, as well as social care provision, on which mental health service users are particularly reliant. It can’t be considered without taking account of the attacks being made on mental health service users’ access to disability and welfare benefits and the harsh medical tests now being applied to them. Hardly developments calculated to improve the nation’s “mental well-being”.

What’s most worrying though are the likely effects on mental health policy and service users of the Government’s unqualified and unevidenced commitment to GP (general practitioner) commissioning. Whether this ends up as a market free-for-all, or merely confirm new conflicting roles for GPs as rationers rather than providers of health care, one thing seems likely. It will almost certainly reinforce the dominance of the medical model in mental health.

Yet as a recent Joseph Rowntree Foundation report further confirms, mental health service users see this as almost entirely problematic – an obstacle to improving their mental health, rather than a driver towards it.* And the Strategy represents no real challenge to this, for all its twenty-first century jargon. What’s really needed is to start over – listening to service users and their organisations.

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