Mental health cuts are ‘driving people to the edge’
Mark Winstanley, chief executive of Rethink Mental Illness: ‘For too many people, going to A&E is the only way they can get care if they’re in a crisis. Photograph: Christopher Thomond /Guardian
Mark Winstanley, head of the Rethink Mental Illness charity, urges the Conservative government to act on its funding promises and prioritise mental health
The day before last week’s election, leaked minutes from the meeting of a key mental health steering group, the Crisis Care Concordat, warned of an NHS “system failure” that was leading to large numbers of people in mental distress turning to A&E for help, due to inadequate community-based mental health services. Concerns were also raised about how many patients, especially young people, were being admitted to hospitals miles away from home because of mental health bed shortages.
It was a stark indication of the increased pressure on emergency healthcare over the previous five years but also, according to Mark Winstanley, the chief executive of the charity Rethink Mental Illness, a reminder that insufficient funding of mental health services for people in crisis was “costing lives”.
Winstanley, who has been in the job since October 2014, points out that despite the previous government’s promises of increased investment in mental health until 2020, budgets were cut and services “badly funded and overstretched”. With the Conservatives securing an overall majority, the situation will deteriorate yet further if firm commitments are not quickly forthcoming, he concludes. “For too many people with mental illness, going to A&E is the only way they can get care if they’re going through a crisis. In many parts of the country there are no suitable crisis services available, full stop.”
With mental health beds reduced by 8% since 2010, Winstanley warns there is no time to lose and that without action more people will have to travel miles for a appropriate care. “Even worse, thousands of people, including children, end up in police cells each year because they can’t get the treatment they need,” he says.
“The Conservatives have made a number of important promises about mental health in their manifesto, including pledging to increase funding for mental healthcare, and to enforce new waiting times for treatment. The prime minister has also explicitly said that the government has the legal duty and resources to make mental health an equal priority to physical health.
“Now the government must show real leadership, by acting on those promises and making mental health a top priority over the next five years. Failing to do so will put the wellbeing of millions of people at risk.”
Winstanley has been at the helm of Rethink, one of the country’s largest mental charities for just over six months, following a stint as acting chief executive. His tenure has coincided with what has to be one of the most politically significant periods ever for mental healthcare. Even five years ago, the idea of mental health featuring at all in an election campaign, never mind prominently (some kind of commitment to it featured in manifestos across the board) would have been unthinkable. Let alone that “parity of esteem”: the idea that users of mental health services would be on an equal footing with those accessing healthcare for physical conditions – for example by introducing guaranteed waiting times for some treatments – would be championed by politicians across the spectrum, alongside vigorous action to tackle the enduring stigma attached to mental ill-health.
However, if Winstanley has praise for those individual politicians who have led the charge to improve services and combat stigma, he is far from complacent about the harsh realities on the ground. “Unfair cuts within mental health” under the coalition government, coupled with a longstanding inequality of funding distribution has meant mental health receives just 13% of NHS funding, despite accounting for more than a fifth (23%) of the disease burden and this needs to be reiterated, he says. So too does: “showing that investing in things like early intervention does save money” in the longer term. The fact that so many children can’t access services tailored to their needs when in crisis is a scandalous situation, he remarks. Even after three decades in the sector he sounds genuinely exasperated that life expectancy for people with some serious mental illnesses can be as much as 20 years lower than the average.
Winstanley started out at Rethink (then called The National Schizophrenia Fellowship) as a welfare rights officer in the mid-1980s and has held an assortment of roles over the years including director of corporate affairs and HR director, which he says has given him a deep appreciation of the mental health issues ranging from crisis care to stigma. He insists his lengthy career at the charity in no way renders him a “steady Eddie” whose instinct is to play it safe. With experience stretching well beyond the voluntary sector, including public appointments in areas like education and health, most recently as a non-executive director of NHS North West, he says his vantage points are broad, giving him a solid perspective on what has improved – and what still needs to be fixed.
Winstanley says there is no getting away from the impact of cuts to health and social care and local government budgets, along with the fallout of welfare reforms for people with mental health difficulties. “When I go out and meet our staff and carers and the people who use our services, it’s heartbreaking. There’s usually a queue of people who want to speak to me and they’re telling me horrific stories about what its like on the ground. In fact, in many places things have gone backwards. So it’s not that we haven’t seen the progress we’d hoped for – in some places it really is that there are no services to be had.”
Official as well as anecdotal feedback illustrates how serious the situation is, he says. “I was told off the record by one trust chief executive that the only way to get a bed in their [area] was to be sectioned. We’re concerned that people are being left in terrible conditions either alone or with family and friends trying to cope with that.”
It may have something to do with him having started out as a community-based welfare that leads to him singling out the controversial work capability assessment (WCA) for particular opprobrium. The assessments have seen many people with mental health conditions endure great stress with thousands wrongly found fit for work, he says.
“It’s self-evident that in difficult times [with] the pressures that people are facing, their mental health will deteriorate so we are in a position where there is greater need and less resource. It does push people to the edge. We looked at research from 1,000 GPs where they said that 21% of their patients had suicidal ideation because of the stress of the WCA. So people are being driven to the edge.”
One hurdle in the way of improving provision that rarely gets attention is the “disconnect” between national priorities and local implementation, he says: it’s not just a matter of saying more needs to be spent. In some instances the “fragmented” structure of healthcare in England can put obstacles in the way of mental health being a priority on the ground, whatever the national rhetoric, he suggests.
“Even if the politicians, NHS England and the Care Quality Commission are all behind [something] you then get down to the local CCGs [clinical commissioning groups] who do their own thing. At the moment they make decisions, some of it based on gut feeling. What we need them to do is understand the needs of the local population and make sure the resources match that.
“It’s all well and good saying you’re empowering people locally, but if they don’t have the local support to do some quite radical things, they’re going to stick with the status quo,” Winstanley adds. The result is a postcode lottery in terms of where resources are allocated, with mental health all too often the casualty, he argues. If not adequately addressed things can only get worse, especially if further cuts are made to social care budgets that support the most vulnerable people. Increased demand on A&E is in part “because there isn’t the social care to support people to be discharged.”
Winstanley says he believes that despite the challenges there is a genuine opportunity to harness recent positive political rhetoric into real change. “One of my key roles is to ensure that there’s a spirit of optimism because things are moving, things are changing, there probably is a window of opportunity. If we could turn some – preferably all of the political rhetoric which I think is genuine for most politicians – that really would transform the lives of so many people,” he adds. “It’s going to be a tough fight.”
Credit: Guardian Newspaper