At the start of this year, the UK government announced plans to publish a Major Conditions Strategy covering the main contributors to the burden of disease in England and combining “key commitments in mental health, cancer, dementia and health disparities into a single, powerful strategy”. This replaced plans for a standalone mental health and wellbeing plan, with the government noting that a key driver behind this decision was to “ensure that mental ill health is considered alongside other physical health conditions and that the interactions between them are reflected in any resulting commitments”.
The Major Conditions Strategy is currently in development, following a secondary call for evidence earlier in the summer; feedback will be combined with more than 5,000 submissions made in the original call for evidence for a standalone mental health strategy.
But what is happening in the meantime?
The strategic viewpoint
The NHS Long Term Plan sets out a number of commitments. For children and young people’s mental health services, these commitments include ensuring that funding for services grows faster than overall NHS funding and total mental health spending; that mental health support will be embedded in educational settings; and that a new approach for young adult mental health services will be implemented, tackling existing gaps around the transition to adulthood.
For adult mental health services, the plan highlights a similar commitment to grow investment, stating that “NHS England’s renewed pledge means mental health will receive a growing share of the NHS budget, worth in real terms at least a further £2.3 billion a year by 2023/24.” In addition, it pledges that access will continue to expand for NHS Talking Therapies for people with common mental health problems (particularly with focus on long-term conditions), as well as committing to new and integrated models of primary and community mental health care to support adults with severe mental illness. There are also commitments for emergency mental health care, such as a pledge to increase alternative forms of provision for those in crisis.
Integrated care systems
Drilling down from the national perspective, we come to the integrated care systems.
In terms of what’s happening around mental health in ICSs, we can look to Bristol, North Somerset and South Gloucestershire (BNSSG) ICS as an example, where a draft mental health strategy has recently been published.
Co-produced with people with lived experience and their families, communities along with voluntary organisations, local commissioners and wider mental health stakeholders, the ICS’s draft strategy incorporates the BNSSG Integrated Care Partnership Framework and a constituent trust mental health strategy from Avon and Wiltshire.
The ICS describes itself as a “mental health system” and shares six key ambitions: to provide holistic care; to focus on prevention and early help; to ensure high quality treatment; to provide an economically and environmentally sustainable system; to improve equity of access, experiences and outcomes; and to ensure a diverse, inclusive and trauma-informed workforce.
Actions are shared under each of these ambitions, including providing integrated personalised care teams at primary care level; investing in targeted initiatives for population groups less likely to access physical healthcare; to systematically monitor waiting lists and waiting times within the mental health systems; to work with housing providers and employers to support independent living; to support community-led groups to help co-design, deliver and evaluate services; to establish pathways for people with lived experience to progress into peer support roles and onwards; and to ensure that people of all ages can access mental health services both virtually and in person.
On this note, Kent and Medway ICS provides another example of an ICS utilising digital to support mental health care; last week, a new online mental health service for adults was launched with the aim of improving access to support.
The online support, Qwell, provides a space to get anonymous advice from mental health practitioners in a one-to-one setting; enables people to access self-help tools to help set goals and document feelings, as well as providing access to a library of resources to help support mental wellbeing; and allows users to talk to the wider online community through forums for peer support.
There is no referral or criteria required to use the platform; citizens can access Qwell through any internet-connected device.
The ICS’s chief medical officer Kate Langford acknowledges that it is not always easy for people to ask for the mental health support they need, “so we want to make sure every adult in Kent and Medway has easy access to anonymised support they can sign themselves up for within minutes. Qwell will be integral in providing all year-round support – no problem is ever too small. It will help empower people to prioritise their mental health and talk about what is bothering them, hopefully preventing the need for people to seek urgent help.”
Looking to Greater Manchester Mental Health (GMMH) Foundation Trust, there’s plenty happening to support people in this space. The trust has just launched the prospectus for the new term of their Recovery Academy, which originally launched in 2013 with the aim of helping people to self-manage and support their own health, wellbeing and recovery through provision of learning opportunities in person and online. The trust highlights that Academy resources are co-developed by people with lived experience and available to everybody.
New topics in the updated prospectus include neurodiversity, building confidence and the link between gut health and mental health, alongside “tried and tested favourites” such as understanding and managing social anxiety, an introduction to compassion-focused therapy, and using creativity to improve mental wellbeing.
In addition, GMMH is taking practical steps to tackle unemployment or difficulties in finding work as an exacerbating factor of mental health. The trust has collaborated with Integrated Health Projects (a joint venture between VINCI Building and Sir Robert McAlpine), Manchester City Council and the Skills Construction Centre to open a new Community Skills Centre on the site of GMMH’s new adult mental health inpatient unit.
It is intended to provide ‘hands-on’ support for residents who are not in employment, education or training, to help them develop new skills and experience in the construction space. The trust states that through the centre, participants will be able to gain a Level 1 Award in a construction trade of their choice, “alongside basic digital, maths and English skills, a CV, Construction Skills Certification Scheme (CSCS) Card, and a minimum of 70 hours practical work experience”.
Marc Reed, associate director of capital, estates and facilities, comments: “We are passionate about improving the lives of our most vulnerable residents in any way we can; and moving into training and employment is a great step that can have a really positive impact on mental health. The construction of our new £105m mental health unit provides an excellent opportunity for local people who aren’t in employment, education or training to do just this.”
On a wider note, in the summer we covered the news that a range of partners including the mental health trusts in London, all five London ICSs and London Ambulance Service signed a ‘mental health crisis care agreement’ for the capital, which aims to improve access, patient experience and health outcomes for residents using mental health services in the region.
We also highlighted how a new national phone line for people requiring urgent mental health support launched across Wales.