New legislation that could see the end of mental health stigma in the NHS
post taken from Rethinks Blog.
http://www.rethink.org/about_mental_illness/personal_stories_blogs_forum/blogs/paul_jenkins/the_lords_have_taken.html
post taken from Rethinks Blog.
http://www.rethink.org/about_mental_illness/personal_stories_blogs_forum/blogs/paul_jenkins/the_lords_have_taken.html
The Lords have taken a stand on mental health, now it’s up to all of us to make it a reality
Important things don’t always happen when you are looking for them. Last night’s vote by the House of Lords to enshrine in law the principle that mental and physical health must be treated equally within the NHS, may be one of them.
The amendment is mostly a symbolic change, but one which is highly significant.
For all its revered status as national treasure or religion, the NHS has not always had a good record in responding to the needs of people with mental rather than physical health problems. When the NHS started, most people with mental illness were ‘out of sight, out of mind’ in institutions which were often a byword for abuse and poor care.
In the 1980s and 90s, Community Care, a good policy, was undermined by the leakage of resources to prop up acute services. Even today, after some significant improvements in mental health care, outcomes for people with mental health problems are significantly worse than those with a physical illness.
This is borne out in a number of ways. Mental health care is often characterised by a lack of choice and control for people using services.
People with mental health problems struggle to get access to evidence based interventions. A poll by Rethink Mental Illness in 2010, found just 16% of people who have schizophrenia and bipolar disorder are getting access to all the treatment recommended by Nice for their diagnosis.
People with mental illnesses also experience much worse outcomes in terms of physical health. Can it be acceptable that someone with schizophrenia dies on average 20 years earlier than the rest of the population?
Most concerning is the fact that the NHS continues to be one of the places where people with mental health problems most regularly experience stigma and discrimination, whether in mental health services themselves or in primary care and A&E.
I accept that such things will not be changed overnight by a few words in primary legislation. The inequalities I have described above are symptomatic of a deep seated ‘Cinderella’ status which is represented as much in the culture of health services as it is policy agendas or formal systems of governance.
However, symbols are important. As Dr Johnson said, having a legal duty “helps concentrate the mind”. Furthermore, there are many situations in which this duty to promote an equality of esteem could be of practical benefit to people who use mental health services and their families. It will be relevant to how Ministers set the proposed mandate for the new NHS Commissioning Boards. It will be relevant in reviewing the balance of objectives in the various outcome frameworks set for the NHS, social care and public health. It should be considered in setting priorities for investment in research.
It will give an important message to Clinical Commissioning Groups and Health and Wellbeing Boards about their priorities and about the need to engage mental health service users and their carers in local decision making. Finally, it sends a clear message of ambition that whatever the NHS can achieve for people with physical illness, it must achieve for people affected by mental illness.
In response to the defeat, the Government has said that this is not a matter of principle and that there may be other ways of establishing parity of esteem. That may be so. I do not doubt the Government’s good intentions in relation to mental health, which have been demonstrated in its mental health strategy and its investment in the expansion of talking therapies and the continuation of work to challenge stigma. However, if they share a fundamental passion to see parity of esteem then there can be no clearer symbol than to place it as a duty on the face of this legislation.
In the next couple of weeks there is a duty on all of us in the field of mental health; people affected by mental illness, professionals, voluntary organisations and NHS bodies, to demonstrate the strength of feeling on this issue.
It would be a travesty for this amendment to be overturned in the Commons for the sake of political expediency and for MPs to vote against a change which directly affects at least one in four of us.
For all its revered status as national treasure or religion, the NHS has not always had a good record in responding to the needs of people with mental rather than physical health problems. When the NHS started, most people with mental illness were ‘out of sight, out of mind’ in institutions which were often a byword for abuse and poor care.
In the 1980s and 90s, Community Care, a good policy, was undermined by the leakage of resources to prop up acute services. Even today, after some significant improvements in mental health care, outcomes for people with mental health problems are significantly worse than those with a physical illness.
This is borne out in a number of ways. Mental health care is often characterised by a lack of choice and control for people using services.
People with mental health problems struggle to get access to evidence based interventions. A poll by Rethink Mental Illness in 2010, found just 16% of people who have schizophrenia and bipolar disorder are getting access to all the treatment recommended by Nice for their diagnosis.
People with mental illnesses also experience much worse outcomes in terms of physical health. Can it be acceptable that someone with schizophrenia dies on average 20 years earlier than the rest of the population?
Most concerning is the fact that the NHS continues to be one of the places where people with mental health problems most regularly experience stigma and discrimination, whether in mental health services themselves or in primary care and A&E.
I accept that such things will not be changed overnight by a few words in primary legislation. The inequalities I have described above are symptomatic of a deep seated ‘Cinderella’ status which is represented as much in the culture of health services as it is policy agendas or formal systems of governance.
However, symbols are important. As Dr Johnson said, having a legal duty “helps concentrate the mind”. Furthermore, there are many situations in which this duty to promote an equality of esteem could be of practical benefit to people who use mental health services and their families. It will be relevant to how Ministers set the proposed mandate for the new NHS Commissioning Boards. It will be relevant in reviewing the balance of objectives in the various outcome frameworks set for the NHS, social care and public health. It should be considered in setting priorities for investment in research.
It will give an important message to Clinical Commissioning Groups and Health and Wellbeing Boards about their priorities and about the need to engage mental health service users and their carers in local decision making. Finally, it sends a clear message of ambition that whatever the NHS can achieve for people with physical illness, it must achieve for people affected by mental illness.
In response to the defeat, the Government has said that this is not a matter of principle and that there may be other ways of establishing parity of esteem. That may be so. I do not doubt the Government’s good intentions in relation to mental health, which have been demonstrated in its mental health strategy and its investment in the expansion of talking therapies and the continuation of work to challenge stigma. However, if they share a fundamental passion to see parity of esteem then there can be no clearer symbol than to place it as a duty on the face of this legislation.
In the next couple of weeks there is a duty on all of us in the field of mental health; people affected by mental illness, professionals, voluntary organisations and NHS bodies, to demonstrate the strength of feeling on this issue.
It would be a travesty for this amendment to be overturned in the Commons for the sake of political expediency and for MPs to vote against a change which directly affects at least one in four of us.
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