interviews

Good mental health within our reach

Shortly after the publication of the Mental Health Taskforce report, its chair and chief executive of Mind, Paul Farmer, delves deeper into the major reforms expected locally.

When Mind’s chief executive, Paul Farmer, unveiled the first major details of what was then still an ongoing taskforce study at last year’s Health and Care Expo, he promised the audience that we were “at the start of a new era for mental health”. 

Earlier this year, when the much-delayed but widely anticipated Mental Health Taskforce report was published, Farmer stood by his words. The report, which he fiercely argued was “realistic and practical”, outlined a series of reforms needed in the next five years to ensure the NHS gets on the right track towards achieving parity of esteem between physical and mental health. 

The mental side to physical problems 

Speaking to NHE after the report launch, the charity’s boss, who has led the taskforce team alongside vice-chair Jacqui Dyer, was happy to say the government had agreed to a £1bn uplift in the mental health budget by 2020 – but argued more could be done. As well as identifying extra cash, he said, there are clear benefits in “really integrating approaches” between mental and physical health so that the health service can start to feel the impact of what can be achieved collaboratively. 

A classic example of this, outlined in the report, is diabetes, where costs can balloon by 50% due to the poor mental health support running alongside it. Almost £2bn of extra diabetes costs are attributable to poor mental health, but less than 15% of people with diabetes have access to psychological support. 

This is just one instance of where the NHS can identify and achieve efficiency savings that could then be reinvested into the mental health system. “It’s both a long-term and medium-term thing to really try to make sure the resources are properly directed,” said Farmer. “We showed reasonably clearly that most mental health trusts are fairly well-run and efficient, and they coped with quite a significant increase in demand for their services over the last two years with no significant additional investment in resources. This is really about the whole NHS.” 

Carter and staff health savings 

His comments were timely enough, with the taskforce report coming just a few days after the Carter Review showed how NHS acute trusts could save £5bn over the next five years through efficiency reforms alone. Farmer said the report had “obvious overlaps” with Lord Carter’s work, but both studies still had to operate in a wider context. 

“The obvious focus here is the potential to get the best possible outcomes from the investment in the health service as a whole, and there’s a whole variety of different ways in which you could do that,” he added. “One of which is by recognising the benefits of prioritising mental health, but equally another one is about making sure the mental health of people who work in the NHS is also recognised.” 

There are some practical examples of this happening across the two trusts participating in a pilot project with Mind’s Time to Change campaign, Farmer said, including Northumberland, Tyne and Wear NHS FT and 2gether NHS FT: “They both have some really interesting programmes of work, identifying the support you can give to health professionals by talking about mental health and stigma, but also helping people to look after themselves.” 

Asked if he supported alternative methods of staff self-care, such as through mindfulness or the arts (see pages 52 and 37), the Mind boss said different awareness and engagement approaches, especially early on, will work differently on each workforce. 

“We do lots of work across different businesses, and in some areas, like construction for example, they will think about mental health through the ideas of health and safety,” Farmer continued, “whereas if you’re in a financial services firm, they see mental health as part of their diversity and equality programme. I think our learning from that is that you have to put a focus on where people are most likely to respond.” 

Seven-day mental health 

Another major headline in the report was the need for seven-day mental health services, as is the case with physical health. But it’s no secret that the NHS often misses vital targets across A&E departments as it is, so could the same mistakes be avoided across mental health? 

“We can absolutely learn about how to achieve an appropriate level of support for people, and doing that in a way that is both financially realistic and also sensible for the best use of staff,” he replied. “For example, there is some work now going on looking at what good quality waiting time and access standards for crisis care look like for people with mental health problems, which I think will take a really carefully considered view about getting the balance right.” 

Integrated working and STPs 

Part of having seven-day services also includes ensuring the Crisis Care Concordat is replicated across prevention, which the taskforce pitches in the report as ‘Mental Health Prevention Plans’ based on high-quality evidence. As well as improving housing stock, these prevention plans would be rooted in service integration, particularly between the NHS and councils. 

“The more we can join up effective planning and delivery between local government, public health directors and the NHS, and indeed other partners, including the charity sector, the more likely it is to succeed,” explained Farmer. 

But other integration opportunities are beginning to appear nationally, including the promising Sustainability and Transformation Plans (STPs) every trust must develop. These will bring together the NHS and local government to create two-pronged local plans, led by nominated leaders with devolved knowledge of each health region. 

“The STPs are going to be a key way of making sure that as many as possible of the taskforce recommendations are hardwired into those plans,” he said, adding that he is “really looking forward” to seeing them. “As part of the review process, we would certainly hope that there was a decent reflection of the taskforce’s recommendations in these plans.” 

The first steps in a 10-year agenda 

Similar models of integrated working are already bearing fruit, including Forward Thinking Birmingham, the city’s new reformed mental health system (see more on p62), which Farmer called a “good example of how the local community has got together to come up with a plan that really responds to some very particular needs”. 

He also cited Simon Stevens’ recent appointment of Stephen Firn, chief executive of Oxleas NHS FT, to take a lead on care model construction work, as well as ongoing Vanguard work: “The key element here is making sure that there’s really good learning and evaluation so that other areas can benefit and we don’t have to reinvent the wheel all the time.” 

During his interview with NHE, Farmer consistently stood by his promise that the taskforce’s report was very realistic and practical, with recommendations “grounded in an achievable framework”. Yet he also made it quite clear that we can’t expect to get there in the next three to four years, certainly not in terms of parity of esteem. But added: “I do think this is the first stage of a 10-year plan, which could get us to a point where the NHS gives our physical health and our mental health equal measure.”

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