What every CCG leader should know about mental health

Chris Naylor

20 June 2012

People with mental health problems lose out in the NHS. That’s the case powerfully made in a new report published by the London School of Economics (LSE), which argues that underinvestment in mental health care represents ’the most glaring case of health inequality in our country’. I would particularly recommend the report to everyone working in or with clinical commissioning groups (CCGs).

The argument is a strong one. Mental health problems are far more common than generally appreciated, pervasive in their effects, and all too often go untreated – only a quarter of those experiencing depression or anxiety receive treatment, according to the most recent national survey data.

Those who do receive support often face much longer waits than would be considered acceptable in other clinical areas. Despite the success of the ‘improving access to psychological therapies’ programme, the dramatic drop in waiting times seen elsewhere in the NHS between 2002 and 2010 was not mirrored in mental health. The NHS Constitution gives patients the right to be seen within 18 weeks, yet the majority of people with depression or anxiety still wait for more than six months (often much longer) for psychological therapy.

The LSE report rightly highlights childhood mental health as a particular concern. More than half of all mental health problems start in childhood or adolescence, and access to effective forms of treatment and support for children is limited. Worryingly, there are signs that funding for child and adolescent mental health services is under serious pressure, particularly where services are jointly funded by local authorities and the NHS.

So what role can CCGs play in addressing these problems? The impact of poor mental health is seen in primary care, so it is to be hoped that CCGs put improving mental health care among their highest priorities. There are several things that every CCG leader should know.

First is the scale of the problem. Mental health problems account for a quarter of the overall burden of disease in the UK – more than any other disease category – and have a similar effect on life expectancy to smoking.

Second is the extent to which poorly treated mental health problems drive up costs in other parts of CCGs’ commissioning budgets. Our previous work has suggested that between 12 and 18 per cent of all money spent by the NHS on long-term physical health conditions is linked to poor mental health. If we add the costs related to medically unexplained symptoms, mental health problems cost the NHS at least £10 billion each year in physical health care costs alone.

Finally, CCG leaders should know that improvements can be made without incurring additional net costs.  For example, integrated psychological support for people with long-term conditions can pay for itself by bringing down the costs of physical health care. Another example is early intervention in psychosis teams, which have been estimated to deliver £10 in savings to the NHS for every £1 invested.

A first step for CCGs should be to work with member practices to explore how the interface between mental health services and primary care can be improved. Proposals from the Royal College of General Practitioners to include a mandatory mental health rotation in GPs’ training is an important step in the right direction. But there is much that CCGs can do  more immediately. Investing in mental health and building stronger connections between mental health professionals and primary care would be a significant achievement for CCGs, and one with a compelling economic and clinical basis.


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