What is it about your job that you feel would surprise the public?
I find my job surprising every single day, because there’s so much to mental health. It is such a broad and diverse policy area, we are not just dealing with the role of the NHS or mental health care, we are looking at social security, the criminal justice system, schools – there’s a huge breadth. Mental health is a policy issue that cuts across everything that government does, everything that happens in society, in businesses and the wider world. That surprises me sometimes, and it might also come as a shock to people who think it belongs in one bit of government.
What’s been the biggest change you’ve seen since you started working in the NHS and social care?
The position of mental health as a health and political issue. When I started and mental health would come up in discussion (which was seldom), it was about ‘danger’. People causing an inconvenience to others, or tragic losses of life through homicide. As important as that is, it was the only thing we spoke about. That’s changing now. There’s a lot of political and public concern about mental health services, and a much broader understanding that those who happen to have a mental illness are people with a health condition that is not their fault and which is manageable. That’s a huge change.
If you could make one change to the NHS and social care over the next 10 years, what would it be?
That dealing with someone’s mental health – or supporting someone with a mental health condition on their physical health – is seen as ‘everyday business’. If you happen to have alcohol dependency as well as depression, you get proper joined-up help. If you have diabetes and have psychosis, the help you get for your diabetes is as good as if you didn’t have a mental illness. That it’s seen as normal that clinicians and practitioners work with individuals as individuals, not backing off from someone just because they happen to have a mental health problem. We’re getting closer to it every day, but we’re coming from a really low base.
Change from the top
If you could give Matt Hancock one piece of advice, what would it be?
We’ve really got to reach out and support local government much more effectively. Local councils have such an important role in social care, public health, suicide prevention, providing drug and alcohol services – things that actually keep people well.
I’d also say to please take seriously the recent Mental Health Act review. There are some big changes in there, and will require legislative and system change. It’s really important that report is implemented in full, no matter what happens in the wider world, and we do need to get started on the important recommendations it makes.
What do you wish people at the top of the NHS understood?
That mental health isn’t something you can just ‘bolt on’. It’s not something that’s additional or different from what’s happening every day in the NHS, and cannot be just a paragraph you stick on at the bottom. If you’re providing integrated care, mental health will be there from day one and needs to be part of the planning from the start. Yet so far that is still the exception not the rule in many of the integrated care approaches being tested. Traditionally mental health policies have been created in isolation, and often scuppered because they haven’t been knitted together well enough with the rest of the NHS.
Policy in practice
What policy have you seen successfully implemented, and why did it work?
The National Service Framework for Mental Health for adults in England – it set out very clear targets and expectations for what was required. It was then followed up with really detailed guidelines, and there was money entering the system to implement them.
It’s also 10 years since the Bradley report, which was about supporting people with mental health and learning difficulties in the criminal justice system. One of its cornerstone recommendations was to have a liaison and diversion service in every police station and court in England, and a decade later we’re very close to that being achieved.
What policy have you seen fail, or not be as successful as first intended?
Race equality in mental health, on which the Mental Health Act review once again reminded us of the extraordinary disparities we have. We have inequalities when it comes to diagnoses of severe mental illness, the use of police in detaining someone, the use of the Mental Health Act, secure care, community treatment orders – all of them are much more likely if you are from an African or Caribbean background.
There have been numerous attempts to tackle it, and none of them have managed to make a sustained change. There is still an enormous amount of work to do.
What policy and/or change in behaviour are you currently trying to implement, and how’s it going?
People with long-term mental health problems have much poorer physical health. That’s the case from a young age, and life expectancy is 15-20 years below what it should be. So we’re looking, through Equally Well, to completely change how the NHS and wider system relate to those who have mental health difficulties. Making sure that people get advice on living healthily when they’re young and first diagnosed, provide help with giving up smoking, and give opportunities to exercise. We were thrilled to see the Long Term Plan promise smoking cessation support to everyone using mental health services. If implemented, that will be a huge change.
Bonus question
The NHS is under pressure because...
From the perspective of mental health, it’s partly under pressure because we’ve undervalued and not understood just how important mental health is, and that has a whole-system effect. The bigger picture though is that the NHS has been the sole focus of a lot of recent spending decisions, while other parts of government have really struggled. Without investment in our other public services, we actually increase health care costs, because we leave people to have more health difficulties.
Andy Bell is Deputy Chief Executive of the Centre for Mental Health.
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