The mental health policy landscape: 2017 into 2018

2017 was a year that reframed the UK's political landscape. The triggering of Article 50 set the wheels in motion to exit the European Union, and the Conservatives lost their majority in the general election in May.

While these events dominated the headlines, 2017 was also a year that shifted the landscape of mental health policy.

Looking back: 2017

The 2017 Queen's Speech established the Conservative minority government's commitment to reform mental health legislation, confirmed it would publish a Green Paper on Children and Young People's Mental Health and reiterated it would make mental health a priority in the NHS.

These are all indicators that mental health continues to have prominence in the policy and legislative agenda, but question marks remain around the government’s commitment to adopting prevention measures to appropriately safeguard the nation’s mental health.

Last year was bookended by steps towards achieving the ambitions of the Mental Health Taskforce's Five Year Forward View for Mental Health - the government's response being announced in January and the research strategy in December. In response to the public's input to the Taskforce work, high priority was given to a call for increased help to prevent people developing mental ill-health and for much earlier intervention and this resulted in the publication of the Prevention Concordat for Better Mental Health in August.

The Concordat represents a welcome move to look upstream, focusing attention on the social causes of mental ill-health, demonstrating a keen understanding that policies cannot continue to focus on crisis care.

An increased focus on prevention and early intervention does not, of course, negate the need to address and treat diagnosed mental health conditions effectively and at the time the need arises. This remains vital.

However, a rebalancing towards prevention is crucial for helping to ensure that unprecedented demands on the health service, as well as interrelated demands on other public services, are effectively addressed.

Inequalities in the UK

While progress was made to shape a new policy framework through which to tackle the mental health crisis, a number of reports were published which demonstrate the stark inequalities experienced across the UK and reinforce the urgent need to incorporate mental health into all policies.

The fifth annual 'State of the Nation' report from the Social Mobility Commission is just one example illustrating the extent to which inequalities experienced across the UK have become so deeply entrenched.

The Care Quality Commission’s report on the state of care in mental health services 2014 to 2017 shone a light on the severe shortcomings existing in the current system. The report highlights core challenges around access to mental health crisis care, which represents a “major issue”, with 26% of people who try to contact support services not getting the help they need.

Similar issues of individuals not receiving the help they need can be identified in Thriving at Work, an independent review of mental health and employers by Lord Dennis Stevenson and Paul Farmer. The report found that around 300,000 people with a long-term mental health problem lose their jobs each year.

Underpinning the success of the prevention agenda is the urgent need to address inequalities, and it is clear from the reports published last year that there is still a long way to go. Given that vulnerable groups are exposed to preventable risks to mental health, greater attention needs to be paid to mental health problems related to marginalisation.

Mental health is a cross-cutting and mediating factor in public policy, as highlighted by each of these reports and the Prevention Concordat. Wider public services must urgently assume a more integrated approach to ensure that the protection and improvement of mental health becomes a collective effort across those parts of the system that have a key role in influencing it.

Looking forward: What’s coming up in 2018?

As we look to 2018, the government must ensure its policies are underpinned by a drive to help people thrive mentally, not just survive. It is critical to address the inequities that exist in the system. Opportunities for this to be achieved can be seen in the Children and Young People’s Green Paper and the independent review of the Mental Health Act.

The consultation on the government’s Children and Young People’s Green Paper opens a new chapter in children and young people’s mental health protection and improvement that is so desperately needed.

While further clarity is required on what exactly the government’s commitment to prevention means in policy terms, this formal recognition of the prevention agenda presents new opportunities to shape appropriate measures to safeguard children and young people’s mental health and, importantly, reduce the pain of mental distress and improve the quality of the lives of children and young people.

While the Green Paper focuses on schools, it’s important to be aware that in working to reduce the prevalence of mental health problems, and to make the biggest difference, we need to start at the earliest point, focusing a good deal on child development from conception onwards.

The Conservatives’ commitment to review the Mental Health Act 1983 will be another key feature of the 2018 landscape. The review will examine the causes of the rise in detentions under the Act, the continued disproportionate use of the Act in relation to BAME (Black, Asian and Minority Ethnic) people, and concerns around safeguards.

The scope of the review will be clearer in April, when it publishes its Interim Report. However, it represents the government’s awareness that mental health legislation needs to provide those with mental health problems with choice and, importantly, dignity. This said, the review of the Act cannot be seen in isolation; without addressing the factors that result in people ending up in crisis, there will continue to be a system failure.

Time for holistic change

Today's policy landscape provides some reason for optimism, with the wheels in motion to reform parts of the system. This said, real and lasting change can only be achieved through a holistic approach.

Mental health policies cannot be seen in isolation: the causes, impacts and solutions around mental health issues also need to be explored outside the health sector, reframing the current narrative.

We must look to our schools, workplaces and communities not just to support people who are struggling and support them earlier, but to promote their emotional well-being.

There is political appetite for change, and the New Year offers a number of opportunities to turn this into action. 2017 was a year that saw mental health continue to be high on the political agenda; we must use 2018 as the year to ensure that the rhetoric is further translated into a holistic strategy that also champions early intervention and prevention.