Four Prime Ministers ago, when Theresa May stood outside 10, Downing Street and promised to address “burning injustices” the fact that she included mental health among them suggested the issue was high and still rising up the political agenda.
Her predecessor David Cameron had also said it was a priority, and that we needed to deliver on the commitment in the NHS Constitution that there should be parity between physical and mental health within the healthcare system. His Chancellor George Osborne made a big thing of announcing an additional £600m of funding and, in a rare positive namecheck from a Tory, I was credited along with Lib Dem MP Norman Lamb and Tory MP Andrew Mitchell for having set up the all-party campaign that fought for and won that extra funding.
It was however, as so often with Osborne, as much about the politics as the actual needs of the country, added to which you would be hard pressed to run an accurate audit trail on where the money came from and where it went; and of course the signature policy of the Cameron-Osborne regime was austerity, which has had a severe impact on mental health services, not least because it saw mental health go back to its traditional place at the back of the queue within the NHS.
In his recent interview with me and Rory Stewart on our LEADING podcast channel, Osborne was unrepentant and unapologetic about austerity, insisting both that it was necessary and that it helped to secure economic recovery after the global financial crisis. Unsurprisingly, I disagreed, and he did at least accept that mental health services are far from where they need to be. And though reluctant to admit to any downside to austerity, he was more than happy, as someone who felt we should never have had an EU referendum in the first place, to admit that Brexit has done enormous damage to the country, our economy and public services.
Osborne protegé Matt Hancock was made Health Secretary in the second year of Theresa May’s government, a role for which he would become a central figure in the life of the nation during the Covid-19 crisis. When he first started out in the job in July 2018, Hancock also said that mental health would be a priority, and three months later he hosted a Global Mental Health Summit, at which ministers and experts from all over the world gathered in London to swap ideas and best practise. As with Mrs May’s speech on taking office, Cameron’s rhetoric, deputy Prime Minister Nick Clegg’s support for the (now defunded) Time to Change campaign, and Osborne’s public spending announcement, not to mention positive change in volume and tone of coverage about mental health across the media, it made those of us campaigning on mental health hopeful that we were getting somewhere.
Hancock invited me to speak at the event and, introducing me, said that he felt it was “great that we are talking about mental health more.” I agreed, but I also said that I felt the talking had been going on long enough, and it was time that governments really started to deliver on that promise of parity.
Looking back to those times now, it is hard not to feel that for all the steps forward made during the New Labour era and the early Tory years, we have since gone substantially backwards. Cameron and May at least talked the talk, and in so doing sent out important signals about the direction of travel. A combination, however, of the reality of austerity, the self-inflicted harm of Brexit, Boris Johnson’s catastrophically bad leadership, Liz Truss’s catastrophically bad economic mismanagement, and several years of government defined by lying and scandal, culture wars and distractions rather than by meeting the real needs of the country, has set us back enormously.
Today is revealed another sign of setback, in the form of a letter from Metropolitan Police chief Sir Mark Rowley stating that his officers will no longer answer call-outs related to mental health, unless there is a risk of loss of life. He has given health and social care services a deadline of August 31 to sort themselves out so that police officers are no longer considered the appropriate port of call for someone in mental health crisis.
His frustration is palpable, and understandable, given the police have become the mental health crisis frontline in so many ways, as a result of inadequate services where that frontline ought to be, which is the NHS, and the (overwhelmed) charitable sector. But it is a very dangerous development.
That shift, from NHS as frontline to police as frontline, has become normalised in a matter of a few years. It has happened in large part because of austerity, and because of the wretchedly bad government we have been forced to endure since the referendum of 2016, especially under Johnson. Covid, of course, has not helped, given the vast sums it consumed from the public purse. But the waste, mismanagement and corruption, and the undermining of NHS staff (once we were through the clapping on doorsteps phase) have also played a significant part in getting us from the hopefulness of 2018 to the place we are in now.
And so to another desperate sign of just how bad that place is. When we were all out clapping every Thursday night, Johnson and then Chancellor Rushi Sunak leading the applause from Downing Street, we all cared deeply – or said we did – about the carers we were cheering. We marvelled at their professionalism and resilience, and their commitment to public service, shown not least in the risks they exposed themselves to with dodgy PPE, mixed messaging from government, and huge pressure on their own mental health.
At least NHS staff in England and Wales had somewhere to go for help when they needed it … a network of forty NHS staff mental health and well-being hubs. However, as you shall see here, the government has failed to commit to funding the hubs and guaranteeing their future. Government funding ended on March 31. A third have closed or are closing already. Others are under threat. This places vulnerable NHS and social care staff in psychological danger which in turn threatens patient safety. It shows once more that the clapping aimed at keeping up the morale of NHS workers (and getting cheap PR for the government) was easy, but when it comes to practical help for them, the current version of the 13-year-omnishambles doesn’t even talk the talk, let alone deliver what is needed. Instead we have Sunak trying to tell us that paying nurses a decent wage would send inflation soaring, while Health Secretary Steve Barclay continues to peddle the Johnson manifesto lie that the Tories are building “forty brand new hospitals.” Peter Stefanovic dealt with that particular lie rather well yesterday.
The Minister’s position on the future of the hubs has ranged from ‘a decision has yet to made’, to ‘wait for the NHS workforce plan,’ back to a ‘decision has yet to be made’. Yet given the pressures they are under, health and social care staff need psychological help more than ever, and there is plenty of evidence of the strong link between staff wellbeing and patient safety. Also, the hubs have helped keep staff in their jobs – or supported them to return to work – during a workforce recruitment and retention crisis. So they end up saving money in the long-term.
From a clinical perspective, the presence of the hubs in each region has meant that staff needing help can get rapid and confidential access to psychological help, from qualified professionals who understand the challenges they face. Without the hubs, staff would be added to the same waiting lists for mental health services, that we know continue to be in crisis.
Ah well … as the title of the new book goes, “But What Can I Do?” I can see why, given the quality of some of our MPs, you might think that writing to them isn’t worth the time or the effort. But it can be, and it is worth a go. The British Psychological Society is running a campaign on the issue, part of which is urging people to write to their MPs to make them aware of these cuts and their effect on health and social care workers, and you can do so very easily here. It might make no difference whatever. On the other hand, it just might. Because plenty of the MPs may not know what is happening with the hubs. Plenty of Opposition MPs will not like it one bit. And I suspect a fair few Tories won’t like it either. So give it a go.
I have a recurrent depressive disorder. I have been ill now for over eleven years. When I had my first breakdown, I felt cared for by my local NHS mental health clinic. I saw the same psychiatrist regularly, and I had a care co-ordinator who visited me or called me to check on me between appointments and report any issues I was having back to my psychiatrist. Recovery felt realistic. Since this time the service has fallen into an alarming decline. I now find myself on my tenth psychiatrist in eleven years, none of them want to stay in the NHS. I had a catastrophic breakdown last November, which drove me to the edge. When the psychiatric nurse on the end of the phone asked me how I was feeling I was honest, I was having suicidal thoughts. He then asked to speak to my husband and spent the remainder of the call trying to persuade him to call the police, which he steadfastly refused to do. I didn’t want to die, I just desperately needed help to keep on living, which is what I was asking for. In the past my clinic would have given me an urgent appointment, but this doesn’t happen now. As someone with no history of aggressive or violent behaviour, I’ve never been inside a police station or even spoken to the police. I’m a tiny woman, not even 5ft tall, I wasn’t a threat to anyone. My clinic knew that they were the best people to help me, still calling the police was their advice. Being hauled away in front of my young son for the crime of being mentally ill would have only added to my trauma. I would have felt publicly shamed by it, and it has made me deeply afraid. As a consequence, I no longer want to ask for help.
Three weeks ago, I wrote to my GP about the alarming decline in the standard of care I have been receiving at my local NHS mental health clinic. I wanted to put things on the record and had hoped that he would intercede to help sort things out. He didn’t want to know. I wrote to my MP and sent a copy of the letter to my GP to him. Last week, this was forwarded to my local health authority complaints department. I wrote to this same depart last year, they took five months to respond to my complaint. They simply verified what I said was correct, but ultimately it changed nothing. As a labour supporter, I even wrote to the shadow health secretary about mental health policy issues. However, I received a disappointingly vanilla and minimalist response. Now I feel like a fool for thinking that anyone cares. My illness causes me to feel a sense of hopelessness. But looking objectively there doesn’t seem to be anything to stir any feeling of hope. I will keep on writing for as long as I feel able to, especially because I know I’m not the only patient who has watched their NHS mental health care service disintegrate. However, I expect that if things do not change, I may well be left in the position where there is only one more letter to write.