Vision for mental health policy

Penelope Campling’s book On the brink with patients’ stories from her life in psychiatry starts at the end of the asylum years, when many of us, as she says, were optimistic about the development of community care. But as I keep saying (see eg. previous post), mental health care, like much of NHS provision, has become too dysfunctional and fragmented. As I’ve also said before (see eg. another previous post), in many ways we are now repeating the worst days of the asylum in the community. 

Rights and recovery-orientated services need to be at the centre not the margins of mental health services (see eg. previous post). There were many strengths in the last Labour government’s mental health strategy (see my Mental Health Policy website, developed at the time, although several links are now defunct). Certainly it seemed to give far better direction than has been the case since Gordon Brown’s government lost the election. Where I think new Labour did not do so well was in managing concern about public safety in the context of the rundown of the asylum. There has been a reinstutionalisation of mental health services over recent years, perhaps most reflected in the increase in secure beds in both the public and particularly the private sector. This has been associated with an inappropriate over-preoccupation with risk in services. Risk is not always best handled by increasing coercion. Risk management needs to be more sensibly based on assessment, formulation and management of risk rather than the failed reliance on risk prediction (see eg. another previous post). 

The current Community Mental Health Framework for Adults and Older Adults to transform mental health services has been too non-specific in providing direction and there has been insufficient progress in  its implementation (see eg. previous post). Community Mental Health Teams have become too large and need to be devolved so that there is one in every Primary Care Network (PCN). The PCN mental health teams also need to work alongside non-medical mental health hubs, one of which again should be in each PCN. We wait to see how specific the new NHS 10-year Health Plan, due in June 2025, will be as far as mental health policy is concerned.