It’s estimated 1 in 4 people experience a mental health issue at least once in their life and more than four 15-34 year olds commit suicide every day, you would think Western countries in particular would have sufficient resources available for people of all socioeconomic backgrounds, with mental health being taken just as seriously as physical health, but this is not the case. We are still in an age of premature mental health awareness, research and effective treatments. In the UK, the National Health System (NHS) would be the primary source of support for sufferers, yet many questions are raised over their approach and effectiveness. In a February BBC interview, the deputy prime minister Nick Clegg said it was ‘just plain wrong’ to treat the illness as the ‘poor cousin’ of physical health in the NHS. There remains, he says, ‘too much prejudice, too much discrimination’ around the issue.
The Health and Social Care Act 2012 delineates mental health problems should be treated as seriously as physical health problems. The draft Mandate the NHS Commissioning Board recognises the importance of putting mental health on a par with physical health, which means everyone who needs mental health services having timely access to the best available treatment.The NHS Outcomes Framework 2013/14 notes there has been a stronger emphasis placed on mental health, and apparently the new measure relating to psychological therapies, ensures that the framework takes into account recovery from common mental health problems (depression and anxiety) as well as the treatment of more severe mental illness. I know many would beg to differ.
Economic crisis and ‘False economy’
The 2008 recession led to cuts across the NHS, as the government struggled to deal with soaring deficits. Rethink said mental health accounted for 23% of the disease burden in England but received only 13% of the health budget. Currently people are waiting up to a year for psychiatric consultation in some areas, even after a suicide attempt. The general consensus among the community is that Cognitive Behavioral Therapy (CBT) is shoved down your throat and doctors quickly prescribe medication just to shut you up for a few more weeks. Norman Lamb, the minister in charge of mental health care in England, said ‘It’s a bit hit-and-miss as to whether you get a GP who really understands the issues’.There are no details about when the government plans to introduce more mental health training for GPs, and I personally believe teachers should receive training also.
This is certainly not the right approach to the increasing demand on mental health services and I perceive that this is more costly to society and the economy in the long run. More needs to be done on preventive care and early intervention. Mental health trust budgets for 2013-14 have fallen by 2.3% from 2011-12 (referrals rose by 13%), asking trusts to save almost 20% more from next year’s budget than hospitals. The average cost to support someone with psychosis or schizophrenia in the community is £13 a day, compared with the £350 average daily cost of keeping a mental health patient in hospital. Ideally, the NHS could save more than £50 million a year from a shift in focus.
Sean Duggan, chief executive of the Centre for Mental Health, described the cuts as a ‘false economy’.‘They save the NHS £9 and the wider economy another £9 for every £1 invested in them’..Early intervention programmes were ‘very good value for money’ and the prospect of budget cuts was ‘very worrying’. ‘Early Intervention in Psychosis services are known to be highly effective in helping young people to negotiate their first episode of psychosis,…They offer hope of a brighter future by helping young people to stay in education, to get and keep work, and to support their physical health.’
Some critical areas for improvements
Evidently, the NHS is under extreme pressure for rapid change in improvements of treatment and provision of resources. In 2012, £32 million was invested in training new therapists to meet the demand. Though, in this difficult economic climate involving austerity measures and welfare reforms it leaves little time and resources to acknowledge the psychological complexities of individual cases. It’s commonly known that CBT is cheap; the NHS save £989 every time people were treated with cognitive behavioural therapy instead of going to hospital, but more can be done to improve efficiency.
- Appropriate therapy referrals: CBT helps patients understand the thoughts and feelings that influence behaviors. e.g. a CBT practitioner would say if you smoke cannabis when stressed, it’s actually your depression that smokes when stressed, and would then provide strategies to notice negative thoughts and behavior patterns to overcome your need to smoke. At times, low quality therapy is offered by poorly trained practitioners, it is short term, usually 5 sessions at a time before a review is made. Personally, I advocate the use of Psychodynamic/analytical therapy (talking therapies), which endeavour to determine the underlying causes for your behavior (may be paranoia, low-self esteem, childhood trauma etc..) and then treat each condition accordingly. Dialectical Behavioral Therapy (DBT) may also be more appropriate for those with a Borderline Personality Disorder diagnosis, although it’s costly to run as it tends to last at least a year. Misdiagnosis or sending just anyone to CBT wastes times for all parties involved and costs the government more in the long run. Hence, if an individual is believed to be suffering from anxiety or depression then a CBT referral may be appropriate, but for patient’s with more severe pathological behavior e.g Complex PTSD or Personality Disorders, they will generally require more intensive treatment as the past is often a common cause of today’s behavioral patterns.
- Shared decision making between patients and doctors: This is particularly important as thousands of people are unsatisfied with their therapy and medication. Availability of psychological services is at the discretion of the patient’s GP, who may often prescribe medication. These unfortunate individuals spend months and even years trying out different medication that potentially cause ‘numbness’, mania, suicidal ideation and many other adverse effects. Self esteem is probably at it’s nadir, and to be treated like a guinea pig is unacceptable. Patients hold the key to determining the best treatment for themselves, and the more active they are in the decision making the higher the chances of success.