Dear Rt Hon Jeremy Hunt MP
Please allow me to introduce myself. My name is Liam Rhodes. I met you at a Conservative Party fundraising event in 2013 in Derbyshire, at which you failed to provide an adequate answer as to why mental health beds were falling and waiting times were increasing. Your answer at the time was that the situation was “complex”, and that more funding was needed. That was the case, and remains so today. Indeed, which is the purpose of my letter: To explain to you the failings, costs and opportunities of how your Department can finally honour its pledge, set in law, to provide parity of esteem between physical and mental health conditions.
I was reluctantly pleased to hear that the Prime Minister had delivered a non-existent “Brexit dividend” to the Department of Health and Social Care. My reluctance was primarily based on the fact that there will be no such dividend, and indeed there will be costs to fill, which will probably fall to the lowest-paid by breaking the Government’s promise of no rises in Income Tax.
It is also known botched job of your predecessor has left us with Clinical Commissioning Groups which will be centralised again to to larger CCGs, adding to costs, not reducing them.
That aside, £20bn per year for the NHS and Social Care is a stepping stone in the right direction.
The maximum waiting times for any NHS treatment is supposed to be eighteen weeks. Here in the Southern Derbyshire Clinical Commissioning Group, the average waiting list for a referral to a clinical psychologist has just surpassed three years; the average waiting list for a referral to an autism specialist – following an initial consultation with a psychiatrist, usually for whom your GP has to fight for you to see in the place of an under-qualified CPN after waiting six months – is two years; and the average waiting list for psychotherapy (non-IAPT) is three years.
We can only speculate how many lives have been ruined – whether it be through lost employment, self-harm, addiction, suicide – while patients wait for critical cervices.
I’d like to address how we can better prevent conditions worsening in the first place and turning into full-blown disorders (such as Generalised Anxiety Disorder).
You may recall that recruitment to IAPT was paused by the Conservative-Lib Dem coalition government in 2010. There was a reason for this: its outcomes weren’t great at the time, the choices were limited, and there was an assumption that it may perhaps be a good idea to get counsellors back into GP surgeries again, or to at least provide that as an option. The latest IAPT outcomes make for good reading, but they don’t address issues enough.
It is fantastic that people can self-refer to counselling services and address the issues, but what isn’t great is that people wait two weeks between sessions. What’s also not great is that 49.3% move to recovery at the end. This is because the number of sessions is capped. The idea that you can present in front of a counsellor knowing that your sessions are limited – and at the start of each session, measuring inter-treatment outcomes – is unhelpful to patients. Put yourself in the shoes of someone with an anxiety condition: They already know that their time is limited with that person with whom they will share intimate details of their life before their counselling has begun.
Another problem is choice. Yes, Cognitive Behavioural Therapy can be good for many people, but it is not a panacea, and many patients do not respond to it. Here in the Southern Derbyshire CCG, there are choices between person-centred and CBT counsellors, but there are many more equally as valid approaches out there, such as lifespan integration, psychoanalysis, psychodramatic, gestalt counselling – just to name a few. I am uncertain about other commissioning groups, but considering that SDCCG is known to be one of the “better” ones for IAPT provision, this concerns me.
Many people experiencing mental health issues lose insight very quickly, which is why many people end up in horrible situations where they have to be admitted to hospital. However, even more people have been let through the cracks of the system by lengthy waiting times and have reached crisis point. At this point, if we are talking figures, in one CCG, patients cost the NHS £3,003 per week.
My fear is that additional money for the mental health services in the NHS is going to be thrown into hospitals and not at early-intervention points. One idea would be offering real choice at self-referrals and enabling patients to choose a counsellor with whom they will form a psychotherapeutic alliance with at an early stage.
I know that much of your money will also be used to train much-needed mental health nursing staff. I have had the awkward pleasure of meeting on-ward mental health nursing staff during times when a family member – who suffers with schizoaffective disorder – had reached a crisis point. They are true gems, and we need more of them.
But if we are truly going to have a working mental health system, you need to ensure that money will be directed towards those services that don’t seem worthwhile, such as clinical psychology and specialist services, such as autism and eating disorder specialists. If you don’t, you will fail to fix the issue and fail hundreds of thousands of vulnerable people in this country.
Yours sincerely
Liam Rhodes