Liam Rhodes

With corrections and comments: A response on mental health services from the DoH

With corrections and comments: A response on mental health services from the DoH

l_rhodes July 19, 2018
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Dear Mr Rhodes, 

Thank you for your correspondence of 23 June to Jeremy Hunt about improving mental health services. I have been asked to reply.

I was sorry to read of your relative’s mental ill health …[redacted for privacy and respect], and I appreciate your concerns about the funding and staffing of mental health services.

I would like to assure you that the Government continues to take mental health as seriously as physical health and hold the NHS to account for achieving the objectives set out in the last NHS England mandate, ensuring that mental and physical health conditions are given equal priority. The Government has legislated for parity of esteem between mental and physical health through the Health and Social Care Act 2012.

The letter states, as I stated in my letter to Jeremy Hunt, precisely that which it has failed to deliver on: Parity of esteem between mental and physical health conditions. It has failed to do so now for four years.

The Government increased spending on mental health to £11.6billion in 2016/17, with a further investment of £1billion every year by 2020/21, so that it can ensure that clinically appropriate mental health services continue to be provided to those who need them.

What does “clinically appropriate” mean? Does this mean throwing more money solely into psychiatry and into IAPT…

The Government has invested over £120million to introduce waiting time standards for mental health services. Over the last Spending Review, it also invested over £400million in the Improving Access to Psychological Therapies programme to ensure access to talking therapies for those who need them, and this has contributed to achieving very real improvements in the lives of people with anxiety and depression.

And so it does – without evidence – which is precisely the problem with mental health provisions in this country, as outlined in my original post, in which I stated: “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.”

Spending is tracked by clinical commissioning groups (CCGs). The Mental Health Investment Standard (MHIS), previously known as parity of esteem, is the requirement for CCGs to increase investment in mental health services in line with their overall increase in allocation each year. The NHS planning guidance for 2018/19 states that all CCGs will be required to meet the MHIS, and this will be subject to confirmation by their auditors.

Again, we return to where the money will be allocated. Will it be delivered to third sector organisations which can prevent unnecessary referrals to the NHS, or will they continue to cut funding in favour of what will undoubtedly be a top-down approach.

Funding alone is not enough, which is why there is greater transparency in mental health provision through the NHS England Dashboard, first published in October 2016. The Dashboard increases the visibility of how each CCG is progressing the recommendations of the independent Mental Health Taskforce and includes data on waiting times and funding. The Dashboard can be viewed on NHS England’s website,, by searching for ‘mental health dashboard’.

Transparency is indeed a wonderful thing, and I look forward – in hope – to reading that the NHS commissions alternative providers and unproven solutions other than IAPT to treat ongoing conditions. CBT is a sticking plaster for both depression and anxiety; that is all.

The Government has also announced plans to recruit 21,000 new people to the mental health workforce, who will be able to treat an extra million patients each year.

How many of the 21,000 new people be administrative staff? Again, who will they be treating and why? What conditions will get the most exposure and which will remain largely ignored?

The Government will continue to invest in new and better services across the whole spectrum of mental health conditions. In particular, it will make further improvements in early intervention, investing in community services and expanding access to round-the-clock crisis care support both in the community and in A&E.

By “early intervention”, this response largely means IAPT. It works for many, but not all. Community services is a fantastic buzzword unless you can back it up without cutting funding to those community services that already exist.

I do at least welcome the crisis care and A&E investments.

I hope this reply is helpful.

Yours sincerely,

[Name redacted]

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