Comment

Stop using mental health as an emergency piggy bank

April 4, 2006

Want to prevent cuts to your local mental health services? Then get campaigning, urges Simon des Forges, project worker for service user involvement charity Viewpoint.

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In Hertfordshire, mental health services are significantly under threat.To reduce the estimated £100m deficit across Bedfordshire and Hertfordshire health economy, Hertfordshire Partnership Trust has been told to find 5% "efficiency savings", approximately £5m. Proposals out to consultation include the closure of an acute psychiatric ward, an acute mental health day care service and an early intervention team, as well as reductions to community mental health team (CMHT) services, psychological therapies and alcohol services. This is not a unique situation. Indeed, across England it has been estimated that £16m is being cut from mental health services to offset the deficit. What is unique is the financial status of Hertfordshire Partnership Trust. It has remained within its budget for the past four years.

Service users, carers and staff alike are deflated at the cuts. But people in Hertfordshire are not going to give in easily. An alliance of 10 local mental health organisations, carers, Viewpoint and service users are trying to protect their services and support their trust. Councillors, ministers and MPs are being lobbied to halt the cuts and to consider the long term problems they would cause.

Why bother? It is misjudged to base the argument simply on the fact that the trust is not in deficit. Although a highly significant point, the lack of ring-fenced money in the NHS makes it easier for commissioners to divert funding from one trust, or area, to another. A more salient argument should also consider the risk to users and carers, as well as the long term costs that will result from the short term solutions.

The distress that users and carers are already suffering is real. With a reduction in services across most clinical and community areas, the threshold levels for interventions will rise. People will need to be more unwell to access an acute bed, and CMHTs and crisis assessment and treatment team teams will have to support those people who would have previously been supported in a unit. As a result, when GPs try and refer people to a CMHT, they will find many people being sent back for ‘not being ill enough’. The end result is more people more unwell and at more risk of self harm or suicide.

Then there are the long term costs. Early intervention in mental distress is proven to reap rewards. If a person receives appropriate support swiftly then they are much more likely to recover or remain well for longer periods. With a reduction in support services, recovery times are likely to increase. People will be more unlikely to return to work and will find it extremely difficult to get out of the ’revolving door’ scenario. When an average acute stay (in a psychiatric intensive care unit) costs around £5169 (Note 1, below) - enough for seven years of private talking therapies, any measure which shifts the point of intervention towards the acute end is financially flawed. The additional cost of benefits payments due to loss of earnings will hit the taxpayer hard.

Perhaps the most worrying impact is on the people who are currently not in ‘the system’. While health professionals know that providing swift and appropriate support is the ideal way of working, they will be left feeling helpless as their clients have to deteriorate to a sufficient level before they can receive services. The journey towards recovery will be that much harder as people experience unnecessary distress.

So is there a solution? If mental health services should not be cut, then the savings have to be made somewhere. I am not against our trust trying to be more efficient, but they should not be liable for such significant cuts when their financial management has been sound, as this offers no incentive for a trust to break even.

The pressures to make savings quickly, as set out in the NHS Operating Framework 2006 /2007, are unrealistic and have contributed to the cuts in frontline services. The proposal for the NHS Bank to charge up to 10% for loans will only worsen the situation for those trusts which need help. I am not advocating the overspend as acceptable, but the demand for resolution in such a short space of time does nothing but harm patients and patient care.

Hertfordshire has decided to say no to the cuts. Mental health services cannot continue to be used as an emergency piggy bank. In order to deliver the government's national service framework for mental health and achieve the promises set out in the Choosing Health White Paper, we cannot lie down and simply accept these cuts.

There has been a lot of effort to improve mental health services over the past few year and I, for one, am not prepared to see it thrown away.

Reference:
1. Mental Health and Social Exclusion (2004) Office of the Deputy Prime minister p118-119

Viewpoint

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