The issue nobody is talking about that could decide the next election

Four in 10 people say that mental health could be a factor in who they vote for in 2024, writes Saffron Cordery, deputy chief executive at NHS Providers. So why isn’t anybody listening?

Earlier this year, the government scrapped its long-term cross-department plan for mental health (PA Wire)

There are now 1.9 million people waiting for mental health care in England, according to the latest official figures published this week. But as the waiting list just captures those who have been referred, that’s only part of the story. Of those counted, almost half a million are children – an 80 per cent increase since 2019. Urgent referrals for adults have shot up by more than 82 per cent since the pandemic, and 155 per cent for children and young people. Getting these waiting times down and addressing demand for mental health care has never been more urgent.

We are in this position because of the chronically neglected mismatch between demand and capacity in mental health services. Recent focus and investment in the sector have been welcome, but have not been long term nor broad enough to turn the tide on the scale of historical and structural disadvantage the sector has faced compared to physical health provision. Despite best – and fruitful – efforts of national and local health leaders, the dearth of political will to back them has exacerbated a care deficit whereby not everyone who needs help and treatment for mental health conditions can get it.

It is staggering that at a time when delivering equity between mental and physical health should be paramount, it is being pushed down the national agenda. The King’s Speech was a case in point, with the government deciding not to bring forward the long-overdue mental health bill to improve how and where good quality mental health services are accessed. Given the unacceptable treatment gap for mental health, such a delay is unfathomable.

Overhauling the 40-year-old Mental Health Act has been in the works for over four years. There has been widespread support in the health sector for legislative proposals to ensure appropriate safeguards are in place as well as clearer individual rights and liberties that enable patients and service users to have a more active role in their care planning. Putting patients at the heart of how they access care and treatment is vital to high-quality care.

Addressing race and ethnic inequalities is also an important reason to reform the law. Currently, people from minority ethnic backgrounds are up to five times more likely to be detained than their white counterparts. Urgent action is needed because these disparities have not improved – and in many ways, are getting rapidly worse. Earlier this year, parliamentarians scrutinising the draft proposals to reform the Act called this “a collective failure that is unacceptable and inexcusable”.

The King’s Speech is just the latest sign that national focus on mental health is fading. We are still waiting for new, broader waiting time standards for community and urgent mental health services to be fully introduced. If resourced properly, these would improve patient care and help address the mismatch in demand and capacity for mental health services. It is right that significant focus and investment are given to tackling long waits for hospital care; it is unacceptable that the same isn’t true for mental health.

Earlier this year, the government also scrapped its long-term cross-department plan for mental health, which had the potential to bring a much-needed strategic and systemic approach to mental health policy and delivery over the next decade. Instead, mental health will be folded into the government’s forthcoming Major Conditions Strategy, sharing a focus with cancer, cardiovascular disease, musculoskeletal disorders, dementia and chronic respiratory disease. While its inclusion acknowledges that mental health needs to be prioritised nationally, and there is merit in looking at conditions in the round given the interconnection between physical and mental health, it’s a far cry from the level of attention needed given the relentless rise in demand for mental health services.

We also continue to see a worrying lack of priority for mental health when it comes to capital investment. It is vital that the environments in which patients receive care are safe and therapeutic. This means modern facilities fit for the needs of mental health patients. Capital investment is also a key driver for wider productivity, improvement and transformation of mental health services. But time and again the needs of mental health services are overlooked.

What we need is an ambitious, multi-pronged, strategic approach that looks to improve how and where high-quality mental health services are accessed, as well as support for prevention and earlier intervention. There needs to be a particular focus on addressing inequalities holistically, which means addressing challenges in wider areas such as housing, employment, and public health.

One in four people experience mental health issues and socioeconomic disadvantage is consistently linked to poorer mental health. Black adults have the lowest mental health treatment rate of any ethnic group and those who do receive treatment are four times more likely to be subject to restrictive interventions. We need structural and systemic changes that focus on equity for mental health and address inequalities more broadly – in every facet of public policy and funding.

With a looming general election, politicians need to make mental health a key priority and commit to further concrete measures and investment plans that will truly bridge the enduring gap between mental and physical health provision. Mental health remains a key concern for the public, with four in 10 voters saying it will shape their vote in the next general election. This should be a call to action for all parties to ensure mental healthcare receives the priority it deserves. Mental health conditions do not discriminate, and neither should our approach to addressing them.

For all those [silently] suffering, for all those on waiting lists and for the health of the population, warm words won’t cut it. It’s time to act. We need to reform our outdated mental health legislation, address the drivers of growing demand, and ensure mental health services are properly funded both now and in the long term.

Saffron Cordery is the deputy chief executive at NHS Providers, the membership organisation for the NHS hospital, mental health, community and ambulance services that treat patients and service users in the NHS