Old Problems, New Solutions
Earlier this year, the UK Commission to Review Acute Psychiatric Care for Adults released a report that included insightful health and economic arguments for systemic change in the provision of our services. This set out the need for a more proactive and preventative approach to supporting people with mental health conditions and their families and, in parallel, the pressing need to reduce the costs for NHS and emergency services.
The Commission made some very clear recommendations to service providers, commissioners, service users and their advocates about the need to re-design the current system. They cited the startling cost of inpatient care relative to community support, e.g. inpatient admission can be up to 44 times more expensive than community based support, 1 in 4 inpatients could be more appropriately treated elsewhere, and 1 in 5 inpatients could be discharged, if only there was an appropriate place to discharge them to. All this against a backdrop of mental health bed numbers reducing from over 65,000 in 1987 to currently under 20,000.
In the past, the mental health sector has shown the health economy a way forward, by shifting from inpatient care to community based care in the late 1980s. There were a few patient groups, for example the institutionalised elderly, who did not cope well; the mortality rate for this cohort increased dramatically over the period of the physical moves. But on the whole, the vast majority of people; patients, families, local communities and the NHS woke up to the new reality that, after a bumpy period of adjustment, there was indeed a better, cheaper, more effective way of treating and supporting people with mental health conditions. Providing the same disempowering, dependency creating, institutionalising care is unimaginable now. The current expectation of empowerment and, for many conditions, a recovery and support pathway being the norm, was unimaginable then.
The demands on our NHS are on a continual upwards trajectory and our finances are travelling in the opposite direction. The UK health economy is currently in the grip of deficit financing. The position is unsustainable and there is an increasingly desperate need to find another way. Might this be the stick to push the nation’s strategists to take the leap into properly funded health promotion, and easy access to cross sector support together with self-management plans for long term conditions, both physical and mental?
The UK mental health sector is very well placed, in the service re-design outcomes of the recommended review, to show the rest of the health economy how they might ‘shift up a gear’ again. The question is will we do it?