Mental healthcare in the UK is in desperate need of support. According to a 2001 report by the Office of National Statistics, one in four British adults experience at least one diagnosable mental health problem in any one year, and one in six experiences this at any given time. It's not just about quality of life, either: people are dying. Mortality rates in under-75s suffering from severe mental illness are a shocking three times as high as those in the rest of the population, with a premature mortality rate of fifteen to twenty years. Suicide is the leading cause of death among men under 50 in England and Wales, as well as one of the leading causes overall. Yet mental health research and care remains underfunded, under-recognized, and under-discussed.
This isn't just a fight to keep an acceptable situation ticking over. It's a fight to keep a bad situation from deteriorating further. In their annual QualityWatch report in 2014, the Nuffield Trust specifically highlight the overwhelming demand in mental health provision for urgent care and younger people as one of the main challenges facing UK health and social care services. Under the current government, despite increased demand for crisis care, the number of inpatient beds for mentally ill patients has been slashed by 17%, and the number of full-time inpatient psychiatric nurses has sunk by 13%. Waiting times are also longer for mental health patients than for others: only 74% of such patients were seen within 18 weeks in 2012-13, as opposed to 95% of those with physical ailments.
The imperative to improve mental health in the UK is primarily a moral one. That said, even a hard-nosed economist, insensible to the suffering of individuals, should appreciate the benefits that better mental healthcare can bring. Unsurprisingly given its prevalence, mental illness has a huge economic impact: a 2010 report by the Centre for Mental Health estimated the aggregate costs in 2009-10 as £105.2 billion - rather more than the total NHS budget for the same year, £95.8 billion. As for the benefits of treatment, a report just released by the same Centre finds that, for every £1 invested in group cognitive-behavioural therapy for adolescents suffering from anxiety, £31 is saved in wider costs.
Why should Pirates be champions of mental health? My view is that the movement's key aims are strikingly well-aligned with the societal changes that need to happen in order to see a sea change in mental health provision. Pirates have always striven to reduce unnecessary barriers to the sharing of information, while at the same time defending the individual's right to keep that information private if that is what they want. The barriers to the sharing of information in terms of research data and creative works are to a large extent legal (e.g. copyright, patent law) and institutionalized, while the barriers to the sharing of information about mental health are mostly social and cultural: too many people still see mental illness as something stigmatized, embarrassing, something to be ashamed of, something to keep quiet about. But these barriers too can be broken down, and should be; "sharing is caring". As for privacy, the overwhelmingly negative reaction to the Samaritans' ill-fated "Radar" service in 2014 demonstrated that popular opinion is strongly against automated aggregation of mental health data and against uninvited interventions: while individuals should have the freedom to share their experiences of mental illness, they should also have the right to decide how widely they wish to share those experiences and what should be done with the information.
What follows, then, is a set of three concrete recommendations for PPUK mental health policy in the run-up to the 2015 general election. These align with the recommendations of the Alliance for Mental Health Research Funders' manifesto, Prioritising Mental Health Research, and the CentreForum Mental Health Commission's "Pursuit of Happiness" report, published in late 2014. The overarching principle is that there should be parity of provision as well as parity of esteem between physical and mental healthcare.
1. Mental health spending should be increased in line with the prevalence of mental health problems. Though 23% of the total years lived with disabilities in the UK are due to mental health issues, only 5.5% of medical research funding went toward mental health studies in 2009-10, and only 13% of NHS funding was allocated to mental health. Much more money should be ring-fenced for mental health by the major government medical research funding bodies, the MRC and the NIHR. As the CentreForum Commission's report states, "The cost of doing nothing, or simply settling for gradual change, runs to billions of pounds, but the real cost is measured in human misery, misery for want of a determination to act on the evidence." They suggest an increase of £114 million in research funding by 2020.
2. Unnecessary barriers to health data sharing between government departments should be removed. Mental health questions are linked with questions of education, justice, and many more. The AMHRF report emphasizes that "we need better access to high quality data about mental and physical health, improved coordination of data sharing between government departments (for example between Health, Justice and Education) and more mental health knowledge among the wider public service workforce". Once again, sharing is caring. At the same time it is important that patients retain control over what happens to their data, and feel that their privacy is respected: in this respect, the recommendations of the recent Nuffield Council for Bioethics report on health data should be followed.
3. There should be a dedicated Minister for Mental Health within the Department of Health. This is a key recommendation of the CentreForum Commission's report. Such a new position might be criticized as a cosmetic change; however, even if true, such a criticism would miss the point that, given the stigma that still surrounds mental illness, any move that serves to raise the profile of mental health issues in the public eye is a welcome one.
Much more needs to be done, but these three policies are a start. It's already Pirate policy to trial expanded access to computerised CBT, but we can do more - and that includes pushing for mental health to be at the top of the agenda in the public eye for May 2015's General Election. Liam Fox notes in a blog post that a colleague once told him that mental heath is "not what the public want to hear about" in the context of politics. He disagrees, and so do I.
Today is Time to Talk Day. Let's start now.