UK government aims to implement new mental health strategy as commissioning is given to GPs

BMJ 2011; 342 doi: (Published 04 February 2011) Cite this as: BMJ 2011;342:d797
  1. Caroline White
  1. 1London

The care and treatment of mental ill health is to be put on the same footing as physical health problems, under government plans to tackle the inequalities and discrimination faced by people with mental health problems in England.

Mental ill health accounts for almost a quarter of all ill health in the United Kingdom and one in three GP consultations. It is the largest single cause of disability and in England costs an estimated £105bn (€124bn; $170bn) a year.

The government’s strategy document, No Health without Mental Health, published on 2 February, promises a “life course approach,” with input from across government departments and local government and third sector organisations.

But experts in mental health have questioned how far the strategy can be implemented while the NHS undergoes wholesale change, as laid out in the Health and Social Care Bill published last month (BMJ 2011;342:d418, 20 Jan, doi:10.1136/bmj.d418).

Paul Farmer, chief executive of the mental health charity Mind, welcomed the move as an important step but warned that the success of the strategy would depend on “the ability of a range of bodies to effectively work together while the goalposts are moving.”

The strategy emphasises the need for early intervention and prevention and for a joint strategic approach spearheaded at the local level by the new statutory health and wellbeing boards. It sets out six “shared high level” objectives, which relate to indicators in the three outcomes frameworks for the NHS, public health, and adult social care.

These objectives include boosting the prevalence of good mental health and rates of recovery among mentally ill people and integrating the treatment of mental and physical ill health. People with mental ill health often have poor physical health and die earlier than the general population.

The strategy also aims to eliminate the discrimination and stigma faced by people with a mental illness, enhance their experiences of care, and improve the quality and safety of the services they receive. Patients will be given greater choice and control over their care; and a system of payment by results for adult mental health services is in development.

Implementation of the strategy will be overseen by the cabinet’s subcommittee on public health and an advisory group comprising key stakeholders, including service users and carers, while the cabinet’s committee on social justice will tackle issues underlying poor mental health.

When GP led commissioning starts in 2013, responsibility for monitoring progress will fall to the NHS Commissioning Board and Public Health England, which are due to be set up in shadow form in 20011-12.

As part of a four year action plan the government has allocated an extra £400m to primary care trusts and their successor organisations, to extend access to talking therapies, including to children and teenagers. And it is exploring use of such therapies among elderly people and among people with long term conditions and medically unexplained symptoms.

But the money has not been ringfenced, and it’s not clear how much cash will be available year on year, as “the costs are still being finalised,” a Department of Health spokesperson told the BMJ.

Simon Lawton-Smith, head of policy at the charity the Mental Health Foundation, said that the strategy would work only if it is properly funded across all relevant national and local government departments—which “will be a challenge,” he added, “as the government looks to cut the deficit.”


Cite this as: BMJ 2011;342:d797


View Abstract