Intended for healthcare professionals

Head To Head Maudsley Debate

Should NHS mental health services fear the private sector? No

BMJ 2010; 341 doi: (Published 04 October 2010) Cite this as: BMJ 2010;341:c5385

Heart to Head

With escalating 'human costs', the cost of mental illness in England
is 105.2 billion pounds. [1] The positive benefit from services that
improve overall mental 'wellbeing' [2] has yet to be estimated. Evidence
from Samaritans about NHS commissioning suggests the measures chosen in
the new 'Outcomes Framework' may shape mental wellbeing. [3] Clear
population goals for public mental health could orchestrate a Symphony of
service providers - without clear goals, competition driven by short term
profit and expediency will end in Discord. That atonal clash would hurt
patients, especially those with complex or long term needs.

Some claims in Head to Head (9 October) seem naive, e.g. private
providers are more 'innovative' and their 'new ideas flourish'. Most
stakeholders in mental health research, development and innovation report
these activities much more widespread in NHS trusts than in private
providers. In my own research area of child and family wellbeing (e.g.
resilience in relation to alcoholism, violence or disability) new ideas
may arise from the NHS or Local Government, not from private businesses
busy policing or warehousing children. Grafting mental health models from
the USA to England arouses concern. Compared to the UK, America has much
higher rates of suicide and homicide where 'there has been a near-total
breakdown in public psychiatric services' [4] especially services that can
respond proactively for childhood resilience in the face of trauma, abuse
or developmental problems.

"Strong political leadership" is even more critical to co-ordinate
children's services around clear Outcomes, during times of "financial
turbulence" and reluctance to take responsibility for "complex illness".

(quoting Sir Al Aynsley-Green, http://edition.pagesuite- August Public Servant digital edition,
accessed 9 October 2010).

[1] Centre for Mental Health. The economic and social costs of mental
health problems in 2009/10. London: CMH, 2010.

[2] Burstow P. Better mental health is key front in fight against
poverty. National Mental Health Development Unit (http://www.its- accessed 2 September 2010).

[3] Samaritans. Submission to Health Select Committee inquiry on NHS
commissioning. London: Samaritans, 2010.

[4] Lewin-Fetter V. Self-harm on either side of the pond. Lancet
2010; 376: 1224.

Competing interests: Member of the National Public Mental Health Steering Group for the Department of Health.

10 October 2010
Woody Caan
Professor of Public Health
Anglia Ruskin University, Cambridge CB1 1PT