Mental health: A start of a long journey?

Depressed man Image copyright SPL

Playing devil's advocate, you could say the government is setting its mental health targets in the areas and at the levels it knows the NHS can achieve.

Already nearly two-thirds of patients get access to talking therapies within 28 days. So asking the NHS to ensure 95% are seen within 18 weeks does not seem a big ask.

A similar thing could be said for the two-week wait for help for people experiencing psychosis for the first time.

Nonetheless, those working in the sector are still delighted.

Why? To understand that, you have to consider where mental health stands in the pecking order of the NHS.

Some refer to it as the Cinderella service or poor cousin - as I have written about before. Figures show that the condition gets 11% of the budget, but accounts for 28% of the disease burden.

The result is that many people go without help - something England's chief medical officer Dame Sally Davies highlighted in her recent annual report. An estimated three-quarters of people with a mental illness receive no treatment. For physical disorders, the rate is nearer a quarter.

The hope now of many involved in providing such services is that the attention the targets will bring will lead to more money and resources being ploughed into care.

Ministers - or at least the Liberal Democrat ones who have unveiled the policy at their annual conference - have been referring to it as a "watershed" moment.

But there is still much work that needs to be done to ensure the introduction of targets becomes the truly significant moment both the government and sector hope it will.

Experts believe it is not just how long patients have to wait that is a problem, it is whether they can get a referral and on to a waiting list in the first place.

Image copyright Thinkstock

This is known as eligibility, and Centre for Mental Health deputy chief executive Andy Bell says it goes hand-in-hand with waiting-time targets.

"You can't have one without another if you want to make a real difference. We need to hear more about this," he says.

Although, to be fair, the Department of Health is referring to these targets as a "starting point" on which it wants to build.

This certainly happened with the introduction of targets for routine operations, such as knee and hip replacements, under the Blair government.

Ministers initially focused on the length of the waiting list. But when it became clear that what mattered most was how long people waited, a target of six months was set.

But this only measured the point from diagnosis to treatment. The result was that waits from GP referral to diagnosis started going up and so the target was changed to include that part of the patient journey as well.

The target was eventually reduced to 18 weeks in 2008, but that was 11 years after ministers started tinkering.

That in itself should act as a warning to anyone expecting immediate results from these new targets. But you also need to consider that in many ways mental health care is even more complex than routine surgery.

The government has chosen just two parts of the system - talking therapies and treatment for psychosis. Arguably much more problematic areas are crisis care and child and adolescent mental health services.

Reports have emerged that both are struggling to cope with demand. Outgoing Royal College of Psychiatrists president Prof Sue Bailey recently described the state of services as a "car crash". This focus on mental health promises to be a long journey.