Editorial

Editorial

Article Type: Editorial From: Mental Health and Social Inclusion, Volume 20, Issue 2.

Julie Repper and Rachel Perkins

Reflections on the independent mental health taskforce report to NHS England

At last we have an agreed direction for transformation of mental health services that is largely based on the views and experiences of people who face the challenges of mental health conditions. The report from the Taskforce responds to 20,000 respondents who collectively prioritise service functions of prevention, access, integration, quality and a positive experience of care in order to achieve meaningful lives: their main ambition is to have a decent place to live, a job or good quality relationships in their local communities.

The report is well worth reading, not least because it restates many of the statistics demonstrating the scale of mental health problems, where people currently receive help and how inadequate much of this support is in enabling people to rebuild meaningful, valued and contributing lives.

The report reminds us of the importance of improving accessibility, responsiveness and communication within services, making evidence-based treatment and therapies available in a timely manner and ensuring that this is available across the whole life course. However, the main message lies in the need for greater emphasis on proactive and preventive approaches – and much of this work lies outside the traditional domain of health services.

The lives of many people who live with significant mental health challenges are limited by the lack of access to roles and relationships which they find fulfilling, within which they can contribute, and for which they feel valued. Thus, the role of services needs to change from seeking to eradicate symptoms and health problems to enabling people to stay well and/or live satisfying lives with long-term conditions, many of which have both a physical and emotional impact.

None of this is news for those of us writing in, and reading, Mental Health and Social Inclusion. The journal has been publishing papers that show case innovative examples of practice development that focus on enabling people to develop meaningful roles and relationships within their local communities for many years. Indeed this was its explicit purpose from the inception of the journal as Life in a Day. When we took over as editors of the journal in 2014 we re-stated our vision for the journal:

We want to draw together wisdom and expertise about enabling those of us living with mental health challenges to participate as equal citizens in all facets of the life of our communities (including the communities that exist within the mental health arena). We will welcome input from everyone who has something interesting to communicate around mental health and social inclusion: people working in the mental health arena, people living with mental health challenges and their relatives and friends, individuals and organisations outside mental health services.

We have heard from practitioners and people using services about exciting new ventures in peer support, personal budgets, employment, volunteering and projects enabling people to access roles and relationships within their communities through peer led groups and social prescribing. We have published several papers on recovery colleges which enable people to learn skills and gain confidence in managing their own conditions – and their own lives – even with the disabilities resulting from emotional and physical health problems. And we want to hear more about how these initiatives can be progressed from pilot projects to mainstream services that are routinely available, crossing those artificial boundaries that divide services from real lives.

We have published one paper describing an alliance commissioning model that seeks to transform a whole system of support; coproducing partnership approaches to improve access to community resources and activities. We look forward to hearing more about such system wide transformatory projects that bring together relevant expertise to increase community capacity to accommodate mental health challenges and in so doing reduce fear, ignorance and the resulting discrimination.

There are, however, areas about which we have published very little. People with mental health problems who suffer disproportionate discrimination and experience unacceptably poor access to services do not feature in recent papers published in the journal. The Taskforce report highlights the fact that there has been no improvement in race inequalities relating to mental health care since 2010; nine out of ten people in prison have a mental health or substance misuse problem, only half of veterans of armed forces experiencing mental health problems receive appropriate support. We would like to hear more about what you are doing in these areas. The journal can raise awareness of successful initiatives that focus on these under-served and spread understanding of what good practice looks like.

Similarly, the Taskforce report emphasises the importance of improving support for young people, reminding us that half of all mental health problems have been established by age 14 and 75 per cent by age 24. Once again the importance of preventive work is clear: work that needs to be done with and in schools, with families and in communities before these young people need service interventions. However, services themselves must find ways of engaging with young people and their families in acceptable, accessible and person centred ways, in partnership with community resources so that they build confidence and competence in keeping themselves well. Once again, we would like to receive papers featuring such ventures.

If this work is to be successful then it relies on a shift in relationships between people providing services and those using services. There still exist wide spread perceptions among both providers and recipients that services are (and should be) the experts, whilst those who use services – and their families and communities – are unknowing and passive beings who need to access this expert help if they are to overcome emotional difficulties. Such expectations only serve to increase the burden on services and reduce the confidence of communities and the people within them in their abilities to accommodate and manage mental health conditions. It is only through ongoing and increasing coproduction, that recognises the contribution of lived experience and values the wisdom borne out of living, working and accommodating people with a range of different challenges that relationships can be changed.

Health and social services play a relatively small part in people’s lives. If the recommendations of the Taskforce report are to be achieved, then we must all work towards developing supportive communities in which everyone’s contribution can be valued and all can be supported to both fulfil their potential and support others to do the same.

Further reading

Mental Health Task Force (2016), “The five year forward view for mental health. A report from the independent mental health taskforce to the NHS in England”, available at: www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf (accessed 28 February 2016)