Transcript of feedback session for the roundtable event held with the Health and Social Care Committee Mental Health Expert Panel and mental health practitioners, Tuesday 12th October 2021.
Jane Dacre: We’ll start by hearing feedback from the group which were focusing on children and young people’s mental health.
Peter Fonagy: Broadly, there was an agreement that whilst there was more money in the system than there had been in the past for children and young people’s mental health services, the way that the system was organised did not necessarily lead to the best or most efficient or effective ways of making these resources available. This is creating shortages with target driven care that distorted some of the priorities and an absence of clear outcomes in the system, but most importantly a disintegration and a greater tendency for fragmentation because of the increased load. Underneath that, I think everybody made the point, in different ways, that children and young people’s mental health has been getting worse, and that even if we reach the targets the targets were set at a time when things were very different. Things are now far more challenging and the implications of that haven’t really been as helpful as they could’ve been. I tried to push the group to be specific in what they said, and we have a lot of specific examples that we will be able to use. Very, very helpful discussion.
Jane Dacre: Thank you. Shall we go to the group on adult common mental illness?
Alex Lloyd: We had a really productive conversation and lots of really interesting and important points were made. I think the general sense that I got from the room was that the commitment to have the long-term conditions integrated into IAPT was appropriate, but the execution of that hasn’t necessarily been as flawless.
Jane Dacre: Thank you, so Stephen you must have been focusing on adult severe mental illness.
Stephen Aldhouse: Yes, that’s right. Again we had a really productive and interesting discussion. I think it was interesting to discuss the difference in priorities, and that despite having quite a large number of commitments in adult severe mental health there is still a disparity between how severe mental health is treated against severe physical illness. There was an example of how if ward rounds are missed in acute settings there is an investigation, but if you miss a therapeutic session in adult severe mental illness you don’t get the same level of questions asked. That type of point was raised and I think that was perhaps a real illustration of the different approach that is still being taken, despite these individual commitments. I don’t think we thought any of the commitments were inappropriate, but they’re not necessarily delivering the scope of change that the Government would perhaps envisage.
Jane Dacre: Thank you. And then my group was focused on workforce. It was a bit depressing really; the workforce problems are clearly very significant and even putting things in and observing pledges to beef up the workforce are not working, either because it’s not enough or because they might bring people in but it doesn’t keep them there. There are concerns about attrition. Because of a lack of workforce, particularly in learning disabilities, there are concerns about the way people are working differently and how this has impacted on the rest of patient care, disciplinary working and working as an effective team for our patients. We had all sorts of discussions about how we needed to not only have more money, but we also need to change the culture.
So, generally it sounds like there were fantastic comments and discussions across the board. Can I ask any of the participants if there is something that you would like to add to the summary or feedback to the panel.
Participant 1: Thank you. I’m going to use this opportunity to platform again the importance of collaborative workforce planning between health and social care. I think we’ve got a real opportunity, particularly within the community mental health framework, to really drive system change both in terms of clinical roles but also the importance of mental health social care and it’s role in delivering whole systems. I’m pressing that point. I also want to press the point that we need to make sure that the money flows and the investment flows into social care as well as the NHS.
Jane Dacre: I think you might be preaching to the converted, at least in this room but an extremely fair point there. Are there any other comments?
Participant 2: The point that I’d like to leave you with, that crosses these four working groups, is the importance of encouraging Government to mandate a director of psychological therapists for NHS mental health provider trusts. So many of the projects that everybody’s working on, and the commitments that the Government has made around transforming care to being evidence based and psychologically informed, are just missing the mask without that mandated leadership within NHS provider trusts.
Jane Dacre: Thank you, that’s a very helpful point.
Participant 3: I wanted to make two points. One of them is political I’m afraid, which is to do with the levelling up agenda. The disparity in terms of investment around the country, and therefore availability and access to IAPT services or talking therapy services, follows exactly the kind of inverse care law that was described many, many years ago. And all the areas of the country where we have the highest rates of prescribing antidepressants long-term are the areas with the least provision and the least access to talking therapies. So there is a job there of distributing the investment in a different way to be done there. The second point I wanted to make picks up on what Peter said in terms of the changed conditions. We’ve just got the results in from our annual staff wellbeing survey in psychological therapies and it isn’t a good picture. The impact of the pandemic on psychological staff is showing very high levels of reported depression and burnout amongst the staff. And we obviously know that there are 150,00 bereaved families so maybe a quarter of a million people affected directly by loss. I haven’t seen any proper planning going on around provision for bereavement support and therapy around grief issues for the large numbers of people who are going to need that support.
Jane Dacre: Thank you. A very well-made point.
Participant 4: I just wanted to add to the previous points that to my knowledge we haven’t had an actual costing of the implementation of the NICE guidelines in mental health. So the funding which has been allocated to mental health it’s very difficult to know how that number was arrived at, and it would be really helpful to have and have a costing evaluation of implementing NICE guidelines because otherwise we will end up with inappropriate interventions which will be false economy.
Jane Dacre: That’s really helpful, and is actually something that chimes with some of the other work we’ve done; that there tends to be buckets of cash and it’s hard to know exactly where it’s been costed for and allocated.
It just remains for me to say what happens next. We’ve recorded the discussions today to allow a transcript to be produced and we will give you the opportunity to review this. It will then be sent to our research database of information that we will use to write the report. When the report comes out I hope that you will be able to see things that reflect what you’ve said during the course of this meeting. You’ve been absolutely brilliant, thank you so much. It sounds as if everybody has really contributed and it’s been an absolute pleasure to talk to you. It’s also quite heart-warming to see the passion that people have for their area of expertise. The NHS is struggling but it sounds like it’s in good hands with you guys contributing, so I’m really grateful for all of that. Thank you, it’s been an absolute pleasure to spend some of the afternoon with you.