The announcement of a new network of community-based mental health clinics in England comes as a particularly welcome development, given the rising prevalence of mental health issues among children and young people. Accident and emergency departments have reported an increase in difficult-to-manage symptoms, including aggression and hallucinations. The new specialist walk-in mental health services are expected to alleviate some of this pressure. Additionally, the government has brought forward the deadline for ending out-of-area acute placements and pledged to reduce waiting times for children, both of which are positive steps.
Rising Mental Health Challenges
Declining mental health was a key theme in Alan Milburn's interim report on young people and work, and it is a significant factor behind the rise in claims for illness and disability benefits. Children's anxiety and other psychological difficulties are also among the many challenges facing schools. Recent years have seen steep rises in emotionally based school avoidance, as well as in autism and neurodiversity diagnoses.
While concerns about mental health are shared across government, they have not been prominent in policies put forward by the department where they might be expected to feature most: health. This is partly due to other pressing issues, including social care and enormous hospital waiting lists. It is also because ministers have been awaiting a review led by Prof Peter Fonagy into mental health conditions, ADHD, and autism. Its recommendations are expected soon and will inform an upcoming strategy.
Government's Focus and Commitment
In her first interview with the Guardian as health secretary, Yvette Cooper focused on maternity services and the need to prepare for future heatwaves. However, the commitment to expand community mental health indicates a welcome recognition that this should also be an area of focus. The Guardian view is that parity between mental and physical healthcare became a policy goal in 2011 with the launch of the No Health Without Mental Health initiative, but efforts to stress the importance of psychological wellbeing and its interconnectedness with physical health predate that.
The commitment made in last year's 10-year health strategy to gradually shift resources away from acute hospitals and towards community services would seem to align with this balanced, holistic outlook. However, one year on from its launch, experts including Siva Anandaciva of the King's Fund have raised doubts about "whether the NHS really will be committed to the fundamental shift away from hospital care that the health plan proposed."
Funding and Spending Concerns
This week it was revealed that one mental health trust in east London is planning to make £230m of cuts. Mental health is not ringfenced within NHS budgets, and as a proportion of overall health spending, it fell from 9.0% of the total in 2023/24 to 8.78% in 2024/25. This decline in funding is concerning, especially given the growing demand for services.
The reasons for the lower priority placed on mental health compared with physical diseases and injuries are complex, reflecting cultural as well as structural factors related to how the NHS is organised. Socioeconomic determinants of poor mental health, including incomes, work, and housing, are outside Ms Cooper's remit, but the disparities in access to treatment are irrational and unjust. Severe depression and anxiety are highly debilitating conditions, and expectations about waiting times and treatment options need to be clarified.
Future Directions and Support
There are no easy fixes in a system as complicated as the NHS. It is not clear where the new neighbourhood centres fit into existing plans or who will staff them. However, providing that further details are produced in due course, the shift in focus that they signal should be supported. The Guardian believes that mental health must be made a priority, and the new clinics are a step in the right direction, but sustained funding and clear implementation are essential.
