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An equal footing for mental health
Paul Burstow believes cuts to mental health services would be a false economy Photograph: Frantzesco Kangaris
This being an era when our national political leaders seem increasingly to be parachuted into power more or less direct from university, usually Oxbridge, Paul Burstow is a refreshing throwback. Schooled at a secondary modern, this son of a Savile Row tailor served 11 years as a Liberal Democrat councillor before entering parliament. And he then served five more while he was finding his way as an MP.
As a result, pretty well everyone at Westminster agrees, Burstow knows his stuff. Having shadowed at different times both older people’s issues and health for the Lib Dems, his appointment as care services minister in the coalition government has added invaluable ballast to a Department of Health ministerial team seen by some as a tad lightweight.
Today, Burstow is due to share the platform with Nick Clegg, the deputy prime minister, at the launch of No Health Without Mental Health, the coalition’s cross-government mental health outcomes strategy. Clegg’s involvement, and that emphasis on cross-government working, are strong pointers that this is an agenda designed to be owned far beyond the health department.
“It makes a very clear statement that mental health is not about ‘them and us’; it’s about us,” says Burstow, pointing out that one in four people will suffer a mental health problem of some kind during their lives, while one in six do so at any one time, and that the annual cost of such problems has been estimated at up to £105bn. “We need to start to really understand that as a society. If we do, it’s one of the keys that turns the lock to managing mental health problems in a much more effective way.”
Much the same point lay at the heart of New Horizons, the mental health policy document published towards the end of the Labour government. That sought to shift the emphasis from treatment of illness to preventing it and fostering the mental health and wellbeing of the population as a whole. Why, then, the need for another strategy?
Burstow says that while New Horizons was good in some respects, it lacked a clear sense of how to move “from words on the page to action on the ground”. The new approach will place a much firmer emphasis on early intervention to stop serious mental health issues developing, particularly among children, and will have far greater buy-in across government because of Clegg’s interest – he chose to make mental health the theme of one of his first major speeches as Lib Dem leader in 2008 at the Guardian Public Services Summit – and because of David Cameron’s plan to benchmark national wellbeing.
“We are in a unique place now where there is a real focus on measuring outcomes around mental health because it is at the heart of the web of so many ‘wicked’ issues that often have defeated policy-makers and practitioners,” Burstow says.
The headline initiative in today’s strategy will be a commitment of “around £400m” to continue and expand further the talking therapies programme begun by Labour under the banner Improving Access to Psychological Therapies (Iapt). This investment will take the programme through to 2015 and ensure that cognitive behavioural therapy (CBT) and other therapies will become available universally in England. By 2015, it is forecast, more than 1 million people will, in their own judgment, have “recovered” through Iapt and 75,000 will have been enabled to return to work or education.
An essential part of this expansion will be the development of a psychological therapies model specifically for children. Today’s strategy cites research suggesting that half of all people who experience mental health problems during their lives will experience symptoms by age 14, with three in four doing so by their mid-20s.
“What we have at the moment is a system in terms of the NHS and social care that’s at the wrong end of the pipe,” says Burstow. “It’s managing the consequences of failing to intervene to provide the right support at the right time. It’s containing and coping with mental health problems when it could do so much better by providing that support at an earlier stage.”
Development of the children’s therapies model will be overseen by an Iapt team to be retained within the health department, although other mental health policy jobs are being shed. The team, says Burstow, will not only lead the “re-engineering” of child and adolescent mental heath services, but also help ensure the “necessary grip” to ensure the expansion of Iapt during the transition to GP-led commissioning of health services in 2013. During that transition period, Burstow will also chair a ministerial advisory group to “identify actions to deliver the mental health strategy”. The group’s status will be reviewed after 2012, once GP-led commissioning is under way and the new NHS commissioning board and Public Health England, the planned national public health service, have been established.
Progress on the strategy will be chased by a cabinet sub-committee on public health, with the sub-committee on social justice also having a key interest. But Burstow stresses: “We are not obsessing with process; we are obsessing with outcomes. We are going to be absolutely relentless in pursuit of better outcomes, but we are not going to be doing a lot of micro-management and prescription of how to get to those outcomes.”
Significantly, a companion document being published alongside the strategy sets out the evidence base for early and preventive interventions and will, in Burstow’s words, “help [service] commissioners make the case”. Among research cited in the document are studies demonstrating clear links between mental health problems and poor physical health and showing that preventing the former saves spending on the latter.
The document also demonstrates the value of anti-stigma work. Burstow, who will today announce that the government will part-fund the Time to Change mental health awareness and anti-discrimination campaign on expiry of its current lottery and Comic Relief grants, says: “It’s very compelling. I am very, very sold on the need for these programmes.”
There will be many, though, who will fear that the value of such anti-stigma campaigns, indeed of the government’s mental health strategy as a whole, is at risk from the gathering tsunami of spending cuts.
Burstow accepts that mental health cannot be exempt from that pressure and that commissioners of services have difficult choices to make. “But one thing that is set out in black and white in the strategy,” he says, “is a warning, a piece of advice, to commissioners that just disinvesting from mental health services as a way to protect other services actually shunts costs. That interdependency between physical and mental health is real.”
The strategy warns that “any efficiencies in mental health services need to be carefully thought through so that false economies and greater costs elsewhere in the healthcare and social care system are avoided.” It concludes: “The coalition government has made it clear that it expects parity of esteem between mental and physical health services.”
As Burstow says: “I think that is probably the clearest statement ever made by a government around its view of the funding of mental health. And there’s an awful lot of other organisations, now we have made that statement, who will hold us to account, and the system to account, for delivering on that.”
Status Married with three children.
Lives Sutton, south London.
Education Glastonbury High School for Boys, Carshalton; South Bank Polytechnic, London (BA business studies).
Career 2010-present: minister of state for care services; 1997-present: Lib Dem MP Sutton & Cheam (Chief whip 2006-10, health spokesman 2003-05, older people’s spokesman 1999-2003); 1986-2002: member, Sutton council; 1987-97: various posts, Association of Social Democrat/Liberal Democrat Councillors; 1986-87: print sales, Kallkwik Printers; 1985-86: buying assistant, Allied Shoe Repairs.
Interests Cooking, walking, gym, reading political biographies.