Major Conditions strategy framework – MQ’s Response

Is Mental Health still the Cinderella of the Story?

Opinion by Lea Milligan, CEO of MQ Mental Health Research 

In a move that raises questions about transparency and accountability, the government has chosen to release its much-anticipated Major conditions strategy framework in the depths of the summer parliamentary recess.

This strategic timing, when parliamentary scrutiny is significantly reduced, casts doubt on the government's commitment to addressing the pressing mental health crisis that our society faces.

For context, the mental health sector had been waiting for the government to release the much anticipated 10-year mental health strategy for a long time. This would have been the first focused strategy on mental health from the government in over 12 years, the last being ‘No health without mental health’ published in 2011 by the coalition government of the time.

However, the sector was shocked when, in January of this year, it was announced by Health Secretary Steve Barclay that this much needed strategy was to be scrapped, and would be replaced at some point in the future by a new ‘major conditions strategy’.

Whilst a holistic approach to reducing mortality is laudable, the fact remains that years of under-funding for mental health means it lags far behind the other physical conditions listed in the proposed major conditions strategy, with no apparent recognition from the government that this will need levelling up.

This lack of appreciation from the government of the unique requirements for mental health services, separate to the physical health conditions listed, brings me back to the timing of this new framework, published this week.

At a time when mental health issues are on the rise, affecting individuals across all walks of life, it is crucial that policy decisions are made with the utmost seriousness and transparency.

Mental health is not a matter that can afford to be discussed behind closed doors or rushed through without thorough examination, especially when it is the last on a list of conditions that already sit light years ahead in terms of funding, research and services.

Mental health care should not be subject to political manoeuvring or expedient timing. It is a matter that directly impacts the well-being and lives of millions, and any policies introduced should reflect a commitment to comprehensive, evidence-based solutions.

Across this new framework, one thing stands out above all else – an undue emphasis on individual responsibility and the underestimation of the systemic challenges that contribute to mental health struggles.

While certain aspects of the plan are commendable, the narrative leans heavily on a rhetoric of personal accountability. Such a narrative, while intending to promote public health awareness and participation, risks undermining the complexity of mental health issues and the urgent need for a holistic, systemic approach.

The frequent focus on "bearing down" on personal factors as a solution, risks oversimplifying the complex web of factors that contribute to mental health conditions. Mental health issues often stem from a combination of genetic predispositions, environmental triggers, and socio-economic disparities. Placing the heavy onus on individuals (and employers, who seem to get a free ride on the physical health front!) to prevent or manage mental health challenges disregards the structural barriers that many face, including unequal access to education, healthcare, and employment opportunities.

A recurring implication of individual responsibility is that those with severe mental illnesses could have taken more preventative measures. However, this narrative neglects the fact that mental illnesses like psychosis are often caused by intricate neurobiological factors beyond an individual's control. Blaming individuals for conditions rooted in biology perpetuates stigma and creates barriers to seeking professional help, which is vital for managing these conditions.

While involving employers in supporting mental health among their workforce is important, solely relying on them to address mental health challenges overlooks broader societal factors. Placing the responsibility on employers disregards the government's role in creating policies that ensure safe working conditions, equitable wages, and access to mental health resources for all citizens. The government's duty extends beyond placing this burden solely on employers.

The narrative of individual responsibility can deter people from seeking help when they need it most. Those struggling with mental health issues might feel that they should have been able to prevent their condition, which can lead to self-blame and isolation. This further exacerbates the societal stigma surrounding mental health, making it harder for individuals to access the support and treatment they need.

Detailed Analysis:

While the government's response acknowledges the need to address mental health challenges, there are several areas of concern and limitations in their proposed plans. Despite their commitments, these plans might fall short of creating the transformative change required to adequately tackle the complexities of mental health care.

Early Intervention and Prevention: Limited Scope

While it's promising that the government acknowledges the importance of early intervention, and the commitment to extend mental health support teams in schools is commendable; addressing mental health problems solely through schools neglects other crucial settings where mental health issues arise, such as within families and communities. An overarching strategy that integrates mental health support across various domains is necessary for comprehensive early intervention.

Parity of Esteem: Lacking Definition – but they promise its coming

The government's recognition of the need for parity of esteem between physical and mental health is positive, but the lack of a concrete definition raises concerns about their commitment to achieving this goal. Without clear parameters, it becomes difficult to assess progress and hold the government accountable for tangible improvements in mental health care quality and accessibility.

Waiting Times and Quality Care: Implementation Concerns

While the commitment to implement mental health waiting time standards is a step forward, the current focus on only three service areas limits its impact. Additionally, the deadlines for publishing waiting time metrics appear distant, potentially delaying urgently needed improvements in access to care. Ensuring that waiting time standards are consistently met and that the care provided meets high-quality standards should be a priority, rather than focusing solely on metrics.

Holistic Care for Severe Mental Illness: Inadequate Measures

The government's acknowledgement of the lack of holistic, person-centered care for individuals with severe mental illness is essential. However, the proposed measures to address this issue, particularly through the NHS Long Term Plan (LTP), lacks specifics. Without concrete strategies and resources dedicated to addressing the physical health needs of individuals with severe mental illness, the proposed changes remain superficial.

Substance Misuse: A ray of light

The government's plans to improve mental health treatment for individuals with drug and alcohol misuse conditions are a rare beam of light. The current work on integrating services and the inclusion in this framework shows ongoing commitment to move away from a crime and punishment response to one of recovery – as the election approaches however, this rhetoric may harden as those vying to be the next Home Secretary reach across into the DHSC remit with handcuffs at the ready.

Research and Digitalisation: Limited Impact

While increased investment in mental health research is promising, there is no new spending commitment in here - the money has already been announced and the research commissioned. Additionally, the commitment to digitalise mental health services is long overdue, but without proper infrastructure, accessibility, and changes to how new treatments are approved finally implementing digital therapeutics, the potential impact on service is still years away.

Accountability and Monitoring: Unclear Mechanisms

The government's commitment to drive change lacks specifics on mechanisms for accountability and monitoring. Without transparent and robust accountability mechanisms, it becomes challenging to assess the actual progress made towards the proposed commitments, and hold the government responsible for delivering meaningful change.

The government's response acknowledges the urgent need for improving mental health care, but as was the fear by including such a complex area into a goliath of a plan, the mental health plans lack the depth, scope and clear strategies required for comprehensive and transformative change. The major conditions strategy rightly recognises the need to tackle multi-morbidities and integrate physical health care with mental health services, however, we see nothing in here that doesn’t leave mental health as the (now) fashionable Cinderella service – waiting to go to the ball!