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Continued developments in mental health policy

Country: 
United Kingdom
Partner Institute: 
London School of Economics and Political Science
Survey no: 
(15) 2010
Author(s): 
Adam Oliver
Health Policy Issues: 
Prevention, Funding / Pooling, Quality Improvement, Others
Others: 
Mental health care
Reform formerly reported in: 
Improving dementia care
Further developments in mental health policy
Developments in mental health policy
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no yes no no

Abstract

This report summarises the Government's latest initiatives in the area of mental health policy, and thus supplements previous Health Policy Monitor Reports in this area. Recent initiatives range from broad strategy documents to specific initiatives designed to benefit defined groups, as will be detailed below.

Recent developments

In March 2010, the Government released a broad strategy document for improving public health-based mental health policy, entitled "Confident Communities, Brighter Futures", partly in recognition to the size of the burden of mental health in the UK, estimated to comprise of 20% of the total burden of disease. Mental health policy experts are currently working to fill in the 'evidence gaps' in the initiatives outlined in the strategy document, and thus it is a little early to tell what will be proposed for actual practical implementation, but the broad objective within the report is to improve mental health in communities where this problem is particularly bad and thus to reduce mental health inequalities. The report places an emphasis on the need for a joint strategy between local authorities and the NHS, and highlights the need for early interventions and preventive care via psychological therapies, for promoting initiatives to improve health and reduce stress in the workplace, and for identifying interventions associated with education and lifelong learning so as to promote wellbeing and increase resilience to the onset of mental health problems. 

Aside from this broad-based strategy, the government has, over the past few months, also announced a number of more specific initiatives to improve mental health care for defined groups. For example, in November 2009 the government released an action plan to reduce the over-prescribing of antipsychotic drugs for people suffering from dementia, a practice that is cost ineffective and imposes the risk of undue harm to patients. According to NICE guidelines, these drugs should be prescribed only when a dementia patient poses a risk to him/herself or to others, after all other methods have been tried. However, it is known that antipsychotics are routinely used to treat these patients when they are aggressive or agitated (an estimated half of all patients with dementia demonstrate aggression or agitation at some point), which contravenes the NICE guidance. So as to reduce the perceived need for antipsychotics, the government is working to improve access to psychological therapies to attempt to tackle the causes of aggression. Moreover, the action plan will serve to appoint a new National Clinical Director for Dementia, will establish a clinical audit so as to produce definitive antipsychotic prescribing figures, and will produce guidance together with patient groups on what to do if a family member is given antipsychotics, among other initiatives.

Given the wars in Iraq and Afghanistan, another defined group who receives much attention currently with respect to mental health needs are veterans of the armed forces. In March 2010, the Department of Health announced that they would provide £2 million of additional funding over the 2010/11 financial year to improve health services for armed forces veterans (veterans are treated within the NHS, but this money is being allocated to improve specifically their care within the NHS; also, the DH made an identical official announcement in April 2010, which is a little bizarre, and is either an oversight in announcing it twice, or is a tactic to attract additional credit for its initiatives). The £2 million, which doesn't strike me as an awful lot of money, is intended to fund up to 15 psychiatric nurses to work in Mental Health Trusts with specialist combat stress teams so that veterans can be treated for post traumatic stress in closer proximity to their families, to improve GP training so that they are better able to detect mental health problems in veterans, and to improve information to veterans to make them better aware of the range of services that are available to them.

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual neutral highly controversial
Structural or Systemic Impact marginal neutral fundamental
Public Visibility very low neutral very high
Transferability strongly system-dependent rather system-neutral system-neutral
current current   previous previous

These are all new initiatives that further develop mental health policy. In terms of the broad strategy document, we will have to wait and see what specific policies arise. Regarding the initiatives for dementia sufferers and veterans, both appear very sensible and desirable, although in the case of dementia sufferers it seems clear that frontline health care professionals will need support, training and resources to be able to deal with aggressive patients appropriately, and in the case of veterans, £2 million over the course of a financial year strikes me as a rather limited amount to make a substantive impact.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no yes no no

Initiators of idea/main actors

  • Government
  • Providers
  • Civil Society
  • Scientific Community

Stakeholder positions

As noted above, the Alzheimer's Society, which is a dementia-related patient group, has expressed support for the policy to try to reduce the over-prescribing of anipsychotics. It is possible that some health care professionals, who I suspect often use antipsychotics as an easy way of quietening down aggressive patients, might not be so enthralled with the policy, and may be less than happy that all other means should first be tried in treating a patient that appears to represent a risk to themselves or others. Also, one would expect that the manufacturers of antipsychotics will be less than happy with the new policy direction.

As also noted above, Combat Stress (www.combatstress.org.uk), an organisation that provides trauma care services to veterans, has welcomed the initiatives that will be funded by the aforementioned £2 million, believing that this will help to improve and quicken access to appropriate services for those veterans who are suffering from mental health problems.

Actors and positions

Description of actors and their positions
Government
Central governmentvery supportivevery supportive strongly opposed
Providers
Combat Stress, an organisation that treats veteransvery supportivesupportive strongly opposed
Civil Society
Alzheimer's Societyvery supportivesupportive strongly opposed
Scientific Community
Professor Sube Banerjee, who authored a report to look at the over-prescribing of antipsychotics in dementia patientsvery supportivevery supportive strongly opposed
NICEvery supportivevery supportive strongly opposed
current current   previous previous

Influences in policy making and legislation

Not applicable

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Government
Central governmentvery strongvery strong none
Providers
Combat Stress, an organisation that treats veteransvery strongneutral none
Civil Society
Alzheimer's Societyvery strongstrong none
Scientific Community
Professor Sube Banerjee, who authored a report to look at the over-prescribing of antipsychotics in dementia patientsvery strongneutral none
NICEvery strongstrong none
current current   previous previous
Professor Sube Banerjee, who authored a report to look at the over-prescribing of antipsychotics in dementia patientsNICECentral governmentCombat Stress, an organisation that treats veteransAlzheimer's Society

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

To the best of my knowledge, this has all been discussed above. The main mental health initiatives will come out of the strategy paper, "Confident Communities", but we do not yet know very specifically what those initiatives will be. Despite some inevitable stakeholder concerns, there is, I would say, broad support to limit antipsychotic prescribing and to improve veterans' access to good mental health care services.   

Monitoring and evaluation

There are no evaluations as yet, although there is some data for why these initiatives were introduced. For instance, regarding the limiting of antipsychotic prescribing, it has been estimated that two-thirds of the approximately 180,000 people with dementia in England are prescribed these drugs unnecessarily, which causes an estimated 1,800 deaths per year. With respect to the funding to improve care access for veterans, it has been estimated that there is an average fourteen year timelag between a veteran leaving the armed forces and their seeking professional help for a psychological illness. Therefore, if these data are accurate, the specific policy initiatives outlined in this report are clearly warrented.  

 

Expected outcome

Not applicable

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low high very high
current current   previous previous

More appropriate prescribing patterns will clearly improve quality and may well be cost-efficient. Better access to appropriate mental health care services is likely to improve equity of access for what is a high-need group (i.e. veterans).

References

Reform formerly reported in

Improving dementia care
Process Stages: Implementation, Policy Paper
Further developments in mental health policy
Process Stages: Legislation
Developments in mental health policy
Process Stages: Implementation

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

Oliver, Adam. "Continued developments in mental health policy". Health Policy Monitor, April 2010. Available at http://www.hpm.org/survey/uk/a15/2