To spend or not to spend?

In last 10 years spending on mental health services have been increased, many billions have been invested in what many called a Cinderella service. This invested has been increasing year on year and many specialist services are now operating throughout the country. Things that we can thank the government for and sadly I think they are far too quick to call for these thanks. I like many have suffered for many years and many of them have been dogged with being on waiting lists and having to justify why we need specialist services. Many more have been repeatedly refused services and others have been told that given the lack of trained staff services have been suspended due to extreme waiting lists. It seems to me that more investment is badly required, so why is it that I am now reading that invested has decreased this year.

Mental health spending falls for first time in 10 years http://www.guardian.co.uk/society/2012/aug/07/mental-health-spending-falls I’m confused! The article states

The DoH( department of health) argues that the falls in spending reflect the fact it is treating people before they get seriously ill and need NHS-funded mental health provision

Even more bizarre in my opinion, exactly how they have come to this conclusion I have no idea. If you look at the household survey from 2007 (http://www.ic.nhs.uk/pubs/psychiatricmorbidity07 ) you see that they estimate 16.2% of people have a common mental health disorder and only 24% of them were receiving treatment. (http://www.ic.nhs.uk/webfiles/publications/mental%20health/other%20mental%20health%20publications/Adult%20psychiatric%20morbidity%2007/APMS%2007%20%28FINAL%29%20Standard.pdf)

Which kind of suggests that actually those in treatment are the tip of the iceberg and given the figures on improving access to talking therapies is estimates that only 8.7% of people who need treatment are in have received therapy in the last year 2011(http://www.ic.nhs.uk/statistics-and-data-collections/mental-health/nhs-specialist-mental-health-services/improving-access-to-psychological-therapies-key-performance-indicators-iapt-kpis--q3-2011-12-final-and-q4-2011-12-provisional) that’s not very many people really is it? However I would admit that these are ballpark figures and don’t really get to grips with the money aspect. So when it comes to investment is it simply a matter that the money in setting up the services was more expensive than running them?

Okay so I looked at the NHS expenditure (http://www.nhshistory.net/parlymoney.pdf) and sadly I couldn’t find very much that was comparable, which is not really a surprise however on page 7 you can find this

The largest spending category across this period has been mental health problems. In 2008/09, NHS expenditure on mental health was £200 per head, up from £148 in 2003/04.

So assuming that the ‘per head’ refers to the total population, and only assuming that 16.2% require treatment then it appears that a lot of money is being spent. I’m not convinced. Total population of the uk according to (INShttp://www.ons.gov.uk/ons/rel/census/2011-census/population-and-household-estimates-for-england-and-wales/index.html) is 53 million in England. So that’s 53 million times 200 equals total expenditure. 10.6 billion

Money required to treat the 16.2% of people with one course of 10 sessions of CBT. I’m using an estimated cost for a session of CBT of £50.

16.2% of 53 million is 8586000 people

10 sessions of CBT is £500

Total cost £4293 million. So, so far it looks good.

Right drug treatments

(http://www.guardian.co.uk/society/2010/jun/11/antidepressant-prescriptions-rise-nhs-recession) according to this there were 39.1 million prescriptions for antidepressants (not including other drug treatments for mental illness) estimated at £230 million. Total spend £4523 million still not bad which is 23.4% of the total budget and this is just those people with common mental disorders and doesn’t take into account all those who suffer from other more severe mental disorders.

It seems that if 23% of the budget is spent on just the people needing low level care then they are really not spending enough to cover all the costs of providing the services to treat everyone who needs it.

You think I’m kidding, well here’s a short list of all the other things that mental health are trying to provide.

Hospital care for those confined, short term hospital care for voluntary patients, the crisis team and out of hours cover, acute day services, country psychiatric nurses, complex needs services, occupation health visitors, psychiatrists, other forms of therapy for instance group analytic, social care and rehabilitation...

That not everyone who may be considered to need treatment is seeking it does mean that this is not how the money is being spent however it does beg the question of why the budget is being set to this level, especially since they are well aware of the piece meal service and it’s inability to deliver to the people who are asking for help what they need. That cuts to the budget have to be made is obvious but why cut money to mental health? It doesn’t make sense.

Increasing I don’t understand why people are still saying thanks for what has been done when all it seems to achieve is it becoming less of an imperative need and money being taken away. So one thing may not lead to the other but really it does seem that one land mark moment is swiftly followed by a big blow. We had the commons debate and now we have budget cuts to NHS mental health spending, oh joy!