Mental health in the UK: From awareness to action?
This guest post is from Carin Eisenstein, a Consultant at NPC who advises the Foundation on its mental health portfolio.
October 10, 2018
For World Mental Health Day, Carin looks back at the last year in mental health, highlighting the vital role charities have played in promoting awareness and delivering much-needed care in a difficult funding environment. While there are open promises of increased government funding towards mental health, there remains a need for private funding—now more than ever.
Since the first World Mental Health Day in 1992, a lot has changed in terms of general awareness and increasing openness around mental health.
Mental ill health is now recognised as widespread, particularly when it comes to children and young people (the theme of this year’s World Mental Health Day). Headline after headline speaks to a significant and growing rise in children and young people reporting mental health problems.
The credit for greater awareness can’t be awarded to any one group, but civil society organisations have played a big role. As well as dedicated mental health charities, organisations like the Royal Foundation have campaigned on the issue for years, including last year’s successful Heads Together campaign.
The work to improve knowledge and understanding of mental health has been critical. But we need more than general awareness. We also need insight and action: we must recognize where the system is not up to par and take meaningful steps to address it.
Greater awareness is not the same as better services
On the whole, greater recognition has not been met with improved services, especially for people with more severe mental illness or in crisis, as Hannah Jane Parkinson’s recent piece laid out most poignantly:
“It isn’t a bad thing that we are all talking more about mental health; it would be silly to argue otherwise. But this does not mean it is not infuriating to come home from a secure hospital, suicidal, to a bunch of celebrity awareness-raising selfies and thousands of people saying that all you need to do is ask for help – when you’ve been asking for help and not getting it.”
Instead, there is evidence of a widening gap in services: for instance, 60% of children and young people referred for specialist care are not receiving treatment, and those that do may wait as long as 18 months to be seen.
The role of charities and private donations
For a system overstretched and reeling from budget cuts, staff shortages, and ever-expanding waiting lists, the need to act is urgent and private funding will have an important role to play.
For one thing, the Prime Minister’s pledge to increase long-term funding to the NHS with mental health as a priority is an important first step, but what it will mean in practice remains a big question.
Previous injections of funding to mental health mostly haven’t made it to the front line. This is partly because of structural barriers, such as mental health funding not being ring-fenced—making it more vulnerable to cuts or being diverted to other priorities—or fragmented commissioning, which prevents funds from being allocated efficiently.
In this critical period, as budgets and policy take form, charities’ research and activism on these structural issues—often backed by private donations—are all the more important to keep progress on track.
At the same time, charities are doing crucial work delivering services where the state has withdrawn. Research by Professor John Mohan suggests that three in five mental health charities with income over £500k get over 70% of their funding from the NHS, local or central government.
But reliance on statutory contracts leaves mental health charities vulnerable and often constrained in what they can deliver.
Private funding—particularly multi-year, unrestricted grants—can allow charities to pursue longer-term objectives, or simply to deliver core services that wouldn’t otherwise be funded. This is vital to a stronger, more resilient, and impactful mental health sector.
For example, mental health charities that have capacity to be innovative are finding new ways of working. Often this involves stronger local partnerships with third sector and statutory services, which can put charities in a good position to secure future funding and helps them contribute to more effective and integrated care.
But partnerships and developing different types of services introduces organisational challenges that charities need resources to manage proactively. Donations can support these endeavours.
This is also true for charities making strategic additions to their teams, for instance building capacity around fundraising and business development. Many mental health charities increasingly prioritise measuring impact on their own terms—rightly interrogating how to use their data to help them deliver care more effectively.
All these initiatives require time and resources that most charities struggle to come by, and which is unlikely to come from statutory sources.
If all the awareness raising around mental health is to be worth it, it now needs to be backed with money. For charities to continue delivering key services in the community and also continue their campaigning—they need private funding.
Reference: Mohan, John and Beth Breeze. The Logic of Charity: Great Expectations in Hard Times. Basingstoke: Palgrave Macmillan, 2016. DOI: 10.1057/9781137522658.0006.