By Sonya Cullington, Account Director at ZPB
The government published its Covid-19 mental health and wellbeing recovery action plan on 27 March 2021, which describes how departments across government will consider mental health within new and existing programmes, and the action that will be taken to improve population mental health and address health inequalities. It also sets out the full allocation of the additional £500m for mental health announced in the spending review last autumn. Much of this is being given to speeding up the delivery of existing commitments, for example, to expand talking therapy services, mental health support in schools and community services for adults. And some will be earmarked for meeting specific needs arising from the pandemic – for example, to support NHS staff who have experienced traumas over the last year, and for people living with Long Covid. This year’s national suicide prevention strategy progress report has been published alongside the plan.
The action plan recognises that some people will need further specialist support in the coming months and years as demand for mental health services is expected to rise. The government emphasises that delivering the NHS’ ambitious mental health improvement programme is all the more vital in this context. The plan provides further detail on where the additional £500 million investment for mental health announced at the spending review last autumn will be targeted.
There will be funding:
To accelerate delivery of key commitments the NHS long term plan such as access to children and young people’s mental health support, expansion of adult community support and sustaining and enhancing crisis support.
To invest in training and education of the NHS mental health workforce and begin implementing mental health act reforms.
To tackle critical care ‘backlogs’ as a result of the pandemic such as for people with a learning disability and/or autism, memory assessment and dementia diagnosis, and physical outreach for those with serious mental illness (SMI).
The plan also focuses on steps that can be taken by individuals, who do not require specialist support, to look after their mental wellbeing, as well as the role of local communities in supporting recovery and resilience more widely. There is also a focus on addressing mental health inequalities arising from the pandemic, as well as the wider determinants of mental health.
The cross-government ministerial group set up to shape and oversee the development of the plan will be retained and meet quarterly over 2021/22 to monitor implementation progress. The group will also seek to identify areas for further action, including informing preparations for the next.
The national suicide prevention strategy progress report has been published alongside the plan, which sets out data and trends on suicide and self-harm, progress against existing commitments, and further steps the government will be taking to reduce suicide and self-harm going forwards.
Background and objectives
The plan identifies the government’s key commitments for 2021/22 to respond to the mental health impact of Covid-19 and forms the foundation of future policy development and delivery over the coming months and years. A cross-government group of ministers was created to shape and oversee this work, which will be retained to track implementation and to also steer a cross-government approach to preventing and mitigating the root causes of poor mental health going forwards.The plan sets out the following three objectives for Covid-19 recovery:
1. To support the general population to take action and look after their mental wellbeing.
2. To prevent the onset of mental health difficulties, by taking action to address the factors which play a crucial role in shaping mental health and wellbeing outcomes for adults and children.
3. To support services to continue to expand and transform to meet the needs of people who require specialist support.
The plan also refers to the reforms the government plans to make to the public health system. It states the changes will place prevention at the heart of government and embed expertise, capacity and accountability more widely and deeply across local and national government and the NHS.
Resilience and recovery
This section also emphasises the vital role local communities and local councils have to play in progressing this agenda. The government wants to enable local communities to develop support and services that meet the needs of their population, recognising they are often best placed to understand and develop the right responses to their local contexts and needs.
The plan restates that local authority funding through the public health grant will rise from £3.279 billion in 2020/21 to £3.324 billion in 2021/22. It also confirms £15 million will be targeted to the most deprived parts of the country to invest in prevention and early intervention services, and £5 million will support suicide prevention voluntary and community sector organisations. Specific reference is made to the government’s proposed Health and Care Bill making it easier for different partners to more easily join up to address complex issues. Local councils will also continue to be encouraged to sign up for the Prevention Concordat for Better Mental Health, which has been refreshed to reflect the latest best practice. It notes that in order to build on the goodwill and volunteers who came forward during Covid-19, a volunteering policy will be developed that will look to simplify routes into volunteering and invest in volunteering infrastructure to make access to rapid support more consistent across the country.
It is important to note here that all government departments have committed to promoting PHE’s online Psychological First Aid training to their frontline workers and volunteers and encouraging them to also complete suicide prevention awareness training. Work taking place by the DWP and the Home Office to improve how well staff and police respectively respond to people with mental ill-health and other vulnerabilities is also highlighted.
The plan outlines steps that can be taken by individuals, who do not require specialist support, to look after their mental wellbeing. It signposts to various existing resources, such as the NHS website and Public Health England (PHE)’s Better Health: Every Mind Matters. The government also commits to working with the voluntary and community sector, NHSE and NHSI, PHE and others to develop a plan for building on the legacy and impact of Time to Change so that work to combat stigma and discrimination continues.
Children and young people
This section focuses on specific steps to support children and young people given the disproportionate impact of the pandemic on them. Amongst the commitments outlined is a renewed approach to the distastefully named Troubled Families Programme in 2021/22, which was to focus on building families’ resilience and supporting local and national systems to provide joined-up, efficient local services that identify that meet families’ needs and tracked outcomes in the long term. The government has again committed to working with local councils and NHS mental health services to continue to co-design and strengthen mental health outcomes for the programme. Time will tell.
This section also highlights NHSE and NHSI are working with the first Secure School provider to create a jointly developed and holistic care framework to improve outcomes for the children in the secure estate (children’s home, secure training facilities and young offender institutions). The plan also confirms the Youth Review, led by DCMS, it will conclude in late spring and is set to outline the direction for the out-of-school youth agenda and ensure long term spending and programmes support health and wellbeing outcomes.
Addressing mental health inequalities arising from the pandemic
The government recognises that some groups have reported worse difficulties than others during the pandemic, and these differences in mental health and wellbeing impacts will persist and likely increase as we move forwards. The government has committed to continuing to monitor the differential impacts of the pandemic on mental health and wellbeing, to ensure that its plans are targeted and effective.
Significant commitments made in the plan include:
People with a learning disability and autistic people: findings will be published shortly from research the government commissioned from the University of Warwick and Manchester
Metropolitan University to find out more about the impact the pandemic has had on people with a learning disability, and from the
London School of Economics to better understand the impact of Covid-19 on autistic people. The plan also states a refreshed autism strategy and a national strategy for disabled people will be published later this spring.
People with serious mental illness: as part of the additional £500 million, NHSE and NHSI will invest a further £14 million to work across primary and secondary care services with voluntary and community sector partners to deliver a tailored outreach and engagement for people living with severe mental illness to increase their engagement with physical health-checks, and uptake of flu and Covid-19 vaccinations.
Ethnic minority groups: the government commits to ensuring public health messaging is accessible and reaches ethnic minority groups as per the approach taken to weighting marketing activity for specific PHE and NHS campaigns during the pandemic towards those communities who have been hardest hit and translating key messages into other languages for wider outreach. NHS England and NHS Improvement’s Advancing Mental Health Equalities Strategy and the work to develop and test a Patient Carers race Equality Framework is also re-highlighted.
Domestic abuse and sexual abuse survivors: a further £40 million of funding during 2021/22 will be provided to specialist support services for victims of rape and domestic abuse, in addition to the funding announced by the government previously.
Offenders: a new accommodation service will be launched, providing up to 12 weeks of basic temporary accommodation for prison leavers who would otherwise be homeless in five probation regions. A sum of £2.5 million will be invested in the Enhanced RECONNECT service to further support prison leavers for up to a year after release. Work by the National Social Care Partnership Board to develop a standard model of delivery and the publication of an older offender’s strategy later this year are also highlighted.
Addressing wider determinants of mental health
This part of the plan outlines the steps the government will take to address social, economic and environmental factors given the well-evidenced link between them and mental health. Recent and ongoing action is outlined in the following areas: financial security and employment support; employer and workplace support; housing security; physical environment and access to green spaces; and isolation and loneliness.
New commitments made in this section include supporting cross-government work on digital inclusion, DCMS is gathering evidence on the impact of digital exclusion and exploring how to facilitate high-impact partnerships between government, business and civil society to tackle digital exclusion. The plan also highlights that the money and pensions service publishing delivery plans that will set out how the UK strategy for financial wellbeing will be delivered by 2030, comprising specific proposals to support and improve the financial wellbeing of people with mental health problems.
It is key to note there that the plan commits to work with stakeholders to explore the development of a policy tool that allows policymakers to examine the impact of their proposals on mental health. The plan also states the national suicide prevention strategy advisory group will continue to be convened over the course of 2021/22.
Ensuring NHS services are there for those who need them
The plan emphasises that delivering the NHS’ ambitious mental health improvement programme is all the more vital in the context that some people will need further specialist support in the coming months and years.
This section provides further detail on where the additional £500 million investment for mental health announced at the spending review in the autumn will be targeted, which is summarised below:
To tackle critical care ‘backlogs’ as a result of the pandemic:
£2.5 million to test new models of joint working across services, to support children and young people who have experienced complex trauma as a result of violence
£2.5 million to boost capacity to provide mental health treatment for offenders in pilot areas
£17 million for memory assessment services and recovery of the dementia diagnosis rate
£13 million for support for 18- to 25-year-olds transitioning to adult services
£87 million for funding to support discharge (as previously announced)
£14 million for physical health outreach for those with SMI and remote delivery of checks
£3 million for preparation work for mental health act reforms such as addressing gaps in frontline
To accelerate delivery of key commitments the NHS long term plan:
£79 million (as previously announced), to improve access to children and young people’s mental health support. This includes additional funding for Mental Health Support Teams in schools and colleges and eating disorder, crisis and community mental health services
£58 million for adult community support to bring forward the expansion of integrated primary and secondary care for adults and older adults with SMI
£13 million for crisis support to sustain and enhance the operation of 24/7 crisis lines
£38 million for IAPT to deliver access, waiting time and recovery standards. Additional therapists will be trained as part of this
£1 million for suicide prevention and reduction
To support workforce growth:
£111 million investment in the training and education of the NHS mental health workforce, and to begin implementing the mental health act reforms
Approved Mental Health Practitioner workforce and initiating work to address racial disparities:
£31 million to address particular challenges faced by individuals with a learning disability and autistic people to intervene early to prevent mental ill-health and decrease suicide risk, and reduce consequent pressure on NHS services, including in future years:
£20 million for early intervention and prevention
£5 million for suicide prevention through the VCSE sector
£10 million has been reserved to adapt and evolve the approach to supporting the mental health and wellbeing of NHS staff where needed.
Implementation and next steps
The government have stated they will continue to monitor the following to understand the impact actions are having:
Trends in self-reported mental health and wellbeing outcomes through the monthly publication of PHEs Covid-19 mental health and wellbeing surveillance report
Demand for mental health services, including referrals to secondary mental health services and psychological therapy programmes
Prevalence of mental-ill health, particularly of key at-risk groups including children and young people trends in suicide and self-harm data.
The government has also noted they will continue to monitor key metrics to measure access and quality standards for NHS services as published in the Mental Health Dashboard.The cross-government ministerial group will be retained and meet quarterly over 21/22 to monitor progress against the actions listed in the plan. The group will also seek to identify areas for further action, including informing preparations for the next Spending Review expected this autumn.
It is important that the government and policymakers set out clear, realistic priorities for the sector in line with the new context it is operating in. There needs to be the appropriate flexibility for local areas to make decisions that work best for their communities, particularly given the uneven impact of the pandemic to date.
Further attention is also needed on actions relating to public health and social care, given the clear interdependencies with mental health services.
A more systematic approach to promoting the resources of the voluntary sector is needed – the precarious financial position of key local and voluntary sector partners is a concern for many and the significant impact of this on people who rely on the services they provide.