A New Paradigm for Mental Health

by Professor Paul Burstow, Professor of Mental Health Policy

by Ben Costello, Research Associate in Mental Health, College of Social Sciences

“On the steps of Downing Street, and in her first statement as Prime Minister, Theresa May said ‘If you suffer from mental health problems, there's not enough help to hand’. This echoed the NHS England Mental Health Taskforce’s report in February, the Five Year Forward View for Mental Health, which set an agenda for improving and widening access to treatment and recognised the importance of prevention and early intervention in mental health services. But it remains to be seen whether David Cameron’s commitment of an extra £1bn by 2020 to deliver the recommendations of the Taskforce and to improve mental health services in the UK will be delivered. And even if it is, this will not in itself close the treatment gap.”

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Only by turning the spotlight on how the causes of mental health problems should be tackled can we ensure that mental health services can meet demand and, critically, best serve those experiencing mental health problems. Statistics show the current treatment gap between prevalence and treatment, and the gap is shocking: one in six adults have a common mental disorder (CMD), but only one in three are receiving treatment; one in ten children have a diagnosable mental health problem, yet only one in four receive access to treatment. Access to mental health treatment is falling short of need. When combined with the fact that those with serious mental health problems currently have the same life-expectancy of the general population in the 1950s , there is a clear case for investing in mental health services. The Government’s financial pledge to improve and widen access to mental health treatment is therefore vital for closing the treatment gap, but the method by which the gap is closed needs examining.

Now is the time for change. Closing the treatment gap requires a shift in paradigm. We need to move away from the paradigm of treatment and containment and towards a paradigm of prevention and early intervention. In other words, the treatment gap needs to be closed by reducing the demand for access to mental health services. Simply up-scaling the current service models cannot close the treatment gap; instead we need to downsize the population requiring treatment.

The Birmingham Policy Commission on Mental Health has been established in order to determine how this new paradigm can be developed. The Commission aims to demonstrate that prevention strategies, early intervention approaches, community strength and asset-based approaches, and supporting people to self-care in public services can help to close the current treatment gap.

The Five Year Forward View for Mental Health will make a difference, if the money gets through. But it won’t dramatically close the treatment gap. Theresa May was right to say that there is not enough help to hand. But what matters is answering the question: How do we close the gap? Part of the answer has to be a new paradigm of mental health that centres on providing a framework of preventative and early intervention approaches that reduce the number of those needing to seek treatment in the first place.