In all the brouhaha about inheritance tax some of the significant changes for mental health got overlooked. Most significant may be the stripping down of the multiplicity of targets which has dominated the last ten years to 30 key Public Service Agreements (PSAs). These set out the specific improvements sought, how they will be measured, a plan for delivery and who will be accountable for that delivery. It is a more sophisticated process than setting headline targets and hoping for the best!
One of the 30 targets is social exclusion with a focus on 4 groups of the most excluded : care leavers, offenders under probation supervision, adults with moderate to severe learning disabilities and adults with secondary mental health problems.
The aim is to increase the proportion of at-risk individuals in settled accommodation and in education, employment or training (EET in the jargon!). Care Programme Approach care coordinators are expected to focus on these issues as part of individual care plans. SHIFT’s anti-stigma campaign is important in tackling workplace discrimination and the National Social Inclusion Programme’s creation of regional employment teams is a key element in the delivery strategy.
How will this be delivered? Each individual within the at-risk groups assessed as requiring support to access services will be assigned a lead professional to provide a central point of contact and act for and work with the individual to identify, coordinate and deliver the services that best meet their needs. Their work must be based on a thorough needs assessment and effective joint working involving appropriate information sharing with other professionals. The role can be taken on by a wide range of people and will be determined on a case-by-case basis in consultation with the individual.
Service user involvement is now a clear part of public policy. Local Authorities are told to consider for the most socially excluded adults:
• the potential for governance structures involving users;
• collecting intelligence on users’ needs, perceptions and preferences to
improve service delivery; and
• the potential for user satisfaction indicators linked to the PSA.
The achievement of the PSA may be helped by a section in another PSA on improving health and wellbeing promising increased access to psychological therapies. The Government believes that even a short course of psychological therapy is effective in restoring people with mental health problems to well-being, inclusion and meaningful activity, which it thinks is best indicated through return to, or retention of, work. The Department of Health is rolling out further pilot sites to create effective local incentives to ensure the right number of people who can benefit and receive prompt access to evidence-based psychological therapies in a timely and cost-effective way. The evidence from the pilots will define the most cost-effective and deliverable service models to support commissioners and service providers, and to help further national rollout during the CSR period, with an emphasis on developing psychological resilience through early intervention and improving the mental well-being of the general population.
The emphasis on work as the definer of meaningful activity is a recurrent theme. Key partnerships include developing referral pathways with Job Centre Plus as part of the development of the Pathways to Work Condition Management Programme. Central to this will be developing the role of employers through the development of stress management standards, which will strengthen their role in supporting employees who may be struggling to remain in work with depression or anxiety.
So what will the measurement tool be? This is a comparison of the number of people who have depression and/or anxiety disorders and those diagnosed with depression and/or anxiety disorders; and the number of people who are offered psychological therapies. There are some heroic assumptions built in to the measurement process. First the psychiatric morbidity survey which will give a sound estimate of the number of people with depression and/or anxiety disorders (both diagnosed and undiagnosed) will not be available until mid-2008. The new dataset to count the number of people who are diagnosed with depression and/or anxiety disorders is not yet in place and the data set for those receiving psychological therapies is still under discussion. As the Treasury cheerfully acknowledges all this is ‘aspirational’ which sounds a bit like the wishing and hoping of the earlier target regime.
But it would be churlish not to welcome the huge advance of attempting to measure social inclusion and the clear direction being given. It is wholly in line with what SPN has been saying since its inception- you cannot help people with their mental health issues without looking at their housing, employment or activity, social relationships and their income. The risk as ever is that policy becomes driven by the need to reduce the numbers on incapacity benefit and people are forced into work without proper preparation or adequate support. So we will need to monitor to ensure that these welcome objectives do not fall victim to the Law of Unintended Consequences.
Terry Bamford
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