The UK Government has now launched is much anticipated 10-year health plan. A plan to improve the care for millions of people by localising services in a shift from centralised treatments in hospitals to community treatment centres. They also plan to shift the focus from treatment to prevention in order to reduce the demand on services, and to rebuild the NHS workforce by training many more medical staff and utilising new technologies.
One of the flagship elements of this plan is the introduction of Neighbourhood Health Centres (NHCs). Localised community hubs which have multidisciplinary services including GP’s, urgent care and rehabilitation all under one roof. The aim is to not only increase access to services in a community setting, but also to reduce the silos of care all-too-often experienced by many in the current system.
But what impact will this new plan have on mental health services in the UK?
Poor mental health is increasing UK wide
The recent Adult Psychiatric Morbidity Survey, published on the 26th of June, found that the prevalence of poor mental health is increasing. Young adults (aged 16 to 24) with a common mental health condition such as depression or an anxiety disorder, rose from 17.5% in 2007 to 25.8% in 2023/24.
In older adults (aged 16-64), the prevalence rose from 18.9% in 2014 to 22.6%. In both age groups, the prevalence was higher among women.
But what is driving this increase? And are these drivers going to be addressed by the 10-year health plan?
Whilst there is no single cause for mental health conditions such as depression, anxiety, psychosis or eating disorders, there are certain risk factors that increase the likelihood of someone developing a disorder.
Socioeconomic inequalities
Inequalities are a significant driver of poor mental health. Being constantly worried about money, insecure housing, or living in poverty makes it much more likely that a person will develop depression or other common mental health conditions.
MQ’s Cost-Of-Living report found that people in the UK who are classed as living in poverty are more than twice as likely to develop a mental health problem than those on an average income.
The Mental Health Foundation’s ‘Poverty of Ambition’ report, published last week, found that a greater proportion of people were living in very deep poverty than 30 years ago. They also found that the number of people experiencing destitution had increased by almost two thirds to 3.8 million in 2022.
It should also be noted that as well as causing mental illness and distress, poverty can also be a consequence of mental health problems as it can make it harder to get or hold down a job, maintain relationships or manage money effectively.
So how does the 10-year health plan address this significant driver of poor mental health?
“Evidence shows that people in working class jobs, who are from ethnic minority backgrounds, who live in rural or coastal areas or deindustrialised inner cities, who have experienced domestic violence or who are homeless are more likely to experience worse NHS access, worse outcomes and to die younger. This is an intolerable injustice. Our reimagined NHS will be designed to tackle inequalities in both access and outcomes – as well as to give everyone, no matter who they are or where they come from, the means to engage with the NHS on their own terms.” – 10-year plan.
Whilst the plan itself acknowledges that societal inequalities do have a significant impact on health outcomes, it doesn’t specifically address the root causes of these inequalities. Instead, it focuses on addressing access to care for the most vulnerable people through increasing access to community care and the NHCs.
Whilst this is a laudable goal, this 10-year health plan does not exist in isolation and is impacted by other policies. The Government’s Universal Credit and Personal Independence Payment Bill, more commonly referred to as the Welfare Reform Bill which narrowly passed last week, risks undermining the efforts of this plan by pushing 150,000 people into poverty according to the government’s own assessment.
Links with physical health
People with physical health conditions, especially ones that limit physical activities, are more likely to have a mental health condition. The converse of this is also true, as people with severe mental illnesses die, on average, up to 10 years earlier than the general population.
Conditions that limit mobility or have an impact on a person’s day-to-day activities increase the risk of a person developing a mental health condition. So, what does the health plan say about keeping people physically healthier?
The plan does focus on preventing illness as opposed to treating sickness. This includes plans for more localised care, digitising services to get people access to services faster, and working across sectors to keep people healthier for longer.
The plans to introduce Neighbourhood Health Centres (NHCs) is to create ‘one stop shops’ for communities and to reduce silos in health care. Additionally, the plan wants to make patients active participants in their own care by ensuring 95% of people with complex needs will have an agreed care plan by 2027. Interestingly, the plan doesn’t mention some of the measures which have been drafted into the upcoming Mental Health Bill such as the introduction of statutory care plans for individuals who have been sectioned.
The Government has ambitious plans to partner with the private sector to help keep people healthier. They want to negotiate deals on new medications, such as weight loss injections, on a ‘pay for impact on health outcomes’ basis.
Additionally, they also want to create a new genomics population health service. This will include mapping the genomes of 150,000 adults this year and assessing how genomics can be used in routine preventative care. Additionally, The ‘Generation Study’ is a new programme to test universal newborn genomic testing to identify individuals at high risk of developing common diseases. The intention is to provide early intervention and support before symptoms develop.
Trauma and Adverse Childhood Experiences
There is a strong correlation between ACE’s and a range of significant mental health outcomes in later life. MQ researchers have proven the link between childhood bullying and later mental health problems, whilst other events such as the death of a parent, abuse or childhood poverty can all have life-long impacts.
Traumatic events, chronic stress and discrimination can contribute towards the development of serious illnesses including PTSD for people of all ages.
The Adult Psychiatric Morbidity Survey found that the number of adults reported to have experienced trauma has increased from 31.4% of the population in 2014 to 34.8% in 2023/24. (Bear in mind this follows the pandemic which was a highly traumatic time for many.) Of the people who reported experiencing trauma, a disproportionately larger number now screen positive for PTSD. 5.7% of people in 2023/24 over 4.4% ten years ago.
So how does the 10-year health plan address the prevention of ACE’s and the support offered to victims and other trauma survivors to prevent them from developing PTSD?
The 10-year health plan recognises that early intervention is vital when it comes to young people’s mental health. The plan reiterates the government’s already announced aims to expand mental health support teams in schools and colleges and provide additional support for children and young people’s mental health through Young Futures Hubs.
This has the potential to work well for children and young people who have been identified as being at risk of genetic mental health conditions through the Generation Study.
However, there are no other plans to provide integrated victim support or increase access to talking therapies or other interventions that can help prevent the development of PTSD and other trauma-based illnesses.
