A professional schism hinders Britain's mental-health system
一個專業性的分裂阻礙英國心理健康系統
THE day after Mandy Peck tried to electrocute herselfin the bath her family took her to a mental-health centre in Chelmsford and asked for help.They were told that there were no beds available and sent home. Two days later Ms Peckjumped to her death from a multi-storey car park. She left a daughter behind.
Ms Peck would not have been turned away had she arrived at hospital with a broken leg. Yet theNational Health Service (NHS) often fails those suffering from a broken spirit. The numbers arefuzzy, but about one Briton in four suffers a mental-health problem at some time in their life,ranging from mild anxiety to severe schizophrenia. Less than a third of those receivetreatment. That is in part because many sufferers are ashamed to seek help, but it is also dueto funding gaps and disorganisation within the NHS. The result is a system in crisis, says SueBailey, a former president of the Royal College of Psychiatrists.
This failure is costly. Mental-health problems cause more suffering in Britain than physicalillness, poverty or unemployment, according to Richard Layard, an economist and author of abook on happiness. People with severe mental illnesses have higher rates of physical illnessthan the general public. According to the King's Fund, a think-tank, this costs the NHS between£8 billion ($13 billion) and £13 billion each year. Sufferers are also more likely to commit crime;mental illness has become the most common reason to claim disability benefits. Researchersat the OECD, a club of rich countries, reckon getting mentally-ill people back to work couldincrease employment in Britain by nearly 5%.
Part of the problem is money. The consequences of mental illness cost the British economyover £100 billion a year, according to the Centre for Mental Health, a think-tank, yet the NHSspends just £11.3 billion on the problem. Some, like Mr Layard, see misplaced priorities.Doctors spend about £3.5 billion a year treating the depression and anxiety disorderssuffered by some 6m British adults—a vast amount less than is spent treating the physicalailments of roughly 500,000 patients in the last year of their lives.
Recent cuts to health spending have fallen hardest on mental-health care, just as doctors saydemand is rising. The number of NHS beds for patients with mental illness has declined byover 30% since 2003. Many facilities are now full. As a result patients are having to travel longdistances or wait months for care. To free up room, a mental-health centre in London hasdischarged patients to bed-and-breakfasts. Others are not so lucky: sufferers picked up bypolice are often diagnosed in jail cells. This week Norman Lamb, the minister for care, said thatservices for young people are “stuck in the dark ages”.
A second challenge arises from the way the NHS is structured. Mental-health care is staffedand funded separately from physical care—treatment is focused on the mind or body, but rarelyon both at once. Yet research shows depressed people are more likely than others to developheart and lung disease, and to suffer from strokes. Mental illness also appears to make diseasesmore lethal. On average men with mental-health problems die 20 years earlier than thosewithout them (most from causes other than suicide), says the British Medical Association.
The government is alive to these problems. Britain's spending on mental health may beinadequate, but it compares favourably with that of other rich countries. From April ministershave promised to limit the long waiting times that prevent many people using mental-healthservices. And in 2012 the government pledged to give mental health care equal priority tophysical care, enshrining this principle as part of the Health and Social Care Act. But criticscomplain that the promise has yet to deliver much practical change.
Reform advocates would like better integration between mental- and physical-health care. “Liaison psychiatry” involves placing mental-health specialists in hospitals to work alongsidedoctors. The Centre for Mental Health found that one such initiative in Birmingham reduced thelength of hospital stays and the number of readmissions and improved the health and well-being of patients. The centre calculated that the programme saved four times its costs. Yetsuch services are often meagre.
It would be better and cheaper to keep sufferers out of hospital altogether, says EmmaStanton, who runs Beacon UK, a mental-health consultancy. Ms Stanton recommendstreatment at home through teams of doctors, nurses and social workers. Instead of swallowingantidepressants, health bosses would like sufferers of mild conditions to receive help under aprogramme called Improving Access to Psychological Therapies (IAPT), which aims to expandthe use of treatments such as cognitive behavioural therapy. This helps individuals challengethe gloomy thinking that can lead to anxiety and depression. The National Institute for Healthand Care Excellence (NICE), which evaluates treatments, considers it good value. Yet DavidClark, an adviser for IAPT, says it reaches only a fraction of those who need it. He would like itsbudget doubled.
Convincing politicians to cough up more funds will be tough. Some critics fear that beefing uptreatment of the most common mental-health problems risks saddling the system withoverwhelming costs. Fortunately there is a lot that can be achieved without more cash. Manymental-health services still do not meet the standards recommended by NICE, andcommunication between services is poor. Elaborate therapies are not always necessary—oneeffective treatment for those suffering mental illness is keeping them in a job. Other types oftherapy, say advocates, should pay for themselves by saving health-care costs and increasingproductivity. Improving Britons' mental health is not only humane, but economical.