A new NHS and mental health patients are as powerless as ever

People with mental health problems will be particularly vulnerable under the changes ahead, yet those I’ve spoken to seem resigned to their fate, says Clare Allan

The government’s new mental health strategy, out today, contains a number of welcome commitments, most particularly to talking and children’s therapies. Regrettably, there is no reappraisal of the proposal contained in the NHS health and social care bill to hand responsibility for commissioning mental health services to consortiums of GPs.

This includes handing over services for people with severe and enduring conditions such as schizophrenia and bipolar disorder as well as those with mild to moderate mental health problems; services for people with a dual diagnosis, such as drug or alcohol dependency; and for mentally ill offenders. This includes everything, in fact, with the possible exception of secure psychiatric units.

The NHS health and social care bill makes for far from easy reading. That I can’t claim to fully understand the proposals is neither greatly surprising nor in itself particularly alarming. What does worry me is a lurking suspicion that nobody else quite understands them either. Even those who can unravel the language of the bill and knit it back into something approaching comprehensible English can have little idea of how the reforms will work in practice.

The mental health charity Rethink consulted a sample of 500 GPs. It found that 42% admitted they are worried about commissioning for mental health problems because of their lack of knowledge about services for severe mental illness. Of those questioned, 54% claimed to have difficulties dealing with patients with severe mental illness, and 63% felt it essential that every GP consortium should have a mental health lead.

Central to the government’s reasoning is that as GPs are working on the frontline they have contact with the full range of health issues, rather than being focused on a single specialist area, and are therefore best placed to make commissioning decisions based on the level of need and the budget available. There is some sense to this, certainly, but it is very important to recognise that not all conditions present in the same way, and that not all patients are equally able to advocate for their needs.

Moreover, despite the fact that an estimated third of all GP appointments are mental health-related, the system in surgeries is better suited to diagnosing and treating physical illness than it is to addressing mental health issues. It’s hard to see how much insight a GP can be expected to glean in the average seven-minute appointment from a patient who may be seeking to conceal any problems, whose sole ambition may be to get their prescription and go.

There is a real danger that GPs’ perception of need could be seriously distorted when it comes to mental health. What’s more, as the budget cuts start to bite, it is hard to see how GPs can avoid becoming the focus of lobbying, with resources going to services that have the most widespread support. Past experience would suggest that mental illness is unlikely to top the public sympathy list.

Local “healthwatch” groups are to be created with the aim of making health and social care provision accountable and handling complaints. Again, it is essential that mental health service users are adequately and appropriately represented. Too often, the experiences and concerns of those with mental health problems have been dismissed or explained away as a symptom of their condition. This leaves mental health patients especially vulnerable to poor practice, a particular concern at a time when the government is seeking to cut £20bn from the NHS budget.

So what’s the reaction to the proposals among mental health service users? Among those I have spoken to, the mood is fatalistic. This is hardly surprising. Many people with severe mental illness are struggling just to manage day to day. Many have already experienced cuts, loss of services, closure of day centres, removal of support workers and so on and there is huge concern about benefit changes. But what struck me most forcibly was that no one appeared to feel that they had any power to influence the changes. It’s going to take more than wordplay to realise the government’s ambition of “no decision about me without me”.

• Clare Allan is an author and writer on mental health issues.
• The headline of this article was amended on 2 February 2011 to comply with the Guardian style guide on reporting mental health issues