Where should the money go?

It’s no secret that mental health services are seriously limited by their budgets. Just ask any of us who have waited months for counselling, needed a psych bed when none were available, or been discharged from a service long before we were ready – or even safe.

But there’s another issue when it comes to mental health budgets, and that is, where should the money be spent?

At the moment, a lot of funding is channelled into the IAPT scheme. That’s Improving Access to Psychological Therapies, or, as it’s known in some areas, the Wellbeing team/service.

IAPT allows people with mild to moderate mental health conditions like anxiety and depression to access psychological therapies more easily. In many areas, this means they can self-refer. Currently, a million people every year are helped by IAPT.

This is all well and good. No one would argue that people with mild to moderate mental illness should be able to access support. After all, early intervention could prevent people’s mental health deteriorating, as well as potentially saving millions of sick days every year (kerr-ching!).

But what about the rest of us? Those of us who have more serious and enduring mental illnesses, like severe recurring depression, bipolar and schizophrenia?

This is where resources are seriously lacking – and it’s dangerous.

Throughout my ‘journey’ with mental health services, I’ve been at the mercy of an underfunded NHS.

I’ve been sent home from hospital after attempting suicide with no ongoing support – on more than one occasion.

I’ve had to wait days on one-to-one observation in a general hospital because no psych beds were available.

I’ve been discharged from a mental health hospital despite pleading to be allowed to stay because I felt so unsafe, and told that I had to ‘take responsibility’ for my actions.

I’ve had countless crisis team late arrivals and no-shows, not to mention being discharged from the team after a meeting during which I was explicitly clear that I was going to end my life, including how and when – and yes, I did follow through with my plans.

I’ve had lost count of how many different psychiatrists I’ve been under in the space of six years or so, presumably because the NHS can’t hang onto its doctors, increasing caseloads and petty bureaucracy to the point that they simply can’t cope.

Most recently – just a couple of weeks ago – I had my care coordinator taken from me, even though I was in hospital as recently as June.

I’m far from alone. Spend five minutes on Twitter and you’ll find countless people who’ve been through similar experiences, or worse. And when you have a mental health condition, being treated like this can leave you traumatised and exacerbate your illness.

I’ve no problem with IAPT in principle, but I do have a problem with diverting so many resources into the scheme that people with severe mental illness (SMI) can’t get the help they need because the money isn’t there to finance it.

It’s a bit like treating a patient with a headache at the expense of one who has a brain tumour.

I understand why money is being sunk into IAPT. The NHS is under pressure to produce tangible results where people are ‘cured’ quickly and easily and discharged from services.

That’s far more achievable if they prioritise people with mild to moderate mental health conditions. Many of them can be effectively treated with a handful of CBT sessions and perhaps a short course of antidepressants, and be safely discharged.

This is no less than they deserve – but it also allows the NHS to ‘prove’ its successes. Patient treated? Yep. Patient recovered? Yep. Patient discharged? Yep. There’s demonstrable evidence that the initiative is working; the CCG managers get a big pat on the back and the CQC is happy.

(I’ll gloss over the fact that despite the relative success of IAPT, the most recent review shows that 41% of practitioners have been pressurised into manipulating data, for example by coaching patients to give the ‘right’ answers, and discharging people who are showing positive results early, to avoid having to report a subsequent bad recovery score).

Those of us with SMI, however, don’t reflect well in performance data and league tables. We’re harder to treat, and it’s usually a longer, slower process with a lot of trial and error. Our conditions may be lifelong. We have relapses of varying frequency and severity. We need more complex care, such as inpatient treatment, crisis team support and care coordinators. We can’t be ‘cured’ by a short course of therapy or frontline meds.

In the eyes of the NHS and the powers that control its budgets (I’m looking at you, Boris), we’re a money sink compared to those who can be successfully treated by a short-term intervention, so it’s no surprise that the resources are channelled into services that appear to have greater success rates.

In no way am I suggesting that people with less severe mental health conditions don’t deserve help. They absolutely do, and it’s right that they have access to that as swiftly and easily as possible.

But where does that leave us, the long-term, more complex ‘service users,’ who often find ourselves seriously unwell and unable to get appropriate help because there’s not enough money to pay for psych beds, crisis team intervention, and consistent, high quality care from secondary and tertiary services?

I can tell you where: at risk.