Mental health only made it into all three main party manifestos for the first time in 2015. Two years later, and it would be impossible to imagine any serious political party missing it out. In fact, the first line on the ‘mental health gap’ in the Conservative manifesto suggests that they’ve already accomplished their aims: ‘It was Conservatives in government that gave parity of esteem to the treatment of mental health in the National Health Service.’
This is true – but also not very clear. It suggests mental health and physical health are now on an equal footing in the NHS. They are not.
The Coalition government introduced a mandate for the health service that called for measurable progress towards ‘true parity of esteem’ by March 2015. The 2017/18 Mandate reiterated this, calling for ‘measurable progress towards the parity of esteem for mental health enshrined in the NHS Constitution, particularly for those in vulnerable situations’. So it was Conservatives in government who introduced the ambition of parity of esteem – that is, equal quality and availability of treatment – between mental and physical health. But parity has not been achieved: so the Conservatives have not given parity of esteem in a tangible sense and are instead the ones who started to aim for it.
The independent Mental Health Taskforce published a report in February 2016 which set out the ways in which the structures of the health system make it difficult to achieve parity. Those included legislation around the treatment of people with mental illnesses and funding formulae. Meanwhile, analysis by the King’s Fund in October of that year discovered that 40 per cent of mental health trusts had seen their funding drop – despite NHS England directing clinical commissioning groups to increase mental health spending in real terms.
The Tories do generally accept that mental health still falls far behind physical health. The manifesto does commit to ‘better treatments across the whole spectrum of mental health conditions’. But it doesn’t suggest that there is any more money available to make that happen.
The party also makes the exciting commitment to ‘make the UK the leading research and technology economy in the world for mental health, bringing together public, private and charitable investment’. This would represent a significant shift. Currently just £8 per person is spent on research for mental health conditions, compared to £178 per person on cancer research and £110 on dementia. Given many of the drugs prescribed today to treat mental illnesses, including depression and psychosis, haven’t changed since the 1950s, it’s not as if that disparity in spending reflects less of a need for research. For some severe mental health problems, patients actually end up dying 15-20 years earlier partly down to the side-effects of the drugs they are taking.
Theresa May has long had an interest in mental health, and the manifesto commitment to a new mental health bill addressing some of the worst injustices around sectioning and treatment reflects her understanding of the problems from her time at the Home Office. However, it is difficult to see how the next Tory manifesto will be able to boast that the Conservatives in government have actually achieved parity of esteem for mental health when there seems very little suggestion that they will spend the extra money needed to get there.