Mental health services in the UK are clearly in crisis. The independent regulator of health and social care in England has said that the NHS mental health sector “must overcome an unprecedented set of challenges” if it is to improve its service and achieve government goals. Perhaps the biggest challenge is that training for a badly-needed injection of new mental health professionals should already have begun and it is hard to see where any outside help will come from.
Unreasonable Expectations
A report from the Care Quality Commission found examples of excellent care but also “too much poor care and far too much variation in both quality and access”. The Government has pledged almost £1bn to fix mental health services but a lump sum isn’t a simple fix. It wants to add 21,000 nursing jobs in the next four years but the Royal College of Nursing has called that time scale unreasonable.
The NHS is losing staff due to stress, the public sector pay cap and the uncertainty caused by Brexit. There’s one vacancy for every 10 mental health nurses and 40,000 vacancies across all NHS nursing. On top of this the demanding nature of the mental health sector is particularly hard on the staff’s own well-being.
The challenge is not just to encourage people into the field but to train them too. Training can take three to four years and then they need to gain experience. Mental health nurses tend to be older and more experienced – they are rarely fresh from the classroom and cannot be fully trained in a hurry.
The £1bn is obviously welcome but the Tories don’t seem to understand that staff must see some of it. They have retained the cap on public sector pay and stopped bursaries, meaning new staff must apply for student loans and enter a capped-salary workforce in debt. It’s no wonder that the average dropout rate for nursing students is 20%. The 8000 new recruits boasted of by Health Secretary Jeremy Hunt are simply not enough.
Foreign Aid
If we can’t recruit British medical students and staff then our only option is to look oversea – a backup plan that’s becoming increasingly uncertain in the wake of Brexit.
Nursing is the largest NHS sector for EU workers, accounting for 35% of all NHS staff from the EU. Some 7% of our nursing pool is from the EU – a coincidental 21,000 people. Hunt has repeatedly stated that EU jobs are protected and the NHS will continue to hire from the EU post-Brexit. But he’s also asserted that he wants the NHS to be self-sufficient and to not rely on a foreign work force.
His contradictions continue as the NHS repeatedly carries out recruitment drives abroad. Even now NHS England is employing emergency GPs from Spain, Lithuania, Greece, Poland and Croatia to plug gaps. If the free movement of people disappears with our EU membership, which countries will we turn to?
A World of Trouble
The NHS isn’t allowed to actively recruit medical staff from developing countries – we cannot pillage their already scarce human resources. Our largest foreign staff influx comes from India and the Philippines, the latter of which is considered “developing” but has an agreement with the UK for hiring medical workers. Staff from these countries may be ideal for traditional physical medicine but their specialist training in mental health is another matter.
Mental health is a global problem that the World Health Organisation is tackling with a seven-year action plan, aiming to strengthen and integrate mental health services across the world. Despite the CQC’s poor findings, the UK is still one of the world’s better mental healthcare providers. In July 2017 The New York Times hailed our screening service as “the world’s most ambitious effort to treat depression, anxiety and other common mental illnesses”.
The UK has the world’s fifth-highest number of mental health nurses per 100,000 people (67.35) and ninth-highest for psychiatrists (14.63). The countries we recruit from most heavily are not so lucky. For every 100,000 people, India has just 0.12 nurses and 0.3 psychiatrists and the Philippines fares only a fraction better at 0.49 and 0.46. The WHO has scaled up its efforts and education in the Philippines because of the trauma of recent natural disasters. Recruiting from countries where the WHO has deemed the number of mental health workers “grossly insufficient” is hardly ethical behaviour by the UK.
At a time when the whole world is focused on increasing mental health awareness and treatment, the UK can’t poach workers from countries in worse positions. With inadequate training of homegrown mental health staff and dwindling outside options, UK mental healthcare will be adding isolation to its own growing list of symptoms.
by Jo Davey
The post NHS: Money Alone Can’t Cure Mental Health appeared first on Felix Magazine.
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