Why mental health matters in the Opportunity Society

Continuing the 2020 series of papers on the Opportunity Society, Nicky Morgan MP and James Morris MP look at the health, social and economic rationale for making an explicit commitment to improving the nation's mental health

If we believe that the 'opportunity society' is about offering people a hand up and not a hand out, about enabling individuals to achieve their potential and providing support when things go wrong, then we cannot ignore the hundreds of thousands of our fellow citizens who are affected by poor mental health.

In this short paper we make the case that governments need to make a clear commitment to address and improve our nation's mental health � for health, social and economic reasons. For the purposes of this paper we are focusing on conditions such as anxiety, depression, personality disorders and schizophrenia. Dementia and addictions are often included when talking about mental health. Of course, all these illnesses need to be tackled but we believe that the numbers affected by conditions such as depression and personality disorder are so huge and, left un-treated, have such wide ramifications, that they must be given a particular focus.

Mental illness accounts for 23% of the UK's total burden of disease (compare this to cardiovascular disease or cancer which each account for 16% of the total burden of disease). Yet only 13% of current NHS health expenditure is on mental health. The World Health Organisation estimates that depressive disorders were the third biggest global health problem in 2004 and by 2030 they will be the largest.

The LSE / Centre for Economic Performance's Mental Health Policy Group estimated, in June 2012, that the cost of mental illness to the Exchequer is �28bn in terms of benefits paid to working-age people and taxes lost. The Centre for Mental Health estimates mental illness reduces GDP by 4.1% or �52bn a year.

How it could change...

We would like to see a society where there is no stigma attached to having a mental illness. Instead, if someone suspects they may be ill or has had a formal diagnosis there is open, honest and speedy communication with those around them, including any employers.

Mental resilience needs to be emphasised early in life, particularly in schools. According to a recent article in The Times "between 1991 and 2001 the number of children prescribed antidepressants in the UK rose by 70%" and the article reports on a Young Minds survey which found that "in the past year alone [hospital admissions for self-harming] have increased by 10% for under-25s".

The Health & Social Care Act 2012 includes the provision that mental health is to have parity of esteem with physical health. One way to make this a reality is to treat people holistically i.e. to look at all their illnesses/concerns and treat them as a whole. We would like to see the NHS provide really effective paediatric and adult liaison services. If someone with a physical health condition also suffers from mental ill-health and that condition is not treated alongside their physical condition then they are much less likely to recover properly from either condition.

We want to see mental health research being properly funded in the UK. By way of comparison 2008-9 figures show that the UK spent 3.5% of its research budget on mental health compared to 7.1% in the USA, 7.2% in Canada and 9.6% in Australia.

We also believe that mental health conditions can benefit from a big society approach to care and treatment. The voluntary and community sector and social enterprises, working alongside primary and secondary NHS settings, provide fantastic models of care and support for those with mental ill-health and this should be encouraged not frustrated by the state.

Therapies and choice

For too long the approach to mental illness within the NHS and the medical establishment has been to apply what we would call a 'psychiatric' model. By that we mean that it is assumed that mental health problems can be successfully treated by specifically medical intervention. We have seen, for example, the exponential rise in drug based therapies in the NHS. Many GP's see drugs as an easy solution when it comes to dealing with people who present with challenging mental health problems at their surgeries. This reflects a view that mental illness and the symptoms of it need to be controlled rather than creating the conditions in which the underlying causes can be properly addressed.

That is not to say that drug based interventions are never appropriate in some cases of severe mental illness. However, the easy option of using drug based interventions as the default mode of treatment needs to be challenged. We need to de-medicalise our approach to treating mental illness.

Those with mental health problems � across a range of different conditions � need real choice over what kind of therapy is available to them. They need to feel that what they are experiencing is 'normal' and that they have the personal resources to deal with it. They need to be confident that when they come into contact with the NHS (particularly through primary care) that they are going to be given appropriate advice from an experienced practitioner as to the best treatment options available to them. It has been welcome, therefore, that there has been further investment made in Improving Access to Psychological Therapies (IAPT) in an effort to integrate talking therapies into the treatment mix.

The Government has committed �500m to the further roll out of IAPT. However, in terms of broadening choice and challenging the dominant treatment model described above there is still a long way to go. IAPT is very much focussed on Cognitive Behavioural Therapy(CBT) because it is the one talking therapy which NICE recognises as having a sufficient evidence base which describes its effectiveness as a treatment. NICE guidelines for talking therapies are, therefore, very strict and effectively limit the choice that is available to NHS patients who are not able to access longer term psychotherapeutic or psychoanalytical therapies which are widely available in the private sector. As the Centre for Social Justice argued in its recent report 'Commissioning Effective Talking Therapies' there needs to be a radical change in the way the NHS commissions talking therapies to allow more involvement of a wider range of therapies. In order to move to a new model of mental health treatment we need real choice in talking therapies.

It's not just about government

Wellbeing is about good personal, family and wider relationships. Government cannot improve our mental health alone and as set out above it is important to realise that medical intervention is not always the best option or not needed on an ongoing basis. We also know from our own constituency casework and research by organisations such as Mind that in-patient hospital treatment is not always as therapeutic as it needs to be.

To create the 2020 opportunity society we want is achievable but it requires a laser-like focus on mental health across Government, the NHS and the DWP as well as in schools, the criminal justice system and by individuals. The way we talk about and the treatment of mental ill-health needs to change and patients need to be able to choose from a wider suite of treatments.

How we as a society address mental wellbeing and mental ill-health says much about us and our values. The Conservative Party has a great opportunity to offer choice in terms of provider and treatment, support with employment and to change social attitudes to mental health. It is important that we take it now.


James Morris is MP for Halesowen & Rowley Regis and member of the Communities and Local Government select committee. He was previously in business, specialising in computer software. In 2003 he founded Mind the Gap, an independent campaign to promote civic action and to encourage more grass roots involvement in politics. Prior to entering Parliament, James was the Chief Executive of the think tank Localis.

Nicky Morgan is MP for Loughborough. Prior to her election she was a solicitor specialising in Corporate Law advising a range of private and public companies. Nicky has served as Parliamentary Private Secretary to Rt Hon David Willets MP and on the Business, Innovation and Skills Select Committee.

Note: The views expressed in this post are those of the author, not of the 2020 Conservatives group as a collective, the Conservative Party or the Government.