Mental illness accounts for nearly half of all ill health in people under 65, but only a quarter of people are given the treatment they need, according to a new report published today by the London School of Economics.

The report has been written by a distinguished group of mental health and health policy professionals from across London, led by Professor Lord Richard Layard, Director of the Well-Being Programme at the LSE Centre for Economic Performance.

It covers the scale and severity of mental illness and shows that around 17% of adults and 10% of children are suffering from mental illness in England.
(Note: these figures include schizophrenia, bipolar disorder, depression, anxiety disorders, conduct disorders, ADHD and autism, but they do not include dementia, personality disorders or substance misuse).

The authors show that mental illness often has more of a disabling impact on people compared with other chronic health conditions, and they highlight that mental pain is as real as physical pain.

The outstanding statistic from the report is the claim that if the NHS spent more money on psychological therapies it would end up costing them nothing because money would be saved elsewhere in the system. The logic here is that half of all NHS patients referred for first consultant appointments in the acute sector have “medically unexplained symptoms” and the costs of these physical complaints caused by mental illness exceeds £10 billion. The evidence shows that psychological therapies are effective at reducing physical symptoms, so the report concludes that money invested in extra talking treatments would be saved elsewhere.

The mismatch between burden and expenditure is a recurring theme in the short report, which claims that:

Even when we include the burden of premature death mental illness accounts for 23% of the total burden of disease. Yet, despite the existence of cost-effective treatments, it receives only 13% of NHS health expenditure. The under-treatment of people with crippling mental illnesses is the most glaring case of health inequality in our country.

The report recommends a major rethink of mental health care in the UK, to tackling the huge unmet need for effective services and treatment. The following 6 recommendations are made:

1. The government’s announced mental health policies should be implemented on the ground. For example, local Commissioners have been given £400 million in their baseline budgets for 2011-14 in order to complete the national roll-out of Improved Access to Psychological Therapy (IAPT). By 2013-14 this programme should be treating 900,000 people suffering from depression and anxiety, with 50% recovering. But many local commissioners are not using their budgets for the intended purpose.
2. Though included in government documents, such as No health without mental health, the obligation to complete the IAPT roll-out is not included in the NHS Outcomes Framework for 2012/13 which is the crucial document for commissioners. If the government means what it says, IAPT targets should be reflected in the NHS Outcomes Framework.
3. After 2014 the IAPT programme needs a further phase when it is expanded to cover people suffering from long-term conditions and medically unexplained symptoms. The Children and Young Person’s IAPT will also need to continue till 2017.
4. For all this to happen, the Commissioning Board will need to nurture IAPT and make it one of its priority projects, as will Health Education, England.
5. The training of GPs will also need to change and include a rotation in an IAPT or CAMHS service.
6. And recruitment to psychiatry should be increased, if we are to handle properly the more complex cases of mental illness.

Links

How mental illness loses out in the NHS: a report by The Centre for Economic Performance’s Mental Health Policy Group (PDF). London School of Economics and Political Science, 18 Jun 2012.

LSE Mental Health Policy Group – members and publications.