As clinicians with responsibility for the whole of a patient's health, GPs have long been frustrated by the policies and guidance that tie their hands and result in mental health disorders not getting the same kind of attention that physical ailments do.
Mental health accounts for 23% of the burden of illness on the NHS but attracts only 13% of its budget.
The government has made some welcome steps this year that will help give GPs the means to provide effective treatments to more of their patients who present with depression or anxiety, culminating in the recent extension of patients’ rights to choose a mental health provider.
Equal status for mental health
In spring, the Health and Social Care Act enshrined into law parity of esteem for mental health, with physical health, within the NHS. It has since remained unclear exactly what parity would mean in practice to patients, GPs and mental health professionals, but over the past six weeks political leaders have started to offer some clarity.
In a speech at the end of October, Ed Miliband announced a Labour Party task force to develop a strategy for mental health and suggested rewriting the NHS Constitution to give patients the same right to mental health treatments as patients with physical ailments currently have.
A fortnight later, minister for mental health Norman Lamb announced that as part of the NHS Mandate, patients with mental health disorders should not expect to wait for longer than 18 weeks for treatment.
The British Association for Counselling and Psychotherapy (BACP) welcomed both these steps – particularly if it means that we can better measure the performance of the NHS and identify improvements that can be made on the front line. Another important change that should take place is to give patients greater control over their treatment.
Right to choose
Deputy prime minister Nick Clegg has now announced that patients will have a right to choose their provider of mental health services – a right that patients elsewhere in the NHS have had since 2008.
The case for extending this right to mental health is a strong one: research by the 'We need to talk' coalition in 2010 found that having a full choice of therapies means that people are three times more likely to be happy with their treatment than those who wanted a choice but did not get it.
Counselling services in Bristol commissioned using the 'any qualified provider' process are offering patients genuine choice from a range of services and therapies – this is a good model of how choice and access can be improved.
Link to physical health
Mental health care can go further if the NHS recognises not just parity of esteem but the relationship between physical health and emotional wellbeing. A total of 60% of presentations in primary care have a psychological element and patients do not need a clinical diagnosis of depression or anxiety to benefit from talking therapies.
For example, counselling is an important part of treatment for cancer patients, while addressing panic attacks with talking therapies before referring to a cardiovascular unit could benefit both patients and the resource-starved NHS.
While policy change in Westminster is essential, it is important to recognise that under the new commissioning system, patients will rely on the judgement of GPs and individual clinical commissioning groups (CCGs) to give them the appropriate treatment options. BACP and its members are proactively engaging with local commissioners in the run-up to April 2013 to help inform them about services and help GPs become more influential.
Louise Robinson is healthcare development manager at BACP