NHS must unify mental, physical and social care, says Shadow Health Secretary

27 November 2013

Andy Burnham at the launch

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Video of Professor Layard

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A “fundamental change” to the NHS so that it has responsibility for mental, physical and social care is needed, the Shadow Health Secretary said today.

Andy Burnham called for an end to the “lack of parity” between mental and physical health services and said that patients should have a “right to therapy” for psychological issues just as they had a right to medication for physical problems.

Mr Burnham was speaking before an audience of 100 health experts and social scientists at the launch in London of a booklet on mental wellbeing, published by the Campaign for Social Science. The booklet contains case studies of important research which has influenced government policy in areas such as the provision of cognitive-behavioural therapy and counselling in schools.

Mr Burnham said that since the NHS’s creation in 1948 mental health services had been the lesser partner to physical health services. “Sadly, services have developed differently and we have the situation where mental health remains a poor relation on the fringes of the system – separate organisations, separate buildings,” he said.

“The pressures that modern living is placing on people mean that mental health and mental wellbeing have to move from the fringes of our system to the heart, otherwise we won’t meet 21st century challenges. That does require us to fundamentally rethink how our services are provided.”

He said that the exclusion of social care from the NHS at its creation had allowed over time “a negative model to develop” in which resources were given more to treating illness rather than preventing it before it happened by social care.

He said if people did not have social support that could affect their mental resilience and this could cause physical illness.

“That’s why I’m proposing the unification of physical, mental and social care within the NHS – it’s only then that we can break out of this very medical model of providing support.

“I’m talking about making a fundamental change to the way we think about health – only when the social side is in the NHS settlement will we put prevention into the heart of the system.

“Physical, mental, social – we have got three separate delivery systems to deliver each of those needs. We will never make the changes we want if we perpetuate that kind of way of thinking about public services. The time has come for a paradigm shift in the way we support people and look after all of their needs.”

He had found from shadowing GPs that many patients had social problems, such as benefits, housing, work or relationship issues, and so should get counselling or other social support for these rather than medical treatment.

“In the 21st century surely it must be time to say people should have a right to therapy as well as a right to medication – that’s a big change that we need to make.” Teachers should have training in mental health awareness to recognise problems among pupils, he said.

Mr Burnham praised the “excellent” Making the Case booklet and the research outlined in it, including the work of the economist Professor Lord Richard Layard, who also spoke at the event, held at Portcullis House, Westminster.

Professor Layard said that around eight years ago cognitive-behavioural therapy (CBT) had been “practically unavailable” in the UK. But he and other researchers had made the case that CBT was not simply successful at treating psychological distress but was also cost-effective, in the sense that it helped people keep their jobs or find work, and reduced their need to claim disability benefits. Professor Layard calculated that this saving would offset the cost of the treatment.

This work had led to the setting up, in 2008, of a CBT programme which now treated hundreds of thousands of people a year, with a 50% success rate. He said the programme needed to be doubled in size.

Professor Layard, of the Centre for Economic Performance at the LSE, said that a wellbeing programme for children had been trialled in 22 schools, with a significant reduction in depression in the short-term.

He said that the idea of wellbeing had gradually been taken up by the government over the years. Sir Gus O’ Donnell, the former Cabinet Secretary, had agreed to chair a commission to look at what government should do differently in its organisation and policies if it made wellbeing its central aim.

“All of this is based on social science and none of it would have happened without social science – very good luck with your Campaign,” said Professor Layard.

Dr Nancy Rowland, Director of Research, Policy and Professional Practice at the British Association for Counselling and Psychotherapy (BACP), talked about research programmes the BACP had carried out with universities on counselling services in schools. This work had encouraged the Wales Assembly to introduce counsellors into every secondary school in the country, and this was being extended to primary schools.

“I hope I have demonstrated how social science research can inform strategy,” Dr Rowland said. “The overall ending is that the mental health of children and young people in Wales is improving, which is a huge impact to have.”

Other speakers at the event included Dr Mike Shooter, the President of the BACP, and Dr Sergio Iavicoli, President of the European Academy of Occupational Health Psychology. The Advisory Group which oversaw the project comprised Professor Woody Caan AcSS, Dr Dawn Hillier, Ambra Burls and Professor Jerome Carson.

The BACP and the European Academy, with the British Academy of Management, sponsored the booklet, which is the ninth in the Making the Case series. Each booklet summarises research that has had a direct benefit for society. Previous booklet topics include crime, climate change, ageing, management and sport.

• The Campaign is sponsored by the Academy of Social Sciences.

Photos – clockwise from top left: audience; Richard Layard and Andy Burnham; Andy Burnham; Dr Nancy Rowland

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