Memorandum by the Royal College of Psychiatrists
The Royal College of Psychiatrists wishes to
draw to the attention of the Health Committee the following concerns:
1. Feedback from the members of the College
is that in many areas the priority that central government is
giving to mental health services is not reflected in their local
public health services. An important factor in this is the stigma
and prejudice that often exists and can result in some health
professionals and senior management considering mental health
issues as less important than physical health. This is particularly
significant for groups who have more that one diagnosis that is
potentially stigmatising such as those with both a learning disability
and a mental health problem. This will inevitably lead to health
2. The experience of many members of the
College in relation to some of the Government initiatives, particularly
HAZ, EAZ and HImP, is that projects have often been hurriedly
constructed to attract funding and are then poorly thought through,
poorly co-ordinated and not well evaluated. There is a cynicism
about the real impact of this approach and a strong impression
that there is a lack of strategic coherence to local plans.
3. There is considerable concern about the
capacity and ability of PCGs and PCTs to manage a huge and complex
agenda of health issues. Their mixed commissioning and providing
role, and their limited experience of commissioning, could also
lead to skewed priorities. The latest organisational changes carry
the potential for fragmentation or mismanagement of good quality,
and focused mental health services and may well not promote the
necessary changes to improve those services that are less effective.
Some PCGs have a strong commitment to mental health, some have
a weak commitment, and some have idiosyncratic views that are
not in line with the NSF expectations for future service development.
The public health role in informing, influencing and monitoring
this situation is very important.
4. The NSF for Mental Health is an important
tool for improving the mental health of the population. However,
the tight deadlines, the imperative for hard-pressed and under-resourced
agencies to work together, and the expectation that this work
will be absorbed by existing staff, may be unrealistic and therefore
will not lead to the public health gains expected. Furthermore,
it requires service developments that are based on an assumption
that the existing services are adequate. Sadly this is often not
the case. For example, the College makes recommendations about
the human resources required to safely and adequately deliver
consultant expertise to a population, but the funding of services
is generally insufficient for such recommendations to be implemented.
This is just one example of the way in which public health priorities
have not addressed mental health issues in many parts of the country.
3 July 2000