Reflections on a shadow minister for mental health

Mark Brown reflects upon what the advent of a (Shadow) Minister for Mental Health means for mental health debate in England.

On Sunday 7th of February 2016 I was lucky enough to be present at Changing Minds, a weekend long mental health themed festival at London’s Southbank Centre.

The final keynote was an interview with Labour MP Luciana Berger, the first ever Shadow Minister for Mental Health.  In front of an audience in the Clore Ballroom she what she felt the greatest issues were in tackling the current challenges in the lives of people with mental health difficulties and what she viewed her role to be in the process of Labour policy development.  In the discussion of her role, Berger stressed strongly that her brief did not end at improving the provision and funding of NHS mental health services.  She said that she saw it as vital to add a mental health dimension to discussion arounds other areas of policy, listing her work with colleagues on policy formulation around areas such as housing and education.  I asked from the audience what she felt was the biggest uphill struggle in her brief so far or in the future. Her answer was “all of it.”  She was keen to stress that the audience should remember that she represents the party in opposition.

In the weeks after Luciana Berger’s appointment to the Shadow Cabinet I was asked to give comment by Disability Now on what her appointment meant for mental health more generally.  The comment I originally gave was much longer.  What interested me was that my thoughts at the time of the value of a minister for mental health, shadow or otherwise, almost directly reflected the position that Berger herself expressed to the audience at the Southbank Centre.

Looking out my original comments, it was interesting to see how closely her chosen understanding of the role mirrored my own musing.  As my full comments said:

“It’s a victory for the raised profile of mental health that there is political capital to be gained by addressing it. There’s something strong to be said for a minister (or in Luciana Berger’s case Shadow Minister) for mental health. Mental health is potential an issue that runs through all other areas of public policy, rather than being a particular piece of government. At a time where it is neccessary to find traction for the consideration of the mental health or illhealth of people as it interacts with public policy; a cross cutting role makes sense.

“It’s worth noting that Scotland has taken a different approach to mental health to the national government, with a stronger in principle focus on mental health across policy rather than just within health or social care.

“Even a shadow minister for mental health can help to bring texture and context to policy debates about mental health which, without an anchor in the real world of people’s lives tend to fly off into rhetoric and abstraction.

“In many ways it should be the role of a shadow minister for mental health not just to turn up when mental health services are being discussed; but to turn up to everything else and bring an understanding of the ways in which a given policy area impacts upon the mental health of the country and the lives of those with mental health difficulty within it. This means asking not just the question ‘how do we make mental health services better?’ but also ‘how do we make a society that supports those with mental health difficulties well and which creates the conditions for positive mental health, regardless of the policy area?’ An analogy for this might be Environment Minister rather than Care Services minister, a minister responsible for holding other ministries to account for their effect, positive or negative, on a particular cross cutting issue.

“To actually begin to take on the question of the ways in which a society better protects its mental health and the health of those that experience mental health difficulties is in some respects a politically unpalatable one because it doesn’t just suggest making better mental health services but also suggests acting upon the social determinants of mental ill-health and on the establishment of strong protections for those who have need of support, treatment or care.

“At present all political parties are dancing around the issue and finding it difficult to give voice to the idea that what we currently have is inadequate, outdated and often greatly out of line with the wishes, needs, aspirations and desires of people who experience mental health difficulty. Austerity is not good news for people’s mental health and tends to cut most harshly against those in most need. People with mental health difficulties often find themselves at the harsh end of of both public policy and market forces, tending to earn less over a lifetime, tending to be more reliant on social security protections and taxation funded support. People with mental health difficulties tend to end up poorer than they would if they had never experienced mental health difficulties; and being poor tends to increase your chances of becoming unwell.

“Mental health services are a vital part of helping people to have the best life they can have but even the best funded; best developed mental health service cannot remedy situations of economic and social inequality. While a focus on prevention is laudable it offers little for people who are already unwell and offers nothing to people who currently have chronic health conditions. No political party is currently answering the question of how we improve the quality of life for those who are already unwell and will always be some variety of unwell.

“I’m looking forward to a political debate about what it means to have a mental health difficulty in the UK and for a mature consideration of the ways in which the common levers of public policy can make life better or worse for people with mental health difficulties.”

As I have written elsewhere, we are still in anticipation of the independent Mental Health Taskforce’s five year mental health strategy.  Even this document, concerned only with NHS mental health services, seems according to some sources to suggest a far greater outlay on meeting mental health need than is currently budgeted.

It would be interesting to see the effect of creating a Minister for Mental Health in  Government.  My sense is that such a role in a majority government would open a can of worms with which few Westminster governments would be comfortable.  In fact, one of the most dangerous things an existing government could do would be to fully take on the process of embedding mental health and mental wellbeing at the heart of all spending decisions.  We might like it but I’m sure any Chancellor would be less than keen.

When thinking about the needs of people with  mental health difficulties in England, the more you look (and listen), the more you find.

Mark Brown is development director of Social Spider CIC.  He is @markoneinfour on twitter.

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