The MHIS – and why losing it would be ‘devastating’ for local mental health services
West Berkshire charities have warned that potential cuts to NHS mental health services due to funding pressures would be “devastating”.
The Secretary for Health and Social Care Wes Streeting confirmed his commitment to the Mental Health Investment Standard (MHIS) in his first appearance before the Health and Social Care Committee yesterday (Wednesday).
But some charities are still concerned the MHIS and the increased spending it guarantees for mental health services each year will not continue in its current form.
They say changing this policy framework could reverse years of progress at a time when more than one million people are stuck on waiting lists for mental health care in England.
“Losing the MHIS would be devastating,” claimed Response, a mental health charity based in Oxford that is expanding to Thatcham next year. “It would mean fewer resources for people struggling with their mental health and longer waits for those urgently seeking help. This is simply unacceptable.”
Mr Streeting said: “I am committed to the MHIS. I think it is really important.
“We have only been in government for five months. We haven’t set the financial allocations for the year ahead yet and I do think, on a number of fronts, people have slightly jumped the gun and gone into battle mode straightaway.”
He added the Government’s mandate to the NHS would be published shortly, with its planning guidance to follow in the New Year.
But where were these concerns coming from?
An earlier statement by the Department of Health and Social Care said: “Claims that we will be cutting back vital mental health services are untrue.
“While funding for reforms and improvements to mental health services will be decided at the Spending Review, the Budget provided an extra £26 million to open new mental health crisis centres and funding to provide talking therapies to an extra 380,000 patients.
“We remain committed to recruiting an additional 8,500 mental health workers, providing access to a specialist mental health professional in every school in England, Young Futures hubs in every community and modernising the Mental Health Act."
It did not rule out cuts to MHIS directly. In fact, it wasn’t mentioned. But first.
What is the MHIS?
The MHIS, set by NHS England, requires Integrated Care Boards (ICBs) – which oversee the planning, commissioning and funding of local health and care services – to spend proportionally more on mental health services than the overall increase in their budget allocation, to address the historic underfunding in mental health.
So, if the overall increase was two per cent, then spending on mental health services would be expected to increase by more than two per cent.
What it does not do, however, is assess how well money is spent and how service users and patients benefit.
ICBs must comply with the MHIS by submitting detailed financial reports at the end of each financial year, which are subject to independent review.
What would the impact be of losing the MHIS?
Speaking to mental health charities and health and social care providers reveals further concerns about the ‘knock-on’ effect that losing the MHIS could have on the success of any future reforms or investments in mental health services.
It also risks local mental health budgets being raided to prioritise other services across the NHS, including A&E, they added, when people with mental health needs would be better served by mental health services.
Adrian Barker, who chairs the Mental Health Action Group, a subcommittee of the Health and Wellbeing Board for West Berkshire, said the MHIS was a “fairly crude mechanism” but helps to ensure mental and physical health are treated equally.
Speaking in a personal capacity, he said: “Given all the financial pressures at the moment, there's a risk that, if the investment standard requirement isn't there, the increasing spending on mental health doesn't continue and it might even slip back.
“It’s not just about mental health services. We should also be thinking how to stop problems happening in the first place. There has been a longstanding aim, both nationally and locally, to move to more prevention, to stop people becoming ill, rather than treating them after they become unwell.
“However, it takes time for the work on prevention to bear fruit, and you can’t stop treating people in the meantime.
“The extra money from the MHIS could be used for some of that prevention, particularly supporting some of the voluntary sector bodies who do such a great job in this area.”
A spokesperson for Response added: “Mental health services are already stretched thin, and removing the MHIS would make this crisis even worse.
“We know the work we do is needed and supports the statutory services so if the government chose to remove this route of funding, it would be devastating for the whole charitable sector.”
Davina Nicholson, clinical lead at Time to Talk West Berkshire, explained that while the charity has kept its waiting lists down to eight weeks through active fundraising, the potential withdrawal of the MHIS could impact it in other ways.
“We do get access to one little pot of NHS money and that's not changing,” she said.
“We are impacted by the fact that statutory services, most particularly CAMHS (Child and Adolescents Mental Health Service), have huge pressures.
“We don't receive the funding we really probably ought to from the statutory services, but we recognise the pressures on those services are so great.
“There's always a knock-on effect. All these services are connected, are related, because we are the landscape.”
But for some of its partners in local health and social care, waiting times are significantly higher.
West Berkshire Council’s executive member for children and family services Heather Codling (Lib Dem, Chieveley & Cold Ash) said: “Like many children and young people’s mental health services, the Emotional Health Academy is experiencing a high number of requests for direct mental health support.
“Our data suggests referral numbers have increased by 20 per cent compared to the same period last year.
“The average wait time for direct, one-to-one support from the EHA is approximately one year.
“This is a lot longer than we would like, and we acknowledge it is not conducive with the early help offer we strive to achieve.
“Every effort is being made to find ways to increase capacity which would enable us to respond quicker to requests for direct support, as well as offer more training to professionals and schools working with children and young people.”
She also confirmed the council has not been made aware of any formal plans to abolish the MHIS.
Chair of West Berkshire Suicide Prevention Action Group Garry Poulson noted the wider causes and effects of mental illness and the need to invest in mental health services, adding: “At a time when all day, every day we are hearing of the poor mental health of young people, how this effects workplaces, the effect on the mental health caused by poor housing and poverty, then you would think that it would naturally follow that the investment in mental health services would increase.”
The Buckinghamshire, Oxfordshire and Berkshire West ICB declined the opportunity to comment.
