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Focus on…Mental health

Sean Duggan, chief executive of the Centre for Mental Health, sets the scene for mental health commissioning in England

The creation of CCGs presents GPs with an opportunity to achieve step changes in both the mental health of their communities and the quality of life of people with mental health problems.

Mental ill health accounts for about a quarter of all GP consultations and one-eighth of the NHS budget, yet up to three-quarters of people with mental health problems never seek or receive treatment. Its social and economic costs outstrip the entire NHS budget, at some £105bn a year. And people with severe mental illnesses can expect to live for some 15 years less than their peers.

Earlier this year, the Government published an ambitious and wide-ranging mental health strategy, No Health Without Mental Health. It set out six objectives for improving the population's mental health and the lives of people experiencing mental ill health. Using these objectives as a guide, commissioners can take a strategic approach to mental healthcare that will have a transformative effect on people's lives.

Commissioning mental healthcare can appear to be much harder than other health services. Many people use mental health services over long periods of time or have fluctuating conditions that are not readily packaged into episodes of care with clear outcomes. Perhaps because of this, Payment by Results is still in development for adult mental health services and some way away for children's services. And mental healthcare cannot be commissioned through the NHS alone. It requires joint work with social services, drug and alcohol services, and a range of other agencies, as the case studies in this edition show.

Yet the potential for commissioners to make a difference to the lives of the one in six of us who will experience mental ill health each year is huge.

Half of all lifetime mental health problems first occur by the age of 14. The sooner a person receives treatment and support for mental health problems, the more quickly they will recover and the less damage it will do to their chances of integrating well in society.

So commissioning for early intervention can make a big difference – not just to people's lives but to the efficiency of the NHS itself. Investing limited resources in children's mental health, psychological therapies, early intervention in psychosis teams and alcohol screening in primary care has been shown to generate big savings within the NHS, for the public purse and for society as a whole.

The way mental healthcare is commissioned can also help to refocus services on what matters most to the people who use them. Supporting people in their own recovery journeys may mean more emphasis on coaching, peer support and help with employment – again, improving the quality of support on offer without costing the NHS extra money and with the potential for long-term savings.

Commissioners can also make a big difference by bridging the artificial divide between physical and mental health. Not only do people with mental health problems have worse physical health than average, but people with long-term conditions also have a higher risk of poor mental health.

There is now growing evidence that liaison psychiatry is highly cost-effective and that psychological therapy for people with long-term conditions can achieve substantial gains in their overall health.

So the opportunity is there for the NHS's new commissioners to bring radical change for the better. Some have already begun to do this and are working to make links not just within the NHS, but with local authorities and other potential partners. If more were to join them, we could achieve better health for all and better value for money across the NHS.

Sean Duggan is chief executive of the Centre for Mental Health