Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Royal College of Psychiatrists (PH 34)

  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 inequalities.

  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

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