“The NHS is only really capable of dealing with people in crisis and this they are struggling with badly owing to burgeoning demand, cost constraints and under resourcing. In many Trusts, the barriers to entry are increasing, GP referrals are being refused and clinicians are being forced to raise the severity levels at which treatment can be offered in the face of static or reducing resources and rising demand. You have to be ever more ill to secure treatment which itself is beset by unacceptable waiting lists and limited care pathways under the IAPT/CAMHS programme. The situation is thus worsening rather than improving.
With people in crisis, not only are individuals impaired, but so too are their families and communities, sometimes for years. The road to recovery from crisis is long, very expensive and typically exhibits a high probability of recurrence. The political, economic and social cost is enormous, to say nothing of the loss to society inherent in multiple impaired life paths, loss of economic contribution and the increased burden on social support systems.
This is especially relevant for young people with rest-of-life potential post trauma. With 75% of psychosis pre-dating higher education, it makes economic, moral and political sense to focus more resources on prevention in the young population. Better education and improved community level mental health literacy, together with stronger, community based early interventions, bringing together presently fragmented programmes, organisations and islands of best practice, will reduce the numbers reaching crisis.
Put simply, we should be aiming to give the NHS less to do. Save one person from crisis and we save fortunes in expensive and challenging treatments. We also save dozens of others from anguish and torment. Moreover, prevention will lead to happier and healthier communities which are better able to progress to make a full economic and social contribution, thereby further reducing dependency on welfare based funding. Wellbeing and resilience education (for young people, teachers, care workers, GPs and parents) has a very low per capita cost profile if properly embedded in the education and community environment. On economic, social and fiscal measures, the case for an increased focus on prevention is incontrovertible.
The government has committed to increased treatment funding via the NHS. If we can reduce the demand for NHS services at the same time via prevention, we can create a virtuous cycle of reduced demand and better provision. Only in this way can we ever hope to bridge the gaping and current disparity between rising demand for care and a woefully inadequate treatment system. We will also save tens of thousands from a thoroughly miserable life.”
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