Realpolitik (see also Political realism; from German: real “realistic”, “practical” or “actual”; and Politik “politics”) refers to politics or diplomacy based primarily on practical considerations, rather than ideological notions or moralistic premises. In this respect, it shares aspects of its philosophical approach with those of realism and pragmatism.
"Manchmal werden Leute den Wald vor lauter Bäumen nicht sehen."

Friday, 10 June 2011

022 - Trapped: What deficit reduction measures mean for mental health provision in the UK

After coming to power in May last year, the Conservative-Liberal Democrat coalition set out a series of deficit reduction measures led by Chancellor of the Exchequer George Osborne MP, in order to re-balance the debts incurred by the UK economy over previous governments.

Much has been made of the inevitable impacts of such measures upon a variety of different areas, including by this site itself on more than one occasion. The British media have also covered a wide range of areas affected by cuts including education, legal aid, VAT, library services and waste collection amongst many others.

One area however in the midst of the potential impacts of wider NHS cuts and heavy job losses has been disappointingly under-reported. This is the impact that heavy-handed deficit reductions will have on mental health provision.

One insider working for the NHS spoke of their area as a result of cuts to funding being reduced to only 12 beds in mental health wards in one hospiral to cover an area population of just under 200,000. This is shocking given that statistics show on average 1 in every 4 in the UK and 10% of children will suffer at some point during their life from some form of mental illness. The United Kingdom also has the highest self-harm rates in Europe (400 per 100,000). Those suffering from mental disorders also show a shorter life expectancy, as much as 15 years for patients of schizo-affective disorder.

Coalition deficit reduction program threatens to undermine mental health provision. Are we on the brink for the sake of a quick economical fix of turning our backs on one of the most vulnerable sections of our society?

The National Mental Health Development Unit has already closed. The total estimated cuts to jobs are more than 15% at several NHS partnerships across the country totalling approximately six thousand jobs according to the website False Economy between 2010-15. Whilst the coalition has been quick to support its £400m investment in mental health services earlier this year, it is interesting to note that the Guardian reports government adviser David Richards was dismissed for revealing this money was not new to the system.

As a result many support centres and day centres will be forced to close, which form types or sections of therapy which many with mental illnesses have become reliant on as a vital crutch for their recovery.

Similar cuts to domestic violence support could also result in an increase in the diagnosesis of certain psychological conditions such as depression commonly associated with the aftermath and recovery from abuse. Statistics from Women's Aid demonstrate that 60% of domestic violence refuge services and 72% of floating support servives - providing help in homes - will after April 1 2011 have received no further council funding. This results in an estimated 40% reduction (320 jobs) in the associated workforce over 89 organisations employing 800 FT and PT staff. Women's Aid have estimated that 70,000 women and children will as a result be unable to obtain any relevant support.

Any reduction in staffing or finance for mental health provision will inevitably impact those most vulnerable. Mismanagement or poor co-ordination of services, or the inability for official sources to take adequate mental health provision seriously are already blamed for incidences of deficient patient care, which will surely only rise as a growing issue becomes more unmanagebale by a reduced workforce.

Similar deficit reductions in the US have already been highly criticised for their negative impacts on mental health provisions. According to a paper by Koyanagi (2006) on Medicaid reductionsreferencing Judge David L. Bazelon (Center for Mental Health Law, Washington DC), it was argued:

Some new options created for state Medicaid programs under Title VI of the Deficit Reduction Act (DRA) could have grave consequences for people with mental illness. Some provisions allow states to limit coverage, increase copayments, impose new premiums, and cap benefits. More positive DRA provisions would make it easier for states to provide home- and community-based services. A ten-state demonstration program will expand coverage for children. The author concludes that a state's adoption of the DRA's mental health-friendly provisions may not offset the damage done by its other provisions.

Mental health experts in the UK have argued that the pace of cuts to the mental health provision and the welfare system in the UK - including draconian revisions to incapacity benefit (IB) requirements - poses a dangerous risk to those in great need of professional care for their conditions.

An open letter to the Guardian called for a more sympathetic movement towards a supportive system that undertook understanding assessments of requirements for recovery as opposed to current abilities for placement in work, and argued that cuts ran the risk of alienating those most in need of help, reporting cases of patients having taken their own lives out of despair. (Paul Farmer Chief executive, Mind, Paul Jenkins Chief executive,Rethink Mental Illness, Professor Bob Grove Joint chief executive,Centre for Mental Health, Dr Jed Boardman Consultant and senior lecturer in social psychiatry, Royal College of Psychiatrists, Bill Walden-Jones Chief executive, Hafal, Billy Watson Chief executive, Scottish Association for Mental Health)

In April the coalition began sending out letters to those on IB requesting they attend a 'work capability assessment' in an attempt to place as many of these people as possible back in the employment sector. It is now sending out over 11,000 requests for reassessment. Whilst it is possible that some currently receiving IB may be suitable for work, critics argue the tests and assessments used are not coherent and sophisticated enough to ensure those who require IB continue to receive the benefit.

Indeed a poll by mental health charity Mind found that 95% thought they would not believed at their reassessment, three quarters felt the assessments had make them feel worse, with 51% reporting suicidal thoughts.

Reports suggest that patients of severe mental disorders have despite GP recommendations, had social events used as evidence of improved cognitive functioning and deeming them therefore as a result fit for employment. Former Labour government communications minister Alistair Campbell has called for patients and carers to stand against such cuts, having suffered a breakdown himself in 1986.

There are clear arguments both for and against the reformation of the National Health Service in order to ensure its survival for decades to come. However, disproportionate cuts undertaken without due care and attention and consultation with medical professionals could demonstrate a neglectful indifference on the government's position on mental health. It could also more worryingly remove vital support to a highly vulnerable section of society, worsen national mental health and leave an appalling number of patients without access to necessary adequate care and recovery.

- sandlefish -

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