I was reviewing my casework one day and I thought, I can count on one hand the number of times someone has come to me about the state of our health and social care system, yet I seem to be approached daily about potholes. Now of course potholes are important, but for me personally what is more important is how we give people in my borough the best possible chance in life. Now you all know some of the challenges we are facing in local government and we all know when local government sneezes, the NHS catches a cold. But what do those challenges mean for mental health services? And what solutions can we explore?
The challenges are quite simple, local government has no revenue. The services that we once ran that provided community interventions and built community capacity are now gone, and this has resulted (in my view) in more people presenting to mental health services at a more acute stage of their illness. I would argue that sometimes in mental health services we put up walls when we get more demand than we can meet. Local government and mental health services need to work together to break down those walls and I want to explore some ways in which that can happen.
To start, I can imagine the majority of mental health services when interacting with local government have built a relationship with the social services department, or maybe youth services or public health. That’s fantastic however there is so much more to local government and I wonder how many have ever considered building a relationship with the planning department?
I am not a planning expert, but in short the council’s planning department decides whether a piece of development is allowed and the impact it will have on the area. When we talk about health in planning committee, if we talk about health, we often talk about GPs. Do we talk about mental health infrastructure?
A planning committee can spend hours arguing about the impact on car parking spaces, or highways, or the view of Mr Smith at number 22 but I would say mental health gets left of the agenda. Will the development at number 24 impact on a locality’s mental health and do we have enough mental health infrastructure to manage it?
It’s important to consider how to influence planning decisions and to that end decisions in planning committee are complicated but are often weighted by a local development plan and national planning policy. I’m not going to go into national planning policy but I do want to discuss local development plans. For those who don’t know, local development plans help shape a locality for decades to come, so what is built where and what infrastructure is going to be put in place to support that.
And when we think about those local development plans:
- How many of those local development plans discuss mental health?
- How many of them include a section about mental wellbeing?
- Do you know how your local development plan will impact on your mental health service provision?
- How will development impact on mental health in a locality?
These are questions that need to be asked because many planning authorities won’t give mental health a second thought, yet mental health services are an essential cog in the system because if people have mental health conditions, then there are major cost implications further down the line for all services. Mental health services need to be proactive in engaging with local development plans because if they are not, they will more likely than not be left out of the picture.
Remember that many councillors and local authorities are at the beginning of their journey in understanding mental health and mental health services need to push local government more often and in the right places. Mental health services need to be very clear and they need to take the time to explain what they do and how they interact with the local community. They need to sell themselves because they do an important job. My advice to clinicians is to see their local council as a patient that needs empowering.
Mental health transcends local government and every single department in a local authority will be impacted in some way, shape or form by mental health, yet not all parts of local government are joined up with mental health services. I am going to be honest here and say local councillors are not held accountable for this because very few people put pressure on us to do something about it.
When local authorities are put under pressure to do something and are empowered to do so, an incredible difference can be made. We as local councillors bring together every single part of the community. We can go to the chief operating officer of the CCG that’s cut your budget. We can speak to the chief executive who has just moved you into the basement. We can also simply put our hand up in a meeting and ask, “has anyone thought about how this change we are making will impact young people with mental health conditions”.
Now I said earlier that local councillors and local authorities are at the beginning of understanding mental health services, but that’s changing fast. The number of local authorities signed up to the mental health challenge has doubled in one year and is now nearing 100 local authorities across the UK who want to be counted as an authority that tries to do more for mental health.
So if you take one thing away from this blog, it would be to speak to your local councillors about mental health, ask them is mental health included in their local development plans and don’t let potholes dominate the political agenda in local government.