The nation’s mental health is getting worse, with an especially significant increase in levels of distress among children and young people over recent years. With mental ill health costing society and the economy £300 billion in England every year, the NHS’s new ten-year plan is a critical opportunity for the Government to invest in mental health – one it cannot afford to miss.
Commissioned by the NHS Confederation’s Mental Health Network, we’re analysing economic evidence about investment priorities for the Government’s ten-year health plan from a mental health perspective.
Our interim analysis has highlighted a range of key investment areas which are backed by economic evidence:
Enabling specially trained health visitors to support new mothers’ mental health
- 1 in 5 women experience a perinatal mental health problem, 70% will hide or underplay maternal mental health difficulties, and suicide is the leading cause of maternal death in the first postnatal year.
- The health and social costs of maternal depression, anxiety, and psychosis were estimated to carry long-term economic and social costs of approximately £8.1 billion for every one-year cohort of births in the UK. This equates to a cost of almost £10,000 per birth.
- A model of integrated service provision for mothers’ mental health, where health visitors, midwives and mental health practitioners offer additional support for women’s mental health alongside supporting them and their baby with their physical health, has been found to be economically viable.
- The PoNDER health visitor training package successfully prevented symptoms of postnatal depression in a population of lower-risk women and was reported to be cost-reducing over a 6-month period (adjusted costs were £82 lower in intervention group compared to control).
- Investing in earlier help for women experiencing perinatal mental health difficulties has multiple benefits and will complement the existing development of specialised services for those with the most severe needs.
Providing evidence-based parenting programmes
- Evidence suggests that some parenting programmes are effective as early prevention strategies to lower the risk of mental health problems and poor emotional development for children.
- One example is Incredible Years, an evidence-based parenting programme that aims to reduce child disruptive behaviours by teaching parents to break cycles of negative parent-child interactions. Research has found that Incredible Years delivered the greatest benefits for the most distressed families, and that it could provide savings to the public sector in the longer term.
- Programmes such as Incredible Years and Triple P would help to achieve long-term benefits for families and children nationwide if implemented at scale.
Expanding the national network of early support hubs for young people
- In October 2023, the previous Government announced almost £5 million to fund early support hubs nationwide to deliver support to children and young people.
- In February 2024, extra funding for early support hubs was offered in local communities. 24 hubs will receive a share of almost £8 million to help young people get support with their mental health at an earlier stage, with services including psychological therapies, specialist advice and support for wider issues including sexual health, exam worries, jobs, drugs, alcohol and financial worries.
- The current Government’s manifesto pledged to establish a nationwide network of easy-to-access early support mental health hubs. This is highly likely to be excellent value for public money.
Developing more digitally enabled talking therapies
- In 2023/24, there were 1.82 million referrals to NHS Talking Therapies – more than double the figure in 2012/13
- In 2021/22, a total cost of £596.8 million was reported by 47 providers of NHS Talking Therapies, a figure based on 4.7 million appointments.
- To increase support, NICE has recommended seven digitally enabled therapies (DET), suggesting that these could free up thousands of NHS therapist hours. Early economic analysis by NICE suggests that these technologies could be cost-effective based on current prices and evidence. However, more evidence is needed to determine the actual clinical and cost-effectiveness of such technologies.
- Expanding NHS Talking Therapies to meet more people’s needs in different ways would be an important further step in the programme to improve access to psychological support.
Further expanding Individual Placement and Support employment services
- IPS (Individual Placement and Support) supports people with severe mental health difficulties to find meaningful, paid employment.
- The EQOLISE project compared IPS with other vocational/rehabilitation services in six European countries, and concluded that IPS clients were twice as likely to gain employment (55% vs 28%) and worked for significantly longer; the total costs for IPS were generally lower than standard services over the first 6 months; and people who gained employment had reduced hospitalisation.
- IPS is currently being expanded across NHS mental health services and in drug and alcohol services. This should continue so that it is available to all who can benefit from it.
Providing a wider range of alternatives to hospital admission in a mental health crisis
- There has been an alarming increase in the number of children and young people presenting at A&E with mental health needs. The number of 11-25 years olds admitted to hospital for mental health reasons increased by 20% between 2017-2023, with 150,000 visiting acute settings for mental health support.
- Recent analysis by York University found that the total cost of secondary mental health services in England increased by 13% between 2016 (£5.1bn) and 2019 (£5.7bn).
- At the end of March 2024, there were 900 recorded out-of-area placements in England – 805 of which were reported as inappropriate.
- NHS England has allocated funding as part of the Long Term Plan to invest in alternative models of crisis support, such as crisis cafes, safe havens, and crisis houses, providing an alternative to A&E or inpatient admission.
- These are crucial investments that require both revenue and capital funding to ensure that people facing a crisis have access to the right support quickly and in safe, therapeutic, trauma-informed environments.
Supporting mental health in later life
- Research on older people’s mental health has found that ageism and discrimination stop older people from accessing support, with poor mental health often dismissed by health professionals as an ‘inevitable’ part of ageing.
- Older people face barriers to mental health support at every level: from being disregarded by professionals to facing a lack of specialist services and being overlooked by national and local mental health strategies in England.
- The total annual cost of dementia in England was estimated to be £24.2bn in 2015, of which 42% (£10.1 bn) was attributable to unpaid care. Social care costs (£10.2 bn) are three times larger than health care costs (£3.8bn).
- The ten-year plan is a crucial opportunity to focus on mental health in later life, with equitable provision of effective support for people over the age of 65.
The Government faces difficult decisions about how to get the NHS – and the nation’s health – back on its feet. But our mental health is too important to be left to chance. We will continue our analysis, producing a fuller report in early 2025 with a comprehensive set of investment priorities to rebuild the nation’s mental health.
