Implementing mental health policy: some lessons from recent history

The Mental Health Taskforce’s Five Year Forward View report (released February 2016) aimed at improving mental health support in and around the NHS. The plan will be the latest of many documents that have aimed to set policy and support its implementation in this field.

Implementing mental health policy was commissioned by NHS England from Centre for Mental Health, and fed into the Taskforce’s planning in 2015. The report reviews previous mental health strategies and their implementation, analysing their impact and looking at what aided or hindered successful implementation.

To ensure that the taskforce report makes as much impact as possible, we have examined what we can learn from previous strategies: looking at what has helped to make them successful and what has held back implementation. We have explored what are the core components of strategies that get implemented, and what we can learn from those that have had less impact and those that generated unintended consequences.

We carried out:

• A brief literature review of previous strategies and their implementation: focusing on how much impact they have made and what has been documented about why.
• Interviews and focus groups with people in key roles supporting the implementation of strategy and the use of resources in mental health care, understanding their perspectives on what makes for success or failure.

Based on this evidence review, we made some key recommendations to the taskforce to aid them in implementing the Five Year Forward View:

1. The Government and the NHS should ensure that sufficient funding is made available to achieve the Taskforce’s recommendations. Investment is needed to support the processes of change, such as protected time for learning, project management and local leadership, and the double running costs associated with reinvestment.
2. The Arms’ Length Bodies should jointly invest in a robust and stable implementation support system for the Taskforce recommendations. This should be sustained for sufficient time to provide a wide range of commissioners and providers of mental health support with ongoing help, advice, training and development.
3. The Taskforce and Arms’ Length Bodies should consider how local leaders and partnership and management arrangements will be identified and supported to implement the report’s recommendations. These will be crucial catalysts of change in localities, and they will need to be mirrored nationally to support and encourage ongoing action.
4. The Arms’ Length Bodies should ensure mental health is given equal prominence in all new and existing policy implementation mechanisms, including in all aspects of the implementation of the Five Year Forward View, to avoid falling back into the margins of the system.
5. The Taskforce report should draw on the values, aspirations and expectations of people with mental health problems and of professionals. It should focus on a manageable set of actions that will bring people together, setting out clear expectations but without rigidly limiting how they are interpreted locally.
6. The Taskforce should stipulate what outcomes it wants to see and be clear how these will be measured. Measurable outcomes are crucial, but they need not be in the form of ‘outcome measures’ if process or input measures are likely to be more effective in holding national and local bodies to account for achieving agreed goals within agreed timescales.
7. NHS England should put in place robust, real-time evaluation mechanisms for the implementation of the Taskforce report. Evaluation is essential to identify what is working well, where difficulties are encountered, and how the strategy might need to be adapted on the basis of emerging evidence.

Read our full recommendations to the taskforce, Priorities for mental health.