A house along Kensington Palace Gardens, which has been named as Britain's most expensive street. Photograph: Getty Images.
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Why Labour's London mayoral hopefuls might regret their opposition to a mansion tax

By resisting a progressive measure backed by most Londoners, they have given Sadiq Khan the chance to position himself as the radical candidate. 

Of London's likely London mayoral candidates, there are now four who oppose the party's policy of a mansion tax. David Lammy (the only officially declared candidate bar transport expert Christian Wolmar) and Tessa Jowell have rejected the measure, which would involve a charge of 1 per cent on property values above £2m, as "a tax on London". Margaret Hodge has declared: "The problem identified is the right one, I just think the solution is too crude to work properly." Even Diane Abbott, a stalwart of the socialist Campaign Group, has warned: "The turbo-charged nature of the London property market means that anyone who bought a family house in a previously unfashionable part of London decades ago could easily now be living in a house worth over £1m. And, although the mansion tax will not affect properties at that level, I suspect that those voters will be jumpy." (Andrew Adonis, who was considering standing, but is now expected to support Jowell, has also criticised the policy). 

Only Sadiq Khan, the shadow London minister and shadow justice secretary, has remained loyal to the party line. Khan, a leading figure on the left of the party and a close ally of Ed Miliband (he ran his leadership campaign), regards the tax as vital to reducing inequality in the capital. 

What explains the hostility of his rivals to a progressive and popular policy? (72 per cent of the public and 59 per cent of Londoners support it.) The primary concern expressed is that it will penalise those who are asset rich but cash poor: people on modest incomes who could struggle to afford the £5,000 bill that a £2.5m property would incur. But this issue has already been addressed by Ed Balls, who announced in June that there would be "protections in place" for this group. This would take the form of a relief scheme, or allowing low-earners to defer payment until the property is sold. The shadow chancellor also responded to the concern expressed by Abbott by pledging that the threshold for the tax would be raised annually in line with average increases in house prices, rather than general inflation. This, he said, would "ensure that more modest properties are not brought into the scope of the tax". 

But rather than policy, it is politics that may explain the mayoral hopefuls' stance. All are keen to avoid being seen as "party hacks", and to be seen to defend Londoners (90 per cent of properties worth more than £2m lie in the capital), even if against their own party, following the example set by Ken Livingstone and Boris Johnson. By opposing a mansion tax they also helpfully align themselves with the position of the Evening Standard, which has long criticised the measure as "a tax on London". 

Yet, for similarly political reasons, they could yet regret their stance. London is one of the most unequal cities in the developed world; it is home to more billionaires than any other, but one in three Londoners live in poverty, two-thirds of them in work. A recent poll found that 80 per cent of residents believe the income gap is too high and that 87 per cent believe rising inequality is unfair. Contrary to claims that "ordinary" voters would be hit, it's estimated that only 0.4 per cent of Londoners would be affected - 80 per cent of them within the wealthy boroughs of Westminster and Kensington and Chelsea. Last year, only two properties in Jowell's borough of Southwark, one property in Lammy's borough of Haringey, and no properties in Hodge's borough of Barking and Dagenham were sold for more than £2m. 

By nonetheless opposing the policy, they have provided Khan with a potent dividing line for the Labour selection contest. Bill de Blasio won election as New York mayor last year (and defeated his centrist rivals) by campaigning on the theme of of "a tale of two cities" and vowing to radically reduce inequality. In resisting the redistributive mansion tax, Labour's London mayoral hopefuls have given Khan the chance to similarly claim this territory for himself. 

George Eaton is political editor of the New Statesman.

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British mental health is in crisis

The headlines about "parity of esteem" between mental and physical health remain just that, warns Benedict Cooper. 

I don’t need to look very far to find the little black marks on this government’s mental health record. Just down the road, in fact. A short bus journey away from my flat in Nottingham is the Queens Medical Centre, once the largest hospital in Europe, now an embattled giant.

Not only has the QMC’s formerly world-renowned dermatology service been reduced to a nub since private provider Circle took over – but that’s for another day – it has lost two whole mental health wards in the past year. Add this to the closure of two more wards on the other side of town at the City Hospital, the closure of the Enright Close rehabilitation centre in Newark, plus two more centres proposed for closure in the imminent future, and you’re left with a city already with half as many inpatient mental health beds as it had a year ago and some very concerned citizens.

Not that Nottingham is alone - anything but. Over 2,100 mental health beds had been closed in England between April 2011 and last summer. Everywhere you go there are wards being shuttered; patients are being forced to travel hundreds of miles to get treatment in wards often well over-capacity, incidents of violence against mental health workers is increasing, police officers are becoming de facto frontline mental health crisis teams, and cuts to community services’ budgets are piling the pressure on sufferers and staff alike.

It’s particularly twisted when you think back to solemn promises from on high to work towards “parity of esteem” for mental health – i.e. that it should be held in equal regard as, say, cancer in terms of seriousness and resources. But that’s becoming one of those useful hollow axioms somehow totally disconnected from reality.

NHS England boss Simon Stevens hails the plan of “injecting purchasing power into mental health services to support the move to parity of esteem”; Jeremy Hunt believes “nothing less than true parity of esteem must be our goal”; and in the House of Commons nearly 18 months ago David Cameron went as far as to say “In terms of whether mental health should have parity of esteem with other forms of health care, yes it should, and we have legislated to make that the case”. 

Odd then, that the president of the British Association of Counselling & Psychotherapy (BACP), Dr Michael Shooter, unveiling a major report, “Psychological therapies and parity of esteem: from commitment to reality” nine months later, should say that the gulf between mental and physical health treatment “must be urgently addressed”.  Could there be some disparity at work, between medical reality and government healthtalk?

One of the rhetorical justifications for closures is the fact that surveys show patients preferring to be treated at home, and that with proper early intervention pressure can be reduced on hospital beds. But with overall bed occupancy rates at their highest ever level and the average occupancy in acute admissions wards at 104 per cent - the RCP’s recommended rate is 85 per cent - somehow these ideas don’t seem as important as straight funding and capacity arguments.

Not to say the home-treatment, early-intervention arguments aren’t valid. Integrated community and hospital care has long been the goal, not least in mental health with its multifarious fragments. Indeed, former senior policy advisor at the Department of Health and founder of the Centre for Applied Research and Evaluation International Foundation (Careif) Dr Albert Persaud tells me as early as 2000 there were policies in place for bringing together the various crisis, home, hospital and community services, but much of that work is now unravelling.

“We were on the right path,” he says. “These are people with complex problems who need complex treatment and there were policies for what this should look like. We were creating a movement in mental health which was going to become as powerful as in cancer. We should be building on that now, not looking at what’s been cut”.

But looking at cuts is an unavoidable fact of life in 2015. After a peak of funding for Child and Adolescent Mental Health Service (CAMHS) in 2010, spending fell in real terms by £50 million in the first three years of the Coalition. And in July this year ITV News and children’s mental health charity YoungMinds revealed a total funding cut of £85 million from trusts’ and local authorities’ mental health budgets for children and teenagers since 2010 - a drop of £35 million last year alone. Is it just me, or given all this, and with 75 per cent of the trusts surveyed revealing they had frozen or cut their mental health budgets between 2013-14 and 2014-15, does Stevens’ talk of purchasing “power” sound like a bit of a sick joke?

Not least when you look at figures uncovered by Labour over the weekend, which show the trend is continuing in all areas of mental health. Responses from 130 CCGs revealed a fall in the average proportion of total budgets allocated to mental health, from 11 per cent last year to 10 per cent in 2015/16. Which might not sound a lot in austerity era Britain, but Dr Persaud says this is a major blow after five years of squeezed budgets. “A change of 1 per cent in mental health is big money,” he says. “We’re into the realms of having less staff and having whole services removed. The more you cut and the longer you cut for, the impact is that it will cost more to reinstate these services”.

Mohsin Khan, trainee psychiatrist and founding member of pressure group NHS Survival, says the disparity in funding is now of critical importance. He says: “As a psychiatrist, I've seen the pressures we face, for instance bed pressures or longer waits for children to be seen in clinic. 92 per cent of people with physical health problems receive the care they need - compared to only 36 per cent of those with mental health problems. Yet there are more people with mental health problems than with heart problems”.

The funding picture in NHS trusts is alarming enough. But it sits in yet a wider context: the drastic belt-tightening local authorities and by extension, community mental health services have endured and will continue to endure. And this certainly cannot be ignored: in its interim report this July, the Commission on acute adult psychiatric care in England cited cuts to community services and discharge delays as the number one debilitating factor in finding beds for mental health patients.

And last but not least, there’s the role of the DWP. First there’s what the Wellcome Trust describes as “humiliating and pointless” - and I’ll add, draconian - psychological conditioning on jobseekers, championed by Iain Duncan Smith, which Wellcome Trusts says far from helping people back to work in fact perpetuate “notions of psychological failure”. Not only have vulnerable people been humiliated into proving their mental health conditions in order to draw benefits, figures released earlier in the year, featured in a Radio 4 File on Four special, show that in the first quarter of 2014 out of 15,955 people sanctioned by the DWP, 9,851 had mental health problems – more than 100 a day. And the mental distress attached to the latest proposals - for a woman who has been raped to then potentially have to prove it at a Jobcentre - is almost too sinister to contemplate.

Precarious times to be mentally ill. I found a post on care feedback site Patient Opinion when I was researching this article, by the daughter of a man being moved on from a Mental Health Services for Older People (MHSOP) centre set for closure, who had no idea what was happening next. Under the ‘Initial feelings’ section she had clicked ‘angry, anxious, disappointed, isolated, let down and worried’. The usual reasons were given for the confusion. “Patients and carers tell us that they would prefer to stay at home rather than come into hospital”, the responder said at one point. After four months of this it fizzled out and the daughter, presumably, gave up. But her final post said it all.

“There is no future for my dad just a slow decline before our eyes. We are without doubt powerless – there is no closure just grief”.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.