Staff at Selly Oak Hospital in Birmingham. Photo: Christopher Furlong/Getty Images
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The UK’s mental health care is in crisis – the next government must act urgently

Mentally ill patients forced to travel hundreds of miles for treatment, forcible sectioning in order to get beds and medical students begging for greater teaching on psychiatry: we're not getting it right

A report this week was grim reading for those involved in mental health care. The survey of GPs revealed that one in five had seen patients harmed as a result of “delays or a lack of support” from mental health services, while shortfalls had forced 82 per cent of doctors to act “outside of their competence”. While this news is shocking, it is just another example of the UK’s mental health care crisis.

Just last week, data obtained from freedom of information requests led to claims that the NHS treated mental health care as a “second-class service”. Indeed, thousands of mentally ill patients have been forced to travel “hundreds of miles” for treatment in recent years. Extreme cases have seen patients being forcibly sectioned so that they can receive care in overcrowded wards. Even medical students have resorted to asking for greater teaching on psychiatry, highlighting the derisory attention that mental health issues receive. Yet the state of mental health services is unsurprising considering that they receive only 13 per cent of the NHS budget, despite mental illness affecting around a quarter of the UK population.

Worse still, national spending on mental health has consistently decreased over the past three years. And the trend isn’t limited to adult care; mental health services for children and adolescents have also seen a fall in funding. This decline seems even more irrational considering adolescence is the period when many mental illnesses first manifest, and that hospitals are recording a rise in hospital admissions for conditions such as eating disorders.

The budget cuts have had a noticeable impact, with doctors citing the changes as a cause of “avoidable deaths and suicides,” while mental health organisations claimed that the cuts “put lives at risk”. Mental illness also has a significant impact on a patient’s quality of life, and is thought to contribute to poor physical health, having been associated with diabetes, cancer and cardiovascular disease. As well as the ethical concerns of these cases, such neglect of the mentally ill also has practical implications; a report by the London School of Economics found that the NHS could save over £50m a year by reversing budget cuts to preventative and early intervention therapies.

Yet perhaps the most striking aspect of the decrease in funding comes from the comparison with other areas of health care. The government, for instance, took great pride in announcing that the Cancer Drugs Fund would be ring-fenced until 2016. While it would be wrong to question the severity of diseases such as cancer, it is worth considering that this budget is reserved for treatments that aren’t ordinarily commissioned because they are not cost-effective. Given the nature of the NHS’s funding crisis, it seems unfair to fund relatively inefficient treatments, while the NHS’s most vulnerable patients are left without basic care.

This is the problem. Eager to brand their “reform” of the NHS as good for patients, the coalition has protected the emotive areas of health care that already benefit from public awareness. Aware that severely cutting the budget for paediatrics or cancer care would result in public outrage, the government are cynically withdrawing care from those most lacking a voice in society: the mentally ill.

Although this current crisis is alarming, such disregard of mental health isn’t a recent phenomenon. Plagued by a history of taboo and prejudice, mental health care has historically been chronically underfunded. With a media happy to brand mentally ill people as “psychos” and a threat to society, it has been relatively easy for politicians to excuse this injustice. But public perceptions are changing; a report by the charity Rethink Mental Illness found that public understanding and tolerance of mentally ill people is improving, while 63 per cent were aware of a close friend having a mental health problem.

This is important; for a politician to stand up for mental health care now wouldn’t just be a principled action, it’d be a popular one. With time, and the excellent work of campaign groups, this positive trend in public attitudes will only continue, allowing society to grow in confidence to discuss one of our greatest health challenges. The mental health charity Mind suggests that the next government commits to a 10 per cent rise in the NHS’s mental health budget over the next five years. Considering the state of mental health care and the current funding disparity between health services, this is not an unreasonable request.

Past governments have chosen an area of health care to focus on, in order to target voter demographics. In 1999, Blair announced his “crusade against cancer”. Seeking the “grey vote”, David Cameron called for a “national challenge” to beat neurological diseases such as dementia. But the disgrace of the NHS’s mental health provision goes beyond party politics. Regardless of who wins the general election, the next government must embrace bold reform to end our longstanding neglect of the mentally ill. 

George Gillett is a freelance journalist and medical student. He is on Twitter @george_gillett and blogs here.

Photo: Getty
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Michael Carrick is the “Geordie Pirlo” that England misunderstood

The Manchester United legend’s retirement announcement should leave Three Lions fans wondering what if?

That it came in the months leading up to a World Cup arguably added an exclamation point to the announcement of Michael Carrick’s impending retirement. The Manchester United midfielder, who is expected to take up a coaching role with the club afterwards, will hang up his boots at the end of the season. And United boss Jose Mourinho’s keenness to keep Carrick at Old Trafford in some capacity only serves to emphasise how highly he rates the 36-year-old.

But Carrick’s curtain call in May will be caveated by one striking anomaly on an otherwise imperious CV: his international career. Although at club level Carrick has excelled – winning every top tier honour a player based in England possibly can – he looks set to retire with just 34 caps for his country, and just one of those was earned at a major tournament.

This, in part, is down to the quality of competition he has faced. Indeed, much of the conversation around England’s midfield in the early to mid-noughties centred on finding a system that could accommodate both box-to-box dynamos Steven Gerrard and Frank Lampard.

As time went on, however, focus shifted towards trequartistas, advanced playmakers and those with more mobile, harrying playing styles. And the likes of Jack Wilshere, Ross Barkley, Jordan Henderson and Dele Alli were brought into the frame more frequently than Carrick, whose deep-lying capabilities were not utilised to their full potential. That nearly 65 per cent of Carrick’s England caps have come in friendlies shows how undervalued he was. 

In fairness, Carrick does not embody similar characteristics to many of his England midfield contemporaries, including a laudable lack of ego. He is not blessed with lung-busting pace, nor is he enough of a ball-winner to shield a back four solo. Yet his passing and distribution satisfy world-class criteria, with a range only matched, as far as England internationals go, by his former United team-mate Paul Scholes, who was also misused when playing for his country.

Rather, the player Carrick resembles most isn’t English at all; it’s Andrea Pirlo, minus the free-kicks. When comparisons between the mild-mannered Geordie and Italian football’s coolest customer first emerged, they were dismissed in some quarters as hyperbole. Yet watching Carrick confirm his retirement plans this week, perfectly bearded and reflecting on a trophy-laden 12-year spell at one of world football’s grandest institutions, the parallels have become harder to deny.

Michael Carrick at a press event ahead of Manchester United's Champions League game this week. Photo: Getty.

Where other players would have been shown the door much sooner, both Pirlo and Carrick’s efficient style of play – built on patience, possession and precision – gifted them twilights as impressive as many others’ peaks. That at 36, Carrick is still playing for a team in the top two of the top division in English football, rather than in lower-league or moneyed foreign obscurity, speaks volumes. At the same age, Pirlo started for Juventus in the Champions League final of 2015.

It is ill health, not a decline in ability, which is finally bringing Carrick’s career to a close. After saying he “felt strange” during the second-half of United’s 4-1 win over Burton Albion earlier this season, he had a cardiac ablation procedure to treat an irregular heart rhythm. He has since been limited to just three more appearances this term, of which United won two. 

And just how key to United’s success Carrick has been since his £18m signing from Tottenham in 2006 cannot be overstated. He was United’s sole signing that summer, yielding only modest excitement, and there were some Red Devils fans displeased with then manager Sir Alex Ferguson’s decision to assign Carrick the number 16 jersey previously worn by departed captain Roy Keane. Less than a year later, though, United won their first league title in four years. The following season, United won the league and Champions League double, with Carrick playing 49 times across all competitions.

Failing to regularly deploy Carrick in his favoured role – one that is nominally defensive in its position at the base of midfield, but also creative in providing through-balls to the players ahead – must be considered one of the most criminal oversights of successive England managers’ tenures. Unfortunately, Carrick’s heart condition means that current boss Gareth Southgate is unlikely to be able to make amends this summer.

By pressing space, rather than players, Carrick compensates for his lack of speed by marking passing channels and intercepting. He is forever watching the game around him and his unwillingness to commit passes prematurely and lose possession is as valuable an asset as when he does spot an opening.

Ultimately, while Carrick can have few regrets about his illustrious career, England fans and management alike can have plenty. Via West Ham, Spurs and United, the Wallsend-born émigré has earned his billing as one of the most gifted midfielders of his generation, but he’d never let on.

Rohan Banerjee is a Special Projects Writer at the New Statesman. He co-hosts the No Country For Brown Men podcast.