Lord Darzi’s report on the NHS is a welcome yet worrying analysis of what needs to be fixed. It paints a stark picture of care that is hard to come by, of delays in treatments - and of fire-fighting at scale. It shows what many of us in the health sector have seen first-hand: the knock-on impacts of cuts to upstream funding.
In response to the findings, we welcome moves by the health secretary to make ‘three big shifts’ in the NHS: to prioritise moving NHS treatment “from hospital to community”, “analogue to digital” and from “sickness to prevention”.
It’s the prevention piece that struck a chord, both in terms of its potential but also in terms of the distance we stand now from this approach.
Health systems have to focus on the highest level of need
As it stands today, systems have to focus on those with the highest level of need, leaving others sitting on waiting lists, potentially for years.
But this situation isn’t inevitable. Offering early and easily-accessible support can alleviate pressures downstream, meaning fewer GP appointments and fewer desperate A&E visits from those with nowhere else to go.
We know from our counsellors that people are receptive to learning and using tools to manage their mental health. We also know that without timely access to support, many of them would be on waiting lists where problems often worsen and become entrenched.
From a financial perspective we know that investing in prevention of poor mental health has the highest economic return of any illness, with potential contributions of 0.4% (>£8bn) GDP by 2030, according to a recent report.
The current overall cost of poor mental health to the UK is today around £119 billion a year, representing 9% of total NHS budgets.
The potential of a ‘health economics’ approach
Focusing on health economics - that is, making healthcare more accessible, equitable and affordable for everyone - means we can make prevention a reality and start to turn the tide on this crisis.
Imagine the payback.
The return on a real commitment to accessible and preventative mental health care would be vast. Not only in terms of huge savings for the NHS, but for our wellbeing, our productivity and our life chances.
We need to focus on giving young people the know-how and tools for life to understand and manage their mental health. To understand the difference between worry and anxiety; to learn to express themselves in ways other than self-harm; to manage and overcome friendship issues.
It becomes less about solving a serious problem and more about decreasing the likelihood that there will ever be one. It is a broader goal of helping to create a healthier, happier population leaving no-one behind.
The impacts of a preventative approach
The macro-economic impacts of a truly preventative approach to health is a massive opportunity that has yet to be realised. Through our work, we often see it:
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The individual who is helped by a Kooth practitioner who goes on to find better relationships with their family and friends. School life often benefits too, positively impacting teachers and classmates - as well as that individual’s future life chances
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The parent we help who feels able to return to work, finding a sense of pride and recovered self-esteem
In a recent paper by the York Health Economics Consortium (YHEC), the many potential impacts of Kooth were identified. Each one shows the incredible ripple effect of a service that is easily accessed and created for and with young people, including notable positive impacts on other NHS services.
These included:
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Preventing children and young people from being hospitalised due to suicidal ideation or self harm
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Preventing arrests for committing crime
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Reducing initial and follow up GP appointments
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Reducing the number of antidepressant prescriptions
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Averting smoking and binge drinking
Support for a preventative system change
While reading reports on the state of mental health care in the UK and in the NHS more generally, I can feel simultaneously downhearted and optimistic.
Downhearted because so many people are not getting the care and support they need. Optimistic because I believe that the groundswell of support for preventative mental health in the context of health economics has huge potential to bring about the system change we have long needed.