Mental health has been in an ambiguous position in recent years. On
the one hand, since Labour came to power in 1997 mental health has
been one of the top three priorities for the health service
alongside cancer and coronary heart disease. This enhanced status
has brought some improvements, notably with the creation of new
On the other hand, the draft Mental Health Bill reveals an agenda
for mental health focused on risk management, and the controversy
over its provisions may have elbowed some more basic issues off the
table, such as access to psychological treatments.
Despite priority status, it remains the case that many people with
mental health problems have a poor quality of life. There are
people with long-term, serious but stable mental health problems,
leading isolated lives. They often lack adequate options on making
long-term recovery, and on rejoining the labour market. Beyond this
group, there is an even larger number of people with relatively
common mental health problems who find few options for treatment
beyond a prescription for pills.
In June, the Institute for Public Policy Research published a
report setting out a vision for mental health in 20 years’ time,
where mental health is taken as seriously as physical health both
by politicians and the public.(1) The report advocated developing
walk-in centres where people can get advice on all aspects of
healthy living, including mental health. So for instance, if an
individual had concerns over their own health or that of a friend
or family member, the walk-in centre would be a place to find
books, information, IT resources or information about local support
People would also be able to talk to “access workers”, trained
professionals who could offer advice, support, or counselling.
These workers would be able to suggest ways for people to look
after their mental health, perhaps through exercise, reading or
volunteering. Where appropriate, access workers could help open up
a quick route into specialist services.
The walk-in centres would also champion mental health issues, by
taking a lead on mental health promotion activities in schools and
workplaces, and co-ordinating local campaigns to tackle stigma and
discrimination against people with mental illnesses. In fact,
creating the kind of services that people feel comfortable to
access in the first place could go some way to reduce the stigma
around mental illness.
Developing this kind of grassroots support could help to fill some
important gaps. About nine in 10 mental health problems are treated
in primary care, and between 30 and 50 per cent of people with a
severe mental health problem only use primary care services.(2) For
many of these people, GPs offer a front door into the health
service. However, while there are some GPs who offer very good
support for people with mental health problems, this does not
appear to be the case for most people most of the time. Relatively
few GPs are interested in mental health issues.
In a study of one local area, three-quarters of GPs said they were
more interested in general medicine than psychiatry.(3) In a survey
by Norwich Union Healthcare of 250 GPs last year, eight in 10
admitted they were over-prescribing anti-depressants and
three-quarters said they were handing out more drugs than five
Moving mental health into the wider community is one way to focus
on developing better treatments. But it could help to move mental
health to become a mainstream priority outside the health service.
This is critical, because for many people the key to being able to
manage a mental health problem is about much more than medical
treatments. Getting advice on housing or training and employment
opportunities, or even just having someone to talk to are all
elements that can be just as important in helping people feel well
Walk-in centres could provide an interface between the health
service and services such as Jobcentre Plus and Pathways to Work
pilots. For example, the walk-in centres could offer training to
people on incapacity benefit to help them prepare for the
The type of community centres we envisage in this report are not
dissimilar to other integrated community-based initiatives, such as
Sure Start and children’s centres, or Link Age for older people.
Last year the Institute for Public Policy Research also put forward
the idea of connected care centres, a model to help provide health
and social support for people with complex needs who live in
deprived communities (5). Rather than a fixed blueprint, connected
care centres are based on core principles, such as co-location of
different professionals and providing a single point of entry into
Although, it was envisaged that connected care centres would be
based in deprived neighbourhoods, many of these principles could
have a wider application in relation to a new community-based
primary care agenda for mental health.
There are already signs that primary care for mental health is
rising up the agenda. Last year, the mental health “tsar”, Louis
Appleby, suggested that the next phase in implementing the 10-year
national service framework would see a new focus on primary care
and mental health promotion. Also, the Labour manifesto for this
year’s elections said: “almost a third of people attending GPs’
surgeries have mental health problems… so we will continue to
invest and improve our services for people with mental health
This is short on specifics, but it could be a promising point of
departure. For one thing, it suggests a new interest in the mental
health of the whole community and a move away from the old, but
still influential view that mental health is all about public order
and risk management.
Since 1997, there has been a significant increase in the number of
integrated community-based initiatives to help tackle complex
social problems and offer people joined-up support in different
areas of life. Mental health needs to become part of the web of
local community-based support. This is one way to ensure that
tackling mental illness and promoting mental health becomes a
mainstream concern for all local communities.
Jennifer Rankin is a researcher at the Institute
for Public Policy Research, where she has written several reports
and working papers on health and social care. Her main interests
are mental health, social care and the future of public
Connected Care Centres
- Co-location of NHS, social care and voluntary sector
- Common assessment procedure.
- Established procedures for sharing information.
- Shared training of staff.
- Single point of entry.
- Round-the-clock support.
- Managed transitions – flexible approach to age boundaries.
- Continuing support – no “closed cases”.
Training and learning
The author has provided questions about this article to
guide discussion in teams. These can be viewed at
www.communitycare.co.uk/prtl and individuals’ learning from the
discussion can be registered on a free, password-protected training
log held on the site. This is a service from Community Care for all
Many people with mental health problems have poor quality
of life and a limited range of treatment options. A new agenda for
community-based services could make a positive difference for
people with mental health problems.
(1) J Rankin, Mental Health in the Mainstream, IPPR, 2005.
Order from www.ippr.org.
(2) Cases for Change, National Institute for Mental Health in
England, 2002. Download from www.nimhe.org.uk
(3) J Boardman et al, “Needs for mental health treatment among GP
attendees”, British Journal of Psychiatry 185
(4) Norwich Union Healthcare, Guide to services for a healthy mind,
2004. Available at www.drfoster.co.uk
(5) J Rankin and S Regan, Meeting Complex Needs: the Future of
Social Care, IPPR/Turning Point, 2004. Download from
* R Layard, Mental health: Britain’s Biggest Social
Problem?, 2005. Available at www.strategy.gov.uk
* The National Service Framework for Mental Health, Five Years
On, Department of Health, 2004. Download from www.dh.gov.uk
* Mental health and Social Exclusion, Social Exclusion
Unit, 2004. Download from www.socialexclusion.gov.uk
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