Time to embrace the potential savings from recovery? |
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| Monday, 28 February 2011 |
In these times of economic hardship and service cuts SRN Director, Simon Bradstreet, asks if it is time we started to champion the potential costs savings from effectively promoting and supporting recovery. For a long time mentioning money and recovery in the same sentence has been a questionable thing to do. For some people all talk of people recovering and moving on with their lives is code for cutting or redesigning mental health services. In some areas service users justifiably questioned the motives of commissioners and planners who were possibly over enthusiastic in their drive to use recovery and inclusion as the justification for the removal of services without adequate involvement and consultation.For others it was also surely no coincidence that the promotion of recovery neatly coincided with the previous Westminster Government’s intention to reduce the number of people in receipt of disability benefits. The suspicion was that recovery was simply a cover for reducing the number of people with experience of mental health problems receiving benefits and forcing people into inappropriate paid employment. These issues remain live and relevant in 2011 but what has undoubtedly changed is the wider economic context. Recovery, and the idea of recovery focused services, was introduced to Scotland at a time of plenty with funding for services and supports at record levels. As we enter a period of significant cost savings and the inevitable trimming of services it’s time to look afresh at the relationship between recovery and the wider economy and ask ourselves how recovery plays out in a time of austerity. At our recent National Gathering event delegates were struck by data presented by Professor Richard Warner showing that schizophrenia outcomes worsened significantly during the Great Depression of the 1920s and 30s. This kind of data provides cause for the field to be wary of the potential negative impact of the current recession on recovery and to maintain funding levels but perhaps this is also an opportunity to look at how we offer supports differently with a longer term view. The recent publication of the new English mental health strategy takes this approach. It highlights the relationship between mental health and other health and social issues while identifying the importance of early intervention as one means of making long term savings. Here there are indications that a similar approach will soon be promoted more widely by the Scottish Government, building on the apparent success of a small number of early intervention services in Scotland.
It is hard to dispute that good early intervention should make long term savings. Treatment should be minimised and every effort made to prevent people becoming long-term mental health service users, with the potential negative impact on personal identity and recovery that this can bring. Equally important though is the justification on moral and ethical grounds. Put simply we should help people at the earliest opportunity rather than holding back on offering support until they reach a point of acute crisis. The arguments for early intervention are compelling but one obstacle faced is that to invest in this type of approach requires a degree of faith in the long term savings (people want savings now, not in 10, 15 or 20 years time). There can also be resistance to change amongst current service providers who fear investing in early intervention would result in cuts in the services and supports they offer. Elsewhere a recent report Kings Fund and Centre for Mental Health takes a detailed look at efficiency and productivity in mental health. It includes in recommendations that are designed to make a more immediate impact, like reducing bed usage and improving the interface between physical and mental health. Considering long-term efficiencies the authors highlight the development of recovery focused services and commissioning policies as one means of making long term savings. This offers a timely reminder in relation to the current rash of retendering of social care services across Scotland and the need to ensure decisions are based on potential recovery outcomes as well as cost. The report also encourages consideration of peer involved services based on developing evidence from the United States that suggests peer involvement in service delivery can reduce costs incurred through, for example, hospital admission. During his recent visit to Scotland Professor Warner also spoke about the role of disincentives within disability benefits in potentially preventing recovery. In essence if you are going to better off remaining on benefits then why take the risk of moving into paid work? As we have previously reported the new Coalition Government’s intention is to reduce financial disincentives to work and while any changes to the benefits system cause huge anxiety and unrest - hardly surprising given we are talking about people’s income - we ought to be open to all options that can help remove obstacles to paid employment and the potential positive impact it can have on mental health and recovery. We are living through difficult times but one thing we can take from an understanding of personal recovery is that every crisis offers opportunity. Ultimately we want to see as many people as possible recovering from mental health problems. In pursuing this we should consider all the options, be open to doing things differently, and get vocal about why recovery can cut costs. Comments (1)
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