Starmer and Streeting have talked the talk on mental health support – now they must walk the walk

The Darzi Review confirmed what many people across the country have been acutely aware of for some time: our health service is in a dire state. Weakened by austerity and a devastating pandemic, waiting lists have ballooned, outcomes have worsened, and Britain’s economy is facing the knock-on effects.  

For those of us in the mental health field, this isn’t new. For decades, mental health has been underfunded. While ‘parity of esteem’ (the idea that physical and mental health should be treated with the same importance) was enshrined in law in 2012, mental health has never enjoyed the funding and focus that physical health has. 

The result is a crisis many mental health professionals saw coming. Almost two million people now sit on NHS waiting lists for mental health support, and millions more would benefit from it, but don’t qualify. Hundreds of thousands of people with mental health problems are too unwell to return to work, because they aren’t getting the support they need. The cost to society and the economy of poor mental health is huge – £117.9 billion every year.  

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It’s a situation which might feel insurmountable, but thankfully, there are reasons to be hopeful. Promising new approaches are being floated by the new government – something which might actually make a difference. 

The prime minister, Keir Starmer, has put forward three major focuses for NHS reform. For us at the Mental Health Foundation, there is one which has the potential to promise real, fundamental change for mental health care if done properly: a greater focus on prevention. 

Far too often in the UK, we don’t support people’s health – particularly their mental health – until they’re already knocking on their GP’s door. We spent £239bn in 2023 on healthcare, but only about £3.5bn on preventative public health measures. For mental health in particular, the situation is even worse, receiving only about 3% of that £3.5bn.

Preventative programmes are things you might not even think of as healthcare, like anti-bullying initiatives. Experiencing bullying can have a huge effect on people’s mental health, both at the time, and throughout their lives. So by investing in programmes to reduce bullying, you lessen the likelihood of an individual’s mental health deteriorating.

The economic benefits speak for themselves – the long-term return on investment for anti-bullying programmes is about £7.50 for every £1 invested. Prevention not only stops harm before it occurs, but it delivers value for money. 

Earlier this month, we published a report which showed that one in five people in England were being let down by their local health system’s plans for preventing poor mental health. Only six plans we evaluated – out of a total of 42 – could be considered excellent.  

None of this is for a lack of trying by those who write these plans. Local decision makers do usually see the need to make the switch to prevention, but they’ve been held-back by a lack of support from central government. 

This is why it’s so positive to see Starmer and Streeting hammering home the importance of prevention. But now they’ve talked the talk on it, we look forward to seeing them walking the walk. 

They should start by restoring the public health grant – a ring-fenced pot of funding for local authorities to bring in their own measures to prevent ill-health – to its pre-cut levels. Since 2015, the grant has been cut by more than £1bn in real terms. This has had a devastating impact on the ability of local councils to deliver prevention. 

We also need dedicated new specific funding for public mental health interventions that have been proven to work. This would be best protected by the creation of a specific funding stream for preventative work, as was recently advocated by the cross-party think-tank Demos. Councils would also benefit from longer term settlements, to allow them to better plan their priorities for prevention while knowing the money is still coming down the line. 

This cannot all be delivered at a local level. Poverty is one of the key drivers of poor mental health, and 30% of children are experiencing it. Adults living in the most deprived areas in England are twice as likely to experience some form of depression than adults living in the least deprived areas.

We need to see a concerted effort from the UK government to reduce poverty by making sure benefit payments are enough to cover the cost of essentials like food, bills and travel costs, and getting rid of the two-child cap which pushes so many families into poverty. 

The economic benefits of delivering a truly preventative approach would be huge – and play squarely into the government’s growth agenda. We could reduce pressure on mental health services, allowing them to finally reduce the waiting lists, as well as on our benefits system. But most importantly, we will stop people suffering with mental health problems which could have easily been prevented. 

The new Labour government are on the right track with prevention. Now, they need to follow that path all the way. 

Oliver Chantler is head of policy and public affairs at the Mental Health Foundation.

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