09 January 2017

Theresa May has today pledged to overhaul mental healthcare, but do these measures add up to the ‘transformation’ of mental health provision that she has promised? Emma Norris says it will take more. 

Theresa May has already given mental health the one thing that most policy areas need if they are to transform: engagement from 10 Downing Street. Our recent research found that prime ministerial engagement – at least early on – is one of the key drivers of success when it comes to making a policy last. This is particularly true of issues that spanned ministerial portfolios and departments, such as rough sleeping or climate change. We can see this reflected in Theresa May’s comments today too, which range across the territory of both Health and Education departments. Ministers and officials from different departments will co-operate more effectively when the Prime Minister applies pressure on them to do so.  

But the real test for the lasting ‘transformation’ that May promises is whether policies survive once her attention dissipates. David Cameron, after all, promised a mental health ‘revolution’ just 12 months ago, but the agenda waned with his own political fortunes.

The Institute’s research found that policies which succeeded in breaking the cycle of endless political reinvention and established a new, but lasting approach, tend to follow a similar pattern:

Start with a high-profile review of existing information and approaches, one that establishes a new way of thinking about the problem. Today’s announcement should be seen as just the start of a longer process to define mental health and to build the capacity in government to tackle it. In that sense, it is the two reviews that Theresa May announced today – into child and adolescent services, and into mental health provision in the workplace – that may prove to have a more lasting impact than the handful of specific policies that will garner headlines.

Entrust the problem to an official or a special unit with direct prime ministerial backing, one that can roam across government and construct a new framework for dealing with the problem – often establishing new institutions, new civil service capacities or new targets. This hasn’t happened yet, but we would expect it to happen soon after early analysis has been completed.

New policies need to be married with new commitment mechanisms. The next Prime Minister might decide to make another issue their big priority. In fact, in the future, the current Prime Minister may find it difficult to give the issue sufficient bandwidth herself. That’s why enduring policies tend to come with commitment mechanisms. In climate change, the statutory obligation of setting new carbon budgets meant that every five years government had to set new targets and design new policies to meet them. While interest in climate change might wane in the intervening period, this commitment mechanism meant that political interest was reengaged and progress rallied on a regular basis. This might not be something for now – but leaving it too long before setting these commitment mechanisms risks failure.

On its own, today’s announcement does not yet add up to a transformation of mental health that we would expect to endure. We haven’t seen a new understanding of the problem, nor a concerted attempt to create a new framework in government (institutions, targets or capacity) for dealing with it. A commitment mechanism is also currently missing, increasing the risk that the agenda disappears from ministerial radars in the future.

All of this may come. But it will require months if not years of prime ministerial engagement to set up. Superficial change can be achieved quickly. If the Prime Minister thinks that a ‘transformation’ of mental health is warranted, it will take more than one speech and a handful of policy announcements.  

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