All of us have mental health needs. Many of us have mental health problems. Some of us are mentally ill. The Mental Health Foundation (1993) reported that, in the UK, one adult in four will suffer from mental health problems and 3 million people will have a severe mental illness. Most of these sufferers are treated by the National Health Service and the public costs alone are estimated at £4 billion each year. Even more are supported by carers, for which one cost estimate is £12 billion each year.
In recent decades the trend to confine the mentally ill in a hospital has been sharply reversed. In 1827 the total number of residents of mental hospitals in England and Wales was 1046, increasing to 148,100 in 1954. It had decreased by 1980 to 75,200. (Source: Andrew Scull). The number of long stay patients (more than five years) has decreased from 30,000 in 1984 to under 10,000 in 1993. (Source: 1995 Social Trends).
Of course, this does not mean we have eliminated mental health problems!
Reduced levels of institutional care can only be balanced by increased community care. Much of this increased level of community care is provided directly by the National Health Service or by the national agencies working with it. Several national networks of local agencies exist, each pursuing the provision of mental health related services using a common philosophy, or serving a particular sector of the community, or focussing on a specific illness or therapy.
The great success of the national agencies speaks for itself and rightly gives these agencies an influential voice with legislators and statutory providers. Their scale enables their associates to draw upon an extensive and excellent resource and information base.
So why do we need smaller, independent agencies?
The Value
Individual sufferers have individual needs. Deciding to meet these needs in the local community means that the care can, and often must, have an individual flavour. So there is often a demand from potential users for new specialisations. Furthermore, the National Health Service is becoming increasingly overstretched, and not all local areas are uniformly served by branches of the national agencies. So it is not surprising that large numbers of independent agencies have been formed, many of them by users or past users of existing services in other areas. Nor is it surprising that these new agencies focus on the special conditions operating in their locality or on neglected sectors of the public.
The value of these agencies is demonstrated by the fact that they are successful (often only after extreme efforts) in obtaining funding from reputable grant making trusts and statutory bodies. Thus their services are accepted as complementary to, not duplicating, the nationally co-ordinated services.
The Gap
These smaller agencies gain much from their independent status, but there is a downside. Their very isolation can mean that they lack the opportunity to compare notes and devise common and wider solutions in conjunction with workers elsewhere. Nor is it easy for them to keep pace with new legislation or advances in care methods, and certainly not easy for their voices to be heard by opinion formers and Government, national or local.
Perhaps more importantly, the real value and scale of their work, in contrast with that of the much better known and represented national networks, is not widely known or appreciated. This can affect the morale of the workers and increases the difficulty of atttracting much needed funding.
The UK Federation of Smaller Mental Health Agencies was formed in 1996 to bridge this gap. At a meeting in the House of Lords in February 1996, 86 independent mental health agencies agreed unanimously that the Federation should be formed to represent and support them. In February 2000 our membership reached 239 groups , representing 157,000 service users.