Devolution and Mental Health - RSA

Devolution and Mental Health

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  • Picture of Tom Harrison
    Tom Harrison
    Assistant Researcher, Public Services and Communities
  • Devolution
  • Health & wellbeing

For decades successive UK governments have sought to centralise power in order to achieve their policy objectives, resulting in the UK becoming one of the most centralised political economies in the world. However, Greater Manchester’s landmark devolution deal in April 2016 brought, for the first time, all £6 billion of health and social care spending under local control, marking an unprecedented opportunity.

Alongside the Centre for Mental Health and leaders such as Cllr Sarah Hayward in London and Dr Martin Reeves in the West Midlands, the RSA has been exploring the extent to which this shift might support a deepening commitment to parity of esteem between mental health and physical health.

At the RSA a crucially important measure of success for devolution is the extent to which the most marginalised in society are served by new structures. This extends to health. As Cllr John Clancy, Leader of Birmingham City Council told the Core Cities Business Summit “we’ve made mental health a priority, as it’s another thing that holds back growth”.

Inclusive Growth Commission: John Clancy from The RSA on Vimeo.

Amongst the opportunities that new policy approaches help facilitate, there is also a danger of the language of devolution clouding yet more centralised directives. Possibly the best example can be found through NHS England Sustainability and Transformation Plans where fast-tracked service redesign alongside huge budgetary constraints has meant a missed opportunity for hard-wiring parity of mental and physical healthcare into the system. RSA research tells us that the issue is a stark example that holds back growth and costs more in the long-term.

Our research showed us that:

  • People with mental health illnesses are a third less likely to be in employment

  • Between 10-45 percent less likely to receive physical health checks like blood pressure, cholesterol checks as well as cervical cancer screening.

  • People with serious mental health conditions die on average 10-15 years younger

  • Take up for talking therapies is as low as 5 percent among those with anxiety and depression in some areas, whilst the dropout rates for these therapies are up to 90 percent in others.

The challenge is how we reverse this trend. We can see hopeful interventions from city Mayoral candidates in discussing the improvement of mental health provision as part of broader reform and inclusive growth strategies.

In addition to direct service improvements, devolution can be a vehicle for a higher profile ‘hearts and minds’ approach to mental health. Both Greater London and the West Midlands have expressed interest in the ‘Thrive’ approach developed in New York City and RSA Fellows such as Iris Elliot are helping to support and learn from these approaches globally. Some cities are grasping the challenge and are leading the way in this agenda.

Sadiq Khan’s mayoral manifesto included specific pledges on raising mental health awareness and Andy Burnham, mayoral candidate for Greater Manchester, has stated that improving child and adolescent mental health services will be a priority if he is elected.

Indeed, the West Midlands Mental Health Commission, chaired by Norman Lamb MP, has not only helped facilitate the introduction of 0-25 year mental health provision, but also helped upskill the region’s education leaders – improving the skills and confidence to deal with mental health in young people, and looking at architecture to develop mentally healthy schools. Our upcoming project with RSA Academies will also seek to consolidate that legacy.

These are great examples of what cities and regions could achieve through utilising the new crop of political leadership to make devolution a meaningful alternative to the current system where central government can too easily opt out of accountability without substantive challenge.


Do we need a Mental Health Manifesto for Cities?

The economic costs of mental health illness (£105.2 billion a year) are well documented, and the Inclusive Growth Commission begins to highlight the social cost. Here we highlight 5 challenges for Mayors that citizens can hold them accountable for:

  1. Cities need to focus on quality of IAPT services and tackle issues of pan-city commissioning (Sandwell in Birmingham has drop-out rates as high as 90% for talking therapies)

  2. Access to physical needs assessments for those with mental health illnesses needs to drastically increase

  3. Access to information, advice and support for the carers of people with complex needs to be protected in order to reduce burden on acute services

  4. The burgeoning employment gap for people with mental illnesses needs to be addressed through targeted support such as the New York City Thrive initiative

  5. The lack of appropriate and safe accommodation for people with complex needs to be addressed by expanding provision for sheltered and supported housing

An inclusive devolution strategy backed by a new crop of political leadership is currently our best opportunity to unleash the potential of people at the economic and social fringes of society. One way to ensure we rise up to the challenge is through holding the fire to our emergent political leaders.

Register your interest for the RSA Inclusive Growth Commission’s Final Report Launch.


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  • Tx for the links and solidarity Tom! As a trustee of a local youth counselling charity in Northampton ( I can vouch for the need to address root causes and provide early support for young people when they need it. The costs (human & economic) are too great as things stand today. You're welcome to visit anytime! KR, Brendan.

  • I agree with a mental health manifesto but why just for cities? Devolution may be a useful trigger to raise and progress this but leaving the majority of the population who do not live in cities behind is not progress. Mental health does need to put on an equal footing with physical health in the NHS and broader society,  especially for young people where current failings in the system of provision create personal, economic and societal problems that could be reduced with more effective and earlier interventions.

    • Hi Brendan - I couldn't agree with you more - and the RSA's Inclusive Growth Commission goes some way to try and un-stick the preoccupation with metro-areas and closed-door deals that miss out huge swathes of the country.


      In terms of early intervention, the need couldn't be more pressing- and new research on mental health in universities only further highlights our need to grasp the issues head-on to challenge some of the route cause of mental distress. 

      See my most recent blog on the issue here: