Brexit and Mental Health Research: making the best of uncertain times
by Ian Bradshaw
As we recover from Thursday’s referendum our thoughts at McPin have started to turn towards what it means for our mission to transform mental health research. As we enter a period of uncertainty it is easy to be downhearted. But it is also an opportunity to think again about how we make the case for research at a time when it is going to be needed more than ever.
Mark Brown has written a sobering overview of what Brexit could mean for the Mental Health sector. I would add that as individual bits of the sector comes under strain the temptation will be to ditch the cross sector working that no one institution sees as their core business but in reality are vital to many people. Looking at affordable housing and mental health earlier in the year I found the most concerning impact of the current reforms was not the results of individual policies but the potential that cumulatively they would widen the cracks that already exist in some areas between local authorities, housing providers and the NHS, and which many individuals in need already fall through.
Looking ahead a sensible planning assumption is that there will be less money. Less money in the NHS, less money in the wider public sector, less money in the voluntary sector, and especially less money for research and development.
If I were still a civil servant I can easily imagine the questions about spending on research when decisions have to be made on stopping existing services. Especially research on mental health. A sector that traditionally has not had the political resonance of some physical conditions. So those of us who know the value of mental health research need to think hard about how we make the case.
I don’t have answers at this stage, but here are some thoughts as somebody new to mental health policy.
First we have to continue to make the case for why mental health is important to everyone. Realistically at a time of financial uncertainty there is likely to be greater power in the economic benefits; not just for individuals but for the whole of society:
- The people who would be able to work, if the right support were available.
- The improved academic performance of children whose schools support their mental wellbeing.
- The savings to the health service from no longer ignoring the mental health of people with long-term physical conditions.
Finding facts that are persuasive and stand up to scrutiny needs robust research and analysis. It is in the interests of everyone in the sector, not just research charities, to support that work.
As advocates for research we need to get even better at selling its value. How does investment in research help to solve the problems we know exist and support more people to reach their potential? It can’t just be a ‘nice to have’. We have to make the hard headed case for the return on investment in research. At a time when budget holders are already wondering how they get through the next few years promising large savings in some indeterminate future will not be enough.
This may mean looking again at research priorities. We must not abandon basic research. But we do need a collective discussion about what the most pressing questions are, and why. How do we achieve the right balance in research spending for short, medium and long term impact in ever more constrained times?
Even before the events of the last week efficiencies in the system that did not harm outcomes for service users were needed. We believe this can only be achieved through investment in research and development and the systems for disseminating results to clinicians. This research will need to be well designed to maximise its effectiveness and value for money. Focussed on the questions of most immediate salience to service users and clinicians, and reported in a way that is easy for those who have to use it to understand. These are all issues that our work here at McPin championing Patient and Public Involvement tackles. It suggests that co-production helps with them.
We need to continue the drive to embed R&D in mental health trusts. The environment for research in academic institutions will get much harder if EU funds and co-operation reduce. But commissioners and providers will still need robust evidence of what works if the ongoing changes to services are to be sustainable. That means both being intelligent consumers of outside evidence and actively seeking to capture and use the knowledge already held by their service users and clinicians. What we at McPin call evidence informed practice. It also raises questions for researchers and charities as to how we build stronger and more productive relationships with a wider range of trusts.
These are all issues that need much more thinking about as time goes on. I would welcome people’s views. How do we best make our case for the role of mental health research post-Brexit?