Training and re-training
To execute this vision, we will need to see significant investment in the training of psychosocial approaches and clinical leadership, especially in GPs and nursing colleagues. In the UK, mental health nursing is the largest profession by numbers, with around 48,000 mental health nurses (around 18,000 working in community settings and a massive 30,000 working in in-patient care). They are supported by about 55,000 support staff (4,500 in community settings and 50,500 in in-patient settings). As a comparison, by the way, there are around 8,000 clinical psychologists with 3,500 support staff.
It remains official Department of Health policy that our nursing colleagues 'should incorporate the broad principles of the Recovery Approach into every aspect of their practice' and 'use their valuable skills in the most effective way possible'.7 This seems easy to translate into investment in training in evidence-based psychological and social therapies. In essence, the vision of care proposed here would see mental health nursing transformed from an adjunct to medical practice to a vehicle through which psychosocial interventions are delivered. All this supports the idea that we actually do have sufficient staff, just (in our view) doing many of the wrong things.8 Our vision would lead to a very significant change in people's actual practice. So the question then is: how much would it cost to retrain them?
This is a very difficult question to answer precisely. The training of nurses, doctors - clinical psychologists too - is complex and the 'mental health' elements are not always easy to separate from more generic training. But in very general terms, the UK system for funding education and training is coordinated by an arms-length body of the Department of Health, 'Health Education England' (with parallel arrangements in the other nations).9 The total annual budget for Health Education England is ?4.9 billion. This pays for all training in healthcare, including medical education and that of nearly all undergraduate and postgraduate healthcare professions (although not the initial psychology degrees of clinical psychologists). It also pays for the post-qualification training of these professions.
That leaves us in the difficult position of estimating how much it would cost to commission a very significant retraining programme in mental health. We might suggest that mental health absorbs perhaps 10% of the total budget (in line with clinical spending ratios), so perhaps around ?500 million a year. Many people might argue that the changes needed would be so radical that all training would need to change. Even then, that would not necessarily mean more training, just different training. The training of new professionals should encompass new material, new ideas, but would not necessarily be more expensive. However, there would be a short-term extra cost: that of retraining existing staff. A reasonable estimate might be that this would absorb up to an extra 20% of the notional 'mental health' training and education budget. That would mean our proposals could add up to ?100 million to the bill.
Thus far, then, we could be looking at maybe a one-off ?100 million for 'transitional support funds' and recurrent costs of maybe ?100 million per annum for training.