The latest NHS 5 year plan NHS 2010-2015: From good to great. Preventative, people-centred, productive is written in the context of the Chief Secretary to the Treasury's document Putting the frontline first: Smarter government. The plan confirms the need for £15 - 20 billion in so-called efficiency savings over the three-year period from April 2011.
Growth in health services does not necessarily lead to improved outcomes. The myth of massive psychiatric need was pointed out in a paper More and more is less and less in 1985. Psychiatry does have its limits, as I described in my 2002 paper in the BMJ.
Mental health teams can recognise the limitations of what can be achieved and will respond to challenges to improve care in this context. Mental health is not a technologically driven service, although CNS drugs are now the highest net ingredient cost to the NHS of all drug groups. Still, drug costs are a fraction of the main expenditure on staff. There is evidence that mental health services create a vulnerability to relapse but they understand the need to encourage independence. Creating a more patient-centred service can actually reduce costs.
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