Today Professor Peter Fonagy’s independent review into mental health conditions, ADHD and autism was published. Alongside, it, the government has committed to a major overhaul of mental health support in its forthcoming Mental Health Strategy. The focus is on prevention and early intervention, so that people get the right help, at the right time, in the right place. 

It’s an ambition I welcome. But looking at what the government has set out today,  I noticed something missing: nursing. 

Mental health nurses spend more time with patients than anyone else in mental health care. If these reforms are going to work, we have to be central to how they’re developed and delivered, not an afterthought.

We need to be in the room 

The Health and Social Care Secretary has asked NHS leaders to urgently look at how people can access advice, assessments and treatment more easily. That work needs a strong mental health nursing voice. 

Policies developed without our input, nationally or locally, are unlikely to reflect the realities of frontline care, or to achieve what they set out to do.

Our expertise is not interchangeable 

We also need to be honest about the workforce - you can’t reform a system without investing in the people who deliver it. Mental health nurses are the backbone of mental health services, yet nursing workforce growth hasn’t kept pace with rising demand. And there’s a growing tendency to treat the mental health workforce as interchangeable, with registered mental health nurses increasingly replaced by unregistered roles, despite fundamental differences in training, accountability and clinical expertise. 

If the government is serious about making these reforms a reality, investment in the registered mental health nursing workforce has to sit at the heart of its implementation plans.

Early intervention needs everyone 

Then there’s the question of what early intervention actually means. It can’t be delivered by mental health services alone - it needs action on the wider social determinants of mental health. Sustainable improvements in mental health outcomes need coordinated support from families, educational settings, community services, workplaces, social care, the wider health system, the voluntary sector and peer networks, alongside access to specialist care where it’s needed. 

And as the focus shifts towards early support, we must make sure people with severe and/or more complex mental health needs don’t lose access to the ongoing care they rely on.

ADHD and autism assessments 

I’m also glad to see plans to strengthen quality assurance, regulation and evidence-based practice in ADHD and autism assessment, including making diagnostic assessments a CQC-regulated activity. More and more mental health nurses are undertaking specialist training and contributing to ADHD and neurodevelopmental assessment services. Any review of standards, clinical guidance, commissioning arrangements or regulation must include meaningful nursing representation.

What happens next

The government has said it will set out more detail in its Mental Health Strategy in the coming months. We’ll be following its development closely, and wherever there’s an opportunity to contribute, we’ll make sure the voice of mental health nursing is heard.

How can these reforms deliver the right care for patients if the people who provide so much of it aren’t part of the conversation?