Recommendations & Conclusions
31 items
1
Recommendation
Fourth Report - Rural Mental Health
Accepted
The current data and information relating to the shape and nature of mental health specifically in rural areas, communities and occupations is regrettably incomplete or unavailable and there have been many calls over time for this to be rectified. Given the strong indications of poorer mental health and well-being in …
Government response. The government acknowledges the need for current data on rural mental health and states that the next Adult Psychiatric Morbidity Survey has been commissioned, with fieldwork underway and results expected in early 2025, which will inform improvements for agricultural and …
2
Conclusion
Fourth Report - Rural Mental Health
Acknowledged
While experience of nature and the countryside is consistently identified as potentially beneficial for people’s mental health, our evidence is equally clear that the isolation inherent in rural living poses a significant challenge to the mental health of those who reside and work in these areas. In addition, other factors …
Government response. The government recognizes that individuals living and working in rural areas may face specific challenges in accessing necessary mental health services, directly acknowledging the committee's observation.
3
Conclusion
Fourth Report - Rural Mental Health
Acknowledged
We believe that, while the available evidence does not reveal a mental health crisis in rural England, there are more than enough glaring gaps, and obvious red flags, to warrant urgent and meaningful action, aiming to achieve a degree of preventative impact rather having to wait for an inevitable crisis …
Government response. The government states the new Suicide Prevention Strategy for England 2023-2028, published on September 11, 2023, identifies priority groups and risk factors, including those affecting rural areas and specific occupations. It also notes that the ONS is using Census 2021 …
4
Conclusion
Fourth Report - Rural Mental Health
Accepted
In particular, the long list of risks and stressors affecting the farming community and veterinary workers is perhaps the immediate priority, not least because there are real opportunities for substantial gains in this area with significant levers for change in the Government’s hands. (Paragraph 46) Suicide prevention and agricultural and …
Government response. The government published a new Suicide Prevention Strategy (2023-2028) that identifies priority groups, including agricultural and veterinary workers, and launched a £10 million Suicide Prevention Grant Fund. The Office for National Statistics is also using Census 2021 data to improve …
5
Recommendation
Fourth Report - Rural Mental Health
Acknowledged
DEFRA should be an active stakeholder in any national suicide prevention strategy, as the Department is responsible for populations and occupational groups arguably at higher-than-average risk of poor mental health and death by suicide. However, DEFRA does not appear to have carved out a clear role in the last two …
Government response. The government acknowledged the importance of addressing suicide risk factors in rural, agricultural, and veterinary populations, noting the new 2023-2028 Suicide Prevention Strategy identifies these groups. It also highlighted a new £10 million grant fund and ongoing ONS data work …
6
Conclusion
Fourth Report - Rural Mental Health
Acknowledged
Adopting a more joined-up approach to public health focused on early intervention could make a positive contribution to preventing suicide amongst agricultural and veterinary workers. It would need to ‘wrap-around’ people at potential risk, incorporating the NHS, other key public services and the regular contacts that people have in their …
Government response. The government pointed to the new 2023-2028 Suicide Prevention Strategy, which includes actions to tackle risk factors for rural, agricultural, and veterinary workers. It also highlighted a new £10 million Suicide Prevention Grant Fund and ongoing ONS data work to …
7
Recommendation
Fourth Report - Rural Mental Health
Accepted
We are very concerned by the evidence indicating that agricultural and veterinary workers have a higher-than-average suicide rate compared to the rest of the population. Although more accurate information is needed, a clear enough picture Rural Mental Health 77 was already established for the Government’s national suicide prevention strategy (published …
Government response. The government states the new Suicide Prevention Strategy for England 2023-2028 was published on September 11, 2023. This strategy identifies priority groups including agricultural and veterinary workers and sets out steps and actions to tackle known risk factors. The Office …
8
Conclusion
Fourth Report - Rural Mental Health
Acknowledged
Local government is carrying a substantial proportion of the responsibility for delivering the existing national strategy through local suicide prevention plans. However, it is unclear how much these have identified, or address, the specific needs of rural areas. Finally, we are very concerned that core local funding is not ringfenced.
Government response. The government points to the new Suicide Prevention Strategy for England 2023-2028, which identifies risk factors affecting rural areas and specific occupations. It mentions a £10 million Suicide Prevention Grant Fund, but confirms funding beyond 2024/25 is subject to future …
9
Recommendation
Fourth Report - Rural Mental Health
Accepted in Part
We recommend that the Government: a) confirm the timeline and consultation process for revising the new National Suicide Prevention Strategy b) confirm and ringfence additional funding beyond 2023/24 for local suicide prevention to allow local authorities to contribute effectively to delivery of the national strategy, and c) commission the ONS …
Government response. The government states the new Suicide Prevention Strategy for England 2023-2028 was published on September 11, 2023. It notes a £10 million Suicide Prevention Grant Fund but clarifies that funding beyond 2024/25 is subject to future Spending Reviews. The Office …
10
Conclusion
Fourth Report - Rural Mental Health
Rejected
Although DEFRA is clearly responsible for working with the Department for Health and Social Care (DHSC) to ensure mental health policy and services are rural proofed, it is unclear what priority, resources and energy DEFRA has assigned to achieving impact in this area. The NHS Long Term Plan and Mental …
Government response. The government acknowledges the importance of rural proofing health policy and inter-departmental collaboration but rejects the idea of a joint Defra/DHSC rural mental health policy and delivery team, stating existing channels are more effective. It confirms the Rural Wellbeing Framework …
11
Recommendation
Fourth Report - Rural Mental Health
Rejected
DEFRA has produced a welcome framework and associated guidance for rural proofing policy but, for instance, claimed close working with DHSC and NHSE 78 Rural Mental Health over the new 10-year cross-government Mental health and wellbeing plan has not so far resulted in a single reference to rural priorities (rather …
Government response. The government rejects the recommendation for a new joint DEFRA/DHSC rural mental health team and a national working group, preferring existing collaborative channels and a new Mental Health Impact Assessment Tool. It also rejects consulting on using the Rural Wellbeing …
12
Recommendation
Fourth Report - Rural Mental Health
Accepted in Part
The solution to providing accessible rural mental health services is unlikely to be “one thing” but more likely a package involving innovation and imagination from both patients and service providers. The new joint DEFRA/DHSC rural mental health team should consider how best to prepare and make an effective and integrated …
Government response. The government cited its 'Unleashing Rural Opportunities' report, ongoing work to improve rural transport and digital connectivity (Project Gigabit), and increased online options for mental health services to address accessibility challenges. The Department for Transport committed to looking for opportunities …
13
Conclusion
Fourth Report - Rural Mental Health
Accepted
We conclude that NHS mental health services are often not fairly accessible for rural communities, with centralised services creating barriers to access, compounded by poor rural transport and weak digital connectivity.
Government response. The government acknowledges accessibility challenges for rural mental health services and outlines existing initiatives under 'Unleashing Rural Opportunities,' including work to improve transport, digital connectivity, and digitally enabled care pathways, with future collaboration on transport systems.
14
Recommendation
Fourth Report - Rural Mental Health
Accepted
Locally the NHS must focus on providing rural communities with good access to services in terms of location and/or via mobile or outreach services, through effective consultation and co-design, and bring the voluntary and community sector into the delivery landscape given its expertise in early intervention as trusted providers. It …
Government response. The government acknowledges the importance of accessible rural mental health services, stating work is already underway through Integrated Care Systems and local public health teams. It rejects launching a new consultation, preferring existing accountability mechanisms.
15
Recommendation
Fourth Report - Rural Mental Health
Rejected
The NHS also needs to open-up access to the rural veterinary community to reflect restrictions on their ability to attend appointments, and support people who need to Rural Mental Health 79 continue practising. Better digital provision could improve service access but must not be the default offer to rural communities, …
Government response. The government highlights existing support initiatives for the veterinary profession but states there are no plans to commission a specific training programme for rural NHS staff. It promotes existing digital and remote access options for mental health services as beneficial …
16
Conclusion
Fourth Report - Rural Mental Health
Acknowledged
We believe Integrated Care Systems (ICS) will be crucial to determining whether NHS mental health services are able to respond better in future to rural communities’ needs.
Government response. The government acknowledges the importance of Integrated Care Systems in providing accessible mental health services for rural communities, stating work is already underway and funding formulas account for rural costs.
17
Recommendation
Fourth Report - Rural Mental Health
Rejected
We recommend the joint rural mental health policy and delivery team issue a call for evidence on the effectiveness of the ICS-model for providing rural communities with access to mental health services and publish its findings with proposals to address any shortcomings, by the end of March 2024. The team …
Government response. The government rejects launching a call for evidence or setting national targets related to the ICS model for rural mental health, stating it does not align with NHS England's new operating model of local accountability. It reiterates that work is …
18
Recommendation
Fourth Report - Rural Mental Health
Rejected
Child and Adolescent Mental Health Services (CAMHS) have been under intense pressure for many years, but a lack of alternative rural social infrastructure and a fall in support for youth services means CAMHS is often the “only show in town”. However, focussing on providing ‘reactive’ mental health services will only …
Government response. The government outlines its existing rollout for Mental Health Support Teams (MHSTs) but does not commit to expanding provision to 100% of rural schools by 2026/27. For Early Support Hubs, it has commissioned a longitudinal study but does not commit …
19
Recommendation
Fourth Report - Rural Mental Health
Rejected
It is very important for the farming and veterinary communities to feel that their circumstances are understood by NHS staff when seeking to access, or receiving, support (otherwise this may work against help-seeking behaviours). Charities with specialist-knowledge can gain people’s trust from a position of credibility, so it makes sense …
Government response. The government recognizes the importance of mental health for farming and veterinary communities but explicitly rejects developing a work programme with specific measures and targets, citing misalignment with NHS England's operating model. It also states there are no plans to …
20
Recommendation
Fourth Report - Rural Mental Health
Not Addressed
We welcome the Government’s commitment to provide more funding for mental health and to ensure local mental health spending increases by the same proportion as overall increases in local health funding. Despite this, we are concerned by the possibility that the system used by NHS England to allocate funding fundamentally …
Government response. The government described how NHS England's weighted capitation formula for Integrated Care Systems already accounts for rural area costs, by factoring in population age, supply-induced demand, distance of services, and ambulance response times. However, it did not provide the detailed …
21
Recommendation
Fourth Report - Rural Mental Health
Accepted
We recommend that DEFRA and the Department for Levelling Up, Housing and Communities set out a timeline and process by which to review and revise the Index of Multiple Deprivation with the aim of more accurately capturing rural deprivation. The Government should commit to reaching a position by the end …
Government response. The government recognizes that the current Index of Multiple Deprivation does not adequately capture rural deprivation and has commissioned an update to the English Indices of Deprivation, with a provisional release anticipated in 2025.
22
Conclusion
Fourth Report - Rural Mental Health
Accepted
Crisis events can have short- and long-term effects on people’s mental health, but civil society groups told us NHS support is minimal or short-term, despite greater support being likely to help people deal more successfully with trauma. Rural health providers suggested only limited local planning takes place with no extra …
Government response. The government outlined existing guidance, partnerships with charities, and multi-agency coordination through Local Resilience Forums for mental health support during emergencies. It stated there are no plans for a dedicated funding stream for rural mental health needs, though Defra and …
23
Recommendation
Fourth Report - Rural Mental Health
Accepted
However, as more extreme weather events are predicted to occur, the Government and NHS England need to adopt a more proactive approach to the mental health and well-being implications of crisis and shock events rather than just leaving it to local areas. We welcome the provision of Mental Health First …
Government response. The government highlighted existing guidance from the UK Health Security Agency, collaborations between the Environment Agency and charitable organizations, and multi-agency coordination through Local Resilience Forums for mental health support during emergencies. It also stated that there are no plans …
24
Recommendation
Fourth Report - Rural Mental Health
Rejected
We recommend that by the end of this year, 2023: a) DEFRA and DHSC, working with all relevant public health, environmental and first responder stakeholders, assess the readiness of local plans for crisis events, and commence consultations on upgrading local preparedness for rural populations’ mental health, and b) HM Treasury, …
Government response. The government rejected the recommendation to establish a dedicated rural mental health funding stream, stating there are no such plans. While acknowledging the need for close planning and provision of support, the response did not commit to assessing the readiness …
25
Conclusion
Fourth Report - Rural Mental Health
Acknowledged
Government policies and regulatory activity are key sources of stress for the farming community so Ministers should think hard about the impact of their decisions. The Environmental Land Management (ELM) programme is a case in point given the prolonged uncertainty. DEFRA’s attempt to take account of mental health at least …
Government response. The government recognized policy uncertainty as a stressor for farmers and detailed how the Farming Resilience Fund provides business support expected to have an indirect positive impact on farmer wellbeing, with providers asked to offer signposting to mental health support.
26
Recommendation
Fourth Report - Rural Mental Health
Rejected
We hope that DEFRA’s attempt to reduce regulatory stress is a positive change in cultural practice. However, encouraging and investing in Mental Health First Aid (MHFA) training for people dealing with farmers is a pre-requisite to ensure they are skilled and able to signpost to mental health support. We recommend …
Government response. The government did not commit to prioritising mental health support as a key deliverable within the Farm Resilience Fund, instead noting its indirect positive impact and current signposting services. It rejected developing an implementation plan to fund and roll out …
27
Recommendation
Fourth Report - Rural Mental Health
Accepted
The Government should look at how to respond to the occupational demands placed on farmers, agricultural and veterinary workers and any cultural barriers that: prevent these workers from taking time away from work, are detrimental for mental health without opportunity for respite, or are a block on taking time off …
Government response. The government highlights its close existing work and regular engagement with the veterinary profession, and points to several initiatives already in place by organisations like the RCVS and BVA to support the mental health of veterinary professionals. It does not …
28
Recommendation
Fourth Report - Rural Mental Health
Accepted
Although it will be challenging for the Government to address this given such occupations can involve lone workers in often isolated rural locations, we recommend that DEFRA sets up a working group to: a) explore options to establish or expand models such as a cooperative or insurance cover system for …
Government response. The government highlights its close existing work and regular engagement with the veterinary profession, and points to several initiatives already in place by organisations like the RCVS and BVA to support the mental health of veterinary professionals. It does not …
29
Recommendation
Fourth Report - Rural Mental Health
Accepted in Part
Some of the challenges of rural daily life can have a significant impact on people’s mental wellbeing. The UK Government needs to address these, including through its various funding routes for levelling-up; but without more detail we cannot evaluate the difference it will make. On upgrading transport infrastructure and digital …
Government response. The government outlined existing rural-proofing mechanisms and the Levelling Up and Regeneration Bill, along with increased digital access to mental health therapy. It committed to the Department for Transport soon publishing its Future of Transport Rural Strategy and stated DfT …
30
Recommendation
Fourth Report - Rural Mental Health
Not Addressed
We recommend that: a) the Government set out how rural proofing has been applied to the Levelling-up and Regeneration Bill; and work with the Office for National Statistics (ONS) to rural proof the Levelling-Up metrics to ensure progress in rural areas is measured effectively b) DEFRA and HM Treasury set …
Government response. The government states it already has extensive rural-proofing mechanisms and publishes annual reports, and describes existing digital therapy options. The Department for Transport will publish its Future of Transport Rural Strategy soon and will look for opportunities to work with …
190
Recommendation
Fourth Report - Rural Mental Health
Accepted in Part
Given the over-reliance on CAMHS in rural areas as a response to mental ill- health amongst children and young people there is an urgent need to address the shortfall in youth services. Including youth services under the levelling-up agenda would give children and young people’s wellbeing the strategic prominence and …
Government response. The government states mental health is a priority driver for the Levelling Up mission and reiterates the National Youth Guarantee by 2025. It rejects a new call for evidence, citing a recent review, but points to existing £300m investment in …