Fourth Report - Rural Mental Health
Select Committee
Environment, Food and Rural Affairs Committee
HC 248
18 May 2023
Recommendations
21 results
1
Accepted
Para 43
Incomplete data on rural mental health indicates a serious failure of foresight.
Recommendation
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 …
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Government Response Summary
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 veterinary communities.
5
Acknowledged
Para 66
Require DEFRA to establish a clear and active role in national suicide prevention strategy
Recommendation
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 …
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Government Response Summary
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 to understand occupational suicide rates for targeted support.
7
Accepted
Para 81
Create clear objectives and actions for agricultural and veterinary workers in national suicide prevention strategy
Recommendation
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 …
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Government Response Summary
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 for National Statistics is also using Census 2021 data to improve understanding of suicide rates in different occupations to help prioritise actions.
9
Accepted in Part
Ringfence local suicide prevention funding and commission ONS for real-time occupational suicide surveillance
Recommendation
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 …
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Government Response Summary
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 for National Statistics is already using Census 2021 data linked with other datasets to improve understanding of suicide rates in different occupations, including farmers.
11
Rejected
Para 96
Establish a national working group and set targets to improve rural mental health outcomes
Recommendation
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 …
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Government Response Summary
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 Framework for measuring rural communities' mental health.
12
Accepted in Part
Para 115
Require joint DEFRA/DHSC team to integrate interventions with DfT and DSIT for rural mental health access
Recommendation
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 …
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Government Response Summary
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 to work with Defra, DHSC, and NHS England to maximize health outcomes for rural communities through the transport system.
14
Accepted
Para 121
Improve rural mental health service access through mobile provision, community involvement, and stigma reduction
Recommendation
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 …
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Government Response Summary
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
Rejected
Para 122
Open up NHS access for rural veterinary community, supporting flexible appointments and appropriate digital provision.
Recommendation
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 …
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Government Response Summary
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 for rural communities.
17
Rejected
Para 124
Issue call for evidence on ICS effectiveness for rural mental health services by March 2024.
Recommendation
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 …
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Government Response Summary
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 already underway through ICSs and local public health teams.
18
Rejected
Para 133
Consult on proposals to expand preventative mental health support for rural children and young people.
Recommendation
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”. …
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Government Response Summary
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 to establishing and funding them by 2024/25.
19
Rejected
Identify farming and veterinary mental health as priorities and develop specific NHS staff training.
Recommendation
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 …
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Government Response Summary
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 commission a specific training programme for rural NHS staff.
20
Not Addressed
Para 143
Provide detailed statement on NHS funding allocation formula for rural mental health needs.
Recommendation
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 …
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Government Response Summary
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 statement of the process and formula requested for independent assurance.
21
Accepted
Para 144
Set out timeline and process to revise Index of Multiple Deprivation for rural deprivation.
Recommendation
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 …
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Government Response Summary
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.
23
Accepted
Para 155
Adopt proactive approach to mental health implications of rural crisis and shock events.
Recommendation
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 …
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Government Response Summary
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 for a dedicated funding stream for rural mental health needs, though Defra and DHSC recognize the importance of careful planning and provision.
24
Rejected
Establish dedicated funding stream for rural communities' mental health needs during crisis events.
Recommendation
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 …
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Government Response Summary
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 of local plans or commencing consultations on upgrading preparedness as recommended.
26
Rejected
Para 167
Fund and roll-out Mental Health First Aid training for front-line staff supporting farmers.
Recommendation
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 …
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Government Response Summary
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 Mental Health First Aid training, stating existing regulations allow employers to tailor first aid provisions rather than prescribing specific mental health training.
27
Accepted
Para 171
Address occupational demands and cultural barriers preventing rural workers taking time away.
Recommendation
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 …
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Government Response Summary
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 commit to new government action to specifically examine and respond to the occupational demands and cultural barriers.
28
Accepted
Establish DEFRA working group to explore leave and support options for rural workers.
Recommendation
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 …
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Government Response Summary
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 commit to setting up a new working group or undertaking the specific explorations and reviews recommended by the committee.
29
Accepted in Part
Para 185
Government must accelerate rural transport strategy and address digital infrastructure shortfall.
Recommendation
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 …
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Government Response Summary
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 will work with Defra, DHSC, and NHS England to maximize health outcomes for rural communities through the transport system.
30
Not Addressed
Para 186
Require Government to detail rural proofing, funding, transport, and digital health access plans.
Recommendation
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 …
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Government Response Summary
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 other departments, but there is no specific response to setting out the geographical distribution of projected funding or issuing a call for evidence on digital access.
190
Accepted in Part
Establish national mission, assess, and fund rural youth mental health services provision.
Recommendation
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 …
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Government Response Summary
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 the Youth Investment Fund and its ongoing independent evaluation, whose findings will be shared with Defra.
Conclusions (10) Observations and findings — click to expand
2
Conclusion
Acknowledged
Para 44
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 Summary
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
Acknowledged
Para 45
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 Summary
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 data to improve understanding of suicide rates in different occupations to help prioritise actions.
4
Conclusion
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 Summary
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 understanding of suicide rates in different occupations.
6
Conclusion
Acknowledged
Para 79
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 Summary
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 improve understanding of occupational suicide rates, indicating a multi-faceted approach.
8
Conclusion
Acknowledged
Para 82
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 Summary
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 Spending Reviews. The ONS is also using Census 2021 data to improve understanding of suicide rates in different occupations, including farmers.
10
Conclusion
Rejected
Para 95
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 Summary
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 is not intended for measuring rural mental health and will not be used for that purpose, pointing instead to the roll-out of a Mental Health Impact Assessment Tool.
13
Conclusion
Accepted
Para 120
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 Summary
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.
16
Conclusion
Acknowledged
Para 123
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 Summary
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.
22
Conclusion
Accepted
Para 154
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 Summary
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 DHSC recognise the need for close planning and provision of support.
25
Conclusion
Acknowledged
Para 166
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 Summary
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.