11 Sep 2023

Mental health: When does a cabinet minister matter?

Noah Froud, Associate Director in the Health team, examines the value of a dedicated Mental Health cabinet position in Government, and considers the difference between policy signalling and policy impact.

Noah Froud

A Cabinet Minister for Mental Health was a novel, political, idea

In a letter posted on her Twitter during last week’s reshuffle,  former Shadow Cabinet Minister for Mental Health Rosena Allin-Khan noted that Keir Starmer “did not see a space for a mental health portfolio in a Labour Cabinet”, leading to her decision to step down from the role entirely. This prompted concerned reactions from stakeholders, including the British Medical Association (BMA) who called the end of the cabinet-level position “disappointing.”

The post of a Shadow Cabinet Minister for Mental Health was established in 2015 by Jeremy Corbyn in his first shadow cabinet. The role was given to Luciana Berger and after her resignation to Barbara Keeley. At the time of its creation, the post was briefed as signalling the importance of mental health to Corbyn. In 2016, it briefly became a political embarrassment when Corbyn temporarily scrapped the post, and then joined activists calling for it to be reinstated.

There is no post with the equivalent power, mandate, and focus in the government. For example, Maria Caulfield, the current Undersecretary of State for Mental Health and Women’s Health is a junior minister within the Department of Health and Social Care (DHSC).

Caulfield is also responsible for disabilities, vaccines, the entirety of the UK Health Security Agency and patient safety. In short, a far cry from Labour’s former position of a cabinet-level minister with a sole focus on mental health.  Following Allin-Khan’s resignation, Abena Oppong-Asare has now been appointed as the Shadow Minister for Mental Health and Women’s Health, apparently shadowing the Government’s structure.

Having a Cabinet role was arguably an effective way to politically signal the importance of mental health, but was the role just that?

Policy signalling does not always lead to policy impact

For example, when Labour Prime Minister Harold Wilson established the “Department of Economic Affairs” (DEA) in 1964 its main achievement was arguably political, helping to paint an attractive picture of Wilson forging a new Britain with the ‘white heat of technology’.

Did the DEA’s establishment help Wilson deliver more for the economy? In itself, absolutely not. Wound up in 1969, whatever historians may argue about the DEA’s results and record, these same historians do tend to pay more attention to individual economic decisions like the devaluation of the pound. It didn’t start a lasting revolution and the Treasury, the institution it was supposed to change, remained as ‘orthodox’ as ever.

The history of the DEA and a potential Cabinet Minister for Mental Health are hardly carbon copies, but maybe there are some similarities to bear in mind.

When you look at it through this lens, the establishment of this post in the shadow cabinet, without any detail on how it could work in practice, feels like more of a political play than a principled, thought-through policy intervention.

How would a Cabinet Minister for Mental Health actually work?

Individual decisions, like those on social security, physical healthcare, immigration, housing will have considerable impacts on mental health.

If a minister for mental health just had responsibility for mental healthcare, then this would be seen as a missed opportunity to address these factors. There’s also no evidence a minister with this portfolio would be less effective sitting under the Secretary of State for Health, rather than parallel to them within the cabinet.

What if the role was extended so that decisions made by government outside of the direct purview of healthcare, but with an impact on mental health, like housing policy, would need to be reviewed by that minister? That would be radical, but probably unworkable. In essence, they would either have veto power over their colleagues’ departments or be made irrelevant and undermined by their colleagues. Neither seems entirely constructive for policy-making. In this case, a minister would be a distraction, not an enabler of delivery.

Ensuring real results

There are other methods you could try to weave a focus on mental health across and throughout government: a cross-departmental strategy; changing the way departments model the impact of their own decisions to give a weighting to improvements in mental health; a ‘tsar’ or arms-length champion for mental health like the Children’s Commissioner; adding it to the responsibilities of a minister in the cabinet office who already takes cross-departmental briefs. In fact, you could do all of those at once.

We have written before about how there is evidence, that serious policy plans, with momentum, do lead to better outcomes. It is not the case that what happens in ministries and Downing Street does not matter, but a minister alone does not maketh momentum.

Starmer’s mission focus

We do not know what would have happened if the first ever Cabinet Minister for Mental Health had taken a seat in the Cabinet room in Keir Starmer’s first Cabinet. We do not know what dynamics would have taken hold, or whether the minister would have been a political risk.

Nor did Keir Starmer. Given his ruthless aversion to risk, a decision which allows him to focus on the ‘missions’ which we know are central to Labour’s preparation for government, seems like a natural one to him. Those missions could clearly deliver for the nation’s mental health. A minister could distract from that delivery.

MHP Group’s Public Affairs team has placed Labour’s missions under the microscope in:  “Mission accomplished – MHP’s guide on what to expect from a Labour government”. Read it here

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