I have come over the last five years to realise that I can only fully understand the diversity and reach of what mental health providers do by going out and seeing for myself.

When considering the gap between how the mental health sector can be perceived at the centre of the health system and the reality of its past, present and potential future, there is always a risk that assumptions are made by policy makers who haven't spent quite enough time on the ground. 

The picture of mental health policy is currently characterised by three disjunctions.

First, mental health is often ignored in the national reform narrative even while ministers and NHSE seem to see it as a big problem. 

As I've been warning for some time now the picture on reform is much less positive with, for example, clarity on neighbourhoods sliding even further into the distance and that the centre is, once again, overwhelmingly focused on acutes.  

The irony is that while mental health rarely seems to be a core part of either the recovery or reform story, there is in fact a huge amount of central policy activity focused on the sector. 

This includes the prevalence review which starts from a debatable assumption of over diagnosis, the development of a modern service framework, a rumoured supply side review led by NHSE chair Penny Dash, as well as the interface with cross Governmental work on economic inactivity, including Alan Milburn's review of NEET's (not in education, employment, or training) policy. 

The soon to be announced national priority director for mental health learning disability and autism has an overflowing in-tray. 

There is a lot of potential in all this, but with only sporadic engagement with the sector, it can feel mental health providers are seen mainly as a problem. 

A second related disjunction is that while mental health is rarely presented by ministers as a place for potential transformation, the sector has in fact been ahead of the curve in delivering more community-based services that reflect a bio/psycho/social approach for decades.  The sector has reduced its bed numbers by almost three-quarters over the last three decades. 

While the public and press understandably focus on the tragic moments when things go wrong, every day the mental health sector supports hundreds of thousands of people with long term and often severe and complex conditions to live in the community. Of course, there is still significant scope for improvement in how we support people with emerging and established mental illness, but there is consistent underestimation of what the sector has achieved and can do in the future. 

This links to a third disconnect. Mental health ought to be central to attempts to reimagine models of care in systems and places. The potential for digital care and digitally enabled delivery is possibly highest in mental health. 

Even more than physical conditions, the role of social determinants in mental health driving morbidity is clear and the evidence for early intervention overwhelming.

An ever higher proportion of demand on the NHS comes from people with a  combination of mental and physical health challenges yet still policy too often falls into the trap of seeing these as separable pathways. 

Evidence from evaluation in Birmingham demonstrated that targeted integrated neighbourhood teams incorporating additional mental health support had a major impact on reducing use of all NHS services. 

Yet, despite three of the eight trusts chosen for the first wave of Advanced Foundation Trusts being mental health providers, the degree to which mental health is being included in conversations about the potential of integrated health organisations (IHOs) and neighbourhoods is highly variable. Just last week I visited a very innovative and successful system to discuss reform and in four hours of productive conversation about the potential for transformation I don't think mental health was mentioned once. 

Arguably some of the responsibility for mental health being on the edges of conversations lies with the sector itself. Before ICBs were decimated, I tried to suggest that mental health leaders should engage positively in system leadership. 

But too often the conversation was dominated by concerns – not entirely unjustified – that system working would simply increase the risk of budgets being raided to subsidise overspending on acute services. 

The mental health crisis has major implications not just for the NHS but for economic dynamism, social cohesion and the well-being of citizens and communities. Profound change is needed. 

Rather than seeing mental health as a problem sector that must be subject to reform, national policy makers should remind themselves of the sector's history of transformation and innovation (preferably by seeing it on the ground) and engage more deeply and ambitiously with its leaders.