Mental health sector ‘is at a crossroads’

The mental health sector ‘is at a crossroads’ with some services using out-dated care that leaves people feeling ‘helpless and powerless’, a new report has found.

The Care Quality Commission (CQC) has published the findings of its inspection of all specialist mental health services, with many examples of excellent care but too much poor care and too much variation in both quality and access across different services.

The report found that 68 per cent of services provided by NHS trusts and 72 per cent of independent mental health locations were rated as good in May 2017, with 6 per cent of NHS and 3 per cent of independent services rated as outstanding. Of the 22 NHS trusts initially rated as inadequate or requires improvement, 16 achieved an improved overall rating when re-inspected. Additionally, 88 per cent of NHS and 93 per cent of independent services were rated as good for having caring and compassionate staff, with 9 per cent of NHS and 5 per cent of independent services rated outstanding.

However, the report has found several areas of concern which need improving, including: physical environments not designed to keep people safe; care that is over-restrictive and institutional; and poor recording and sharing of information that undermines the staff’s efforts to work together to ensure that people get the right care at the right time.

Underlying these concerns is the fact that mental health services are under significant pressure. Figures show a continuing decline in the number of mental health nurses and the number of inpatient psychiatric beds reduced by 4 per cent overall between 2014/15 and 2016/17. At the same time, the number of detentions under the Mental Health Act rose by 26 per cent between 2012/13 and 2015/16. This means that more people risk receiving care that is not good enough - or no care at all.

The CQC recommends doing the following to improve mental health services: treating people as active participants in their own care to promote recovery and reduce dependence on services; investing in better services locally to prevent the need for costly out-of-area placements that risk isolating people from their family and friends; and investing in information technology that enables staff to enter and retrieve clinical information while on the move to reduce wasted staff time and make care safer.

CQC says it will ‘play its part’ by ensuring that everybody gets the care they need to recover, continuing to work closely with experts in the field of mental health care to ensure that inspectors understand the latest thinking on policy and practice.

Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and Lead for Mental Health at CQC, said: “More than ever before, people are being encouraged to talk openly about mental health conditions and to share their experiences - and more people than ever are receiving treatment and care for mental health conditions, in part due to a reduction in the stigma associated with mental ill health. But this vital work must be supported by services that give people the help they need, when they need it.

"The mental health sector is at a crossroads. The Five Year Forward View for Mental Health, published last year, along with the newly introduced waiting time standards, point the way to a future where people have easy access to high quality care close to home and are able to exercise choice. To achieve this vision, the sector must overcome an unprecedented set of challenges – high demand, workforce shortages, unsuitable buildings and poor clinical information systems.

"Some services remain rooted in the past – providing care that is over-restrictive and that is not tailored to each person’s individual needs. This can leave people feeling helpless and powerless. But the best services are looking to the future by working in partnership with the people whose care they deliver, empowering their staff and looking for opportunities to work with other parts of the health and care system.

"These outstanding mental health services provide world-class care, whether in hospital or in the community; the challenge is how to ensure that everyone, no matter where they live or who they are, has access to services of this quality. The good news is that mental health services in England have the raw material to achieve great things.

"We have rated almost every service as good or outstanding for caring - ratings that were informed by our own observations and with interviews with many thousands of staff and patients.

"Those who deliver and commission care must learn from the services that are getting it right. And we will continue to highlight good practice, drive improvement and act on behalf of people to ensure that everyone gets the help they need when they need it."