Mental health care at risk as 'services shrink and demand escalates'

A review by The King’s Fund think tank has revealed that cuts to adult mental health services in England are having a negative impact on the quality of care patients receive.

The briefing found ‘widespread evidence’ of poor-quality care as the sector faces a huge amount of strain with 40 per cent of mental health trusts experiencing an income cut in 2013 through to 2015.

Helen Gilburt, fellow at The King’s Fund and author of the report, commented: “Historically, mental health services have often been the first to see their funding cut, so many trusts felt forced to look at what savings could be made through transformation programmes to pre-empt this.

“Trusts looked to move care from the hospital to the community, focusing on self-management and recovery. Few would dispute the intention and rationale for this – the problems arise with the scale and pace of the changes, which lack the necessary checks to evaluate their effectiveness and the impact on patient care.”

Inadequate support

Driven by the need to reduce costs, trusts have embarked on large-scale transformation programmes to shift demand away from acute services towards recovery-based care and self-management.

The think tank also pointed to growing evidence that there was inadequate support for those with severe mental health problems.

Furthermore, only 14 per cent of patients had reported receiving appropriate care in a crisis, while hospital bed occupancy rates were routinely exceeding recommended levels - leading to patients being sent to units miles from their home.

The King's Fund think tank also found:

• More than two-thirds of mental health trusts had recently overhauled services;

• Of those, more than half had plans to reduce staffing levels or the skills mix in its workforce;

• A quarter aimed to use less qualified staff, by replacing nursing with volunteers and support workers;

• More than ten per cent said they would be further reducing bed numbers.

Patient care

Ms Gilburt added: “Trusts have looked to move care from the hospital to the community focusing on self-management and recovery.

“Few would dispute the intention and rationale for this - the problems arise with the scale and pace of the changes which lack the necessary checks to evaluate their effectiveness and the impact on patient care.”

In response, Paul Farmer, chief executive of mental health charity Mind, said: “This report lifts the lid on the true state of NHS mental health services. The Government has expressed its commitment to putting mental health on an equal footing with physical health but it’s clear that there is an enormous gulf between that aspiration and the day-to-day reality for many.

“We hear every day from people with mental health problems who tell us that support is getting harder and harder to access as services shrink while demand escalates.

“Poor mental health can ruin lives, destroy relationships, take away people’s independence and can lead to some taking their own lives. But with the right support at the right time, people can and do recover or manage their mental health in a way that allows them to lead the life they choose.

’More funding’

“If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line. Failing to deliver the right care isn’t good for people and it’s not good for the NHS.

“We echo the King’s Fund’s call for more funding for NHS mental health services; after decades of neglect and five years of cuts, services are in urgent need of significant investment.”

However, the Government stated that money made available for mental health had been increased by £300 million in 2014 to £11.7 billion, and improvements were being made. This includes the introduction of waiting-time targets, part of the drive to achieve ‘parity of esteem’ between mental and physical health services.

Health secretary Jeremy Hunt said: “This Government believes in the NHS and its values – and we’re investing an extra £10 billion to transform services during this Parliament. A key part of that transformation is building a more patient-focused culture.

“We’ve made progress in creating a stronger partnership between doctor and patient, but we still put too many obstacles in the way of doctors and nurses wanting to do the right thing.

“By being more transparent than ever before about crucial services and freeing up more time for GPs to care, we really can make NHS patients the most powerful in the world.”