Systemic barriers hold back London mental health services, report finds

The report Transforming Mental Health – A Plan of Action for London also describes how drops in funding for mental health has hampered improvements, and calls on commissioners, providers and other stakeholders to pursue more integration.

The report identifies a series of systematic barriers, which it said was holding the city back and preventing improvements in mental health.

It describes the perception of mental health as a “Cinderella service” as “not unfounded”. It added: “A declining share of funding going into mental health is difficult to square with parity of esteem with other areas of healthcare.”

It highlights:

• an overlap of current systems;
• variation in primary and secondary care;
• lack of integration between physical and mental health;
• inconsistent data on activity and outcomes; and
• delays in securing patients the right kind of care.

Such issues led to “a lot of unnecessary duplication of work” and fragmentation of services with patient views’ undervalued. It added that closer integration of services and commissioners to create pan-London solutions was needed.

It also urged improvements in the use of activity and outcomes data to better understand and drive changes.

• London CCGs map out future of mental health commissioning
• Mental health patients ‘let down’
• Sign up to the mental health newsletter

The report concluded: “Our analysis suggests that although [clinical commissioning groups] have been established to take account of local needs, the evidence to support improvement in mental health outcomes – particularly in relation to the acute care pathway – is less locality specific.

“As such, CCGs may benefit by increasingly working together across population boundaries.

“This would facilitate the sharing of resources and expertise, and create a better platform for engagement with NHS providers in order to design care pathways, identify appropriate outcomes and procure accordingly.”

Helen Gilburt, a health policy fellow at the King’s Fund and lead author of the report, said: “Over the last 25 years, mental health provision has undergone a dramatic transformation, with services moving from institutions to community settings.

“Our report shows that mental health services in London need to move away from siloed working, and embark on a second phase of transformation to deliver the change needed to improve services.”

London spends £7.5bn on tackling mental health services through more than 80 separate organisations with the number of people using secondary mental health services higher than the national average across more than three quarters of London’s boroughs.