Taken short

After an exhaustive study of the state of mental health services in England, CHI concludes that they are suffering from desperate staffing shortages, including problems in management capacity.

Sarah Grant reports 'M ental health is still the poor relation of the NHS, ' says Commission for Health Improvement acting chief executive Jocelyn Cornwell following CHI's examination of the state of psychiatric services across England and Wales.

The report, out today, is built on firm foundations. CHI's assessment is based on clinical governance reviews that have now been carried out on behalf of specialist trusts in England and Wales, as well as lessons from two investigations of service failures and its work on child protection.

The report says mental health services are subject to acute staffing shortages, including serious problems in management capacity - and all at a time when the sector faces immense change.

'Resources allocated for service developments have not always found their way into services' and 'commissioning and performance priorities remain focused on the acute healthcare sector'.

The report goes further to explore the implications of these difficulties. One example is the way staffing shortages leave agency staff lacking appropriate training and unable to handle violent situations.

Mental health charity Rethink, whose members were consulted for What CHI has found in: mental health trusts, says the report is 'understated' about the scale of the problem.Head of policy and campaigns Paul Corry says the government needs to emphasise its commitment to mental health as one of its top three priorities.

And he says awkward questions still need to be asked about its funding: 'They need to make it absolutely clear to everybody that money promised to mental health has been spent.'

Report author Dominic Ford, also CHI's mental health development manager, tells HSJ:

'We can say quite clearly that clinical governance is much less developed in mental health services than in the acute sector.

'The reason, I think, is the historical legacy of underfunding, which is behind a lot of the issues around capacity.'

The report alleges: 'Trusts and services are at very different stages in development...a number of trusts are performing well, but a larger number are facing significant challenges.'

Staff shortages are resulting in dependency on locum staff, long hours, failures to organise activities for patients and a lack of time for training and appraisal. But some trusts are finding solutions to providing for the individual needs of patients, which Mr Corry says provide real hope for the future.

Mr Ford praises the work of South West London and St George's Mental Health trust, outlined in the report.

Thanks to its recruitment efforts, about 20 per cent of its staff have personal experience of mental health problems, creating more focused services.

The report also examines the state of service information capacity, which it describes as 'severely under-resourced'.

Progress towards implementing the national mental health minimum data set and developing electronic systems to support the care programme approach is inconsistent.

CHI also highlights the failure of the service to guarantee patients a decent standard of accommodation.

The report echoes the findings of HSJ's recent campaign to improve the quality of mental health estates, saying some 'trusts still deliver care in buildings with Victorian fabric and infrastructure that compromises quality of care and dignity of service users'.

Some surroundings lack bed capacity, proper security arrangements, fresh air for patients, basic washing facilities in seclusion areas and facilities for child visitors.

Mr Ford also spells out specific problems for older users: mixed wards, low staffing levels, lack of capacity in homes and intermediate care and 'immature' performancemanagement systems'.

Another overlooked group is black and ethnic minority users. But the report includes several good practice case studies, including north London's Barnet, Enfield and Haringey Mental Health trust, which provides an outreach service in Tottenham for AfricanCaribbean users aged 16-25.

And there are other lessons the rest of the NHS could learn from mental health (see panel). Chief among them is its ability to involve service users and look after its staff.

Ms Cornwell says: 'We are really impressed with the commitment and dedication shown by both clinical and non clinical staff to high-quality services for patients.

'Though many staff are working under considerable pressure in difficult environments, we only found a handful of mental health trusts where morale was generally poor.' l Service user input: what the NHS can learn The report says mental health services 'are generally better at involving service users than other parts of the NHS'- for example, in service planning and staff recruitment and training.

It cites the patients' council of the medium secure unit at Oxfordshire Mental Healthcare trust, which has resulted in 'numerous example of change'.

But all too often, says the report, 'many professionals said trusts tend to rely on the most articulate service users who do not always represent the diverse user population'.

Also, it adds, a lack of information can result in little improvement over specific issues of care.