The Care Quality Commission’s new findings indicate worrying failings in delivery of the government’s mental health strategy, says Nick Pothecary
In a rapidly changing and uncertain world, successive governments have recognised the importance of promoting good mental health. In 2011, the government launched its mental health strategy No Health Without Mental Health and the Health and Social Care Act 2012 requires the NHS to deliver “parity of esteem” between mental and physical health.
Unfortunately, results from the 2016 Community Mental Health Survey show there is a very long way to go if the reality is to match the rhetoric.
It is, perhaps, unsurprising that the promise of a more progressive approach to mental health has not yet been realised. In the years since the government published its strategy, the NHS has faced unprecedented financial pressures and staff shortages, all the while coping with the increasing workload of serving an ageing, and growing, population.
The survey is carried out annually and was extensively re-developed in 2014, so historical comparisons are only available for the two previous iterations of the survey. Results from 2015 showed a number of areas where performance had worsened since 2014, specifically the areas’ most important to patients and the overall perception of care quality.
The results this year show that these areas and achieving the fundamental aspects of person-centred care (identified in the Picker Principles of patient-centred care) remain problematic, but that service providers have implemented necessary, cost effective improvements where they can, such as better signposting of other services or support groups.
Access to services
The tumultuous economic climate that has contributed to the pressures on our health service is also likely to increase the need for mental health services; in 2016, 20 per cent of respondents to the survey had been in touch with mental health services for less than a year, up from 18 per cent in previous years.
Access to services remains a challenge, with 22 per cent of services users reporting that they did not feel they had seen NHS mental health services often enough for their needs, up from 20 per cent in 2014 and showing no change from the result in 2015. Similarly, a greater proportion of service users said they weren’t given enough time to discuss their needs or treatment (2014, 9 per cent; 2015, 11 per cent; 2016 11 per cent).
Results for crisis care are cause for concern, with too many users reporting a lack of effective crisis care. Of those who had tried to contact the team in a crisis, 3 per cent reported that they were not able to reach them. As in 2015, one in four who did get through, said they didn’t get the help they had needed (24 per cent, up from 21 per cent in 2014). If anything demonstrates the gulf between physical and mental health services, it is this; what if 3 per cent of ‘999’ callers were unable to get through, or if 24% of callers were told that there wasn’t an ambulance available.
It is important to celebrate these positives and recognise that even under difficult circumstances, NHS staff are finding ways to eke out small gains and take advantage of alternative support systems
Support and wellbeing
Despite worrying trends, there is evidence that service providers are finding more effective ways of using their dwindling resources. NHS mental health services can act as a hub for directing people to other services or groups that may be available in the community. This year, a greater proportion of people said that they had received help to take part in a local activity (30 per cent, up from 28 per cent in 2015), or that they had been assisted in getting peer support from people who have similar mental health needs (25 per cent, up from 24 per cent in 2015 and 23 per cent in 2014).
It is important to celebrate these positives and recognise that even under difficult circumstances, NHS staff are finding ways to eke out small gains and take advantage of alternative support systems.
Taken together, these findings show a mixed picture and point to services needing to be more creative in addressing the challenges they face. In particular, it is vital to maintain fundamental standards: responsive crisis care teams and wide access to services more generally. The survey has been designed through consultation with stakeholders and service users and reflects issues that are important to them: such as clear communication, active involvement and effective coordination.
Using survey results to review what people say about services and developing action plans in consultation with users have proven enormously effective techniques for service providers to identify and achieve real improvements for the populations they serve.
Nick Pothecary is senior research associate at Picker.