Exclusive: Mounting aftercare costs eat into mental health budgets

New data compiled via Freedom of Information requests to every clinical commissioning group in the country has sparked fears that new cash promised for mental health services will not be available to expand preventive services.

The analysis reveals that for 54 out of 72 CCGs, which provided data for the past two years, the cost of “aftercare” packages for people previously detained under the Mental Health Act has increased as a proportion of their total mental health spending (see table below).

Under section 117 of the Mental Health Act, CCGs and local authorities have a statutory duty to provide aftercare to patients following their discharge from hospital.

HSJ  revealed in April the average cost per CCG of providing “aftercare” for mental health patients following their discharge increased by 51 per cent from 2013-14 to 2016-17.

NHS Clinical Commissioners Mental Health Commissioners Network chair Dr Phil Moore said CCGs and councils are under “immense financial pressure”.

He said: “It is of course vital that people receive the aftercare they need to support them, but equally it must be recognised that we can only spend our finite budgets once.

“The more that is used on aftercare services, the less that we can spend on other mental health services, including crucially those relating to early intervention and prevention, which can make a huge difference in helping people before a problem starts to have a serious impact on their lives.”

The charity Rethink Mental Illness stressed aftercare is vital for patients trying to get back on their feet after being sectioned.

Associate director of campaigns and policy Danielle Hamm said: “We want to make sure that additional funding for mental health is reaching the frontline and providing new services, as well as bolstering aftercare.”

The charity is calling for the government to commit to meeting the costs of S117 separately from the nearly £4bn pledged to improve mental health services by 2020-21.

The number of people detained under the Mental Health Act has risen by about 30 per cent from 48,600 in 2011-12 to 63,600 in 2015-16, which could partly explain the rising cost of aftercare.

The Mental Health Act code of practice says commissioners should record how many patients are receiving aftercare, and what care they are receiving. However, the act does not set out how councils and CCGs should cocommission aftercare and it is not clear what action will be taken against organisations failing to meet the requirements.

In April, only 75 CCGs provided data on their S117 spend for 2015-16, with 97 saying they did not know how much they were spending.

But responding to HSJ’s most recent request, 150 CCGs were able to provide their S117 spending for 2016-17. This included 60 which originally told HSJ they did not hold that information.

HSJ’s new analysis also found: 

• The average cost of S117 aftercare per CCG rose from £1.5m in 2013-14 to £2.3m in 2016-17; 
• The median percentage point increase for aftercare as a proportion of total mental health spend was 0.92 per cent.
• 48 out of the 51 CCGs which provided data for all four years reported an increase in S117 costs; and 
• 35 CCGs out of those 48 saw S117 spending more than double in four years.

An NHS England spokesman said decisions on funding allocations and local provision of services were for individual CCGs and their local authority.