A new fortnightly briefing covering quality, performance and finances in the mental health sector

Welcome to our new fortnightly expert briefing

Hello and welcome to the first instalment of Mental Health Matters, a new fortnightly briefing from HSJ covering the mental health sector.

It is a very exciting time for the mental health sector, but also a crucial time: the subject has never been more in the public eye, never higher on the political agenda; but with commissioners and providers feeling the pinch there is a risk that plans will be implemented fully.

This briefing will explore how the sector is performing, where the cash is going and whether the plans come to fruition.

Mental Health Matters will initially begin on hsj.co.uk, but in the summer will launch as an email bulletin you can have sent direct to your inbox.

Feedback and comments are welcome, so please feel free to email me in confidence.

Joe Gammie, HSJ mental health correspondent

Road to recovery

The government’s flagship talking therapies service has hit a key milestone for the first time in its nine year history.

The latest data from NHS Digital shows that in January, the improving access to psychological therapies programme helped 50.1 per cent of those who finished a course of treatment into recovery. The service has never previously beaten the 50 per cent goal since it launched in 2008.

IAPT has had much more success in hitting its waiting time targets, which came into effect in 2016-17 – but the failure to hit the recovery standard has dogged the programme for years.

But it is probably not time to celebrate. Despite hitting the target overall, the service is still affected by stark regional variation. While some clinical commissioning groups can boast of a recovery rate as high as 73 per cent in January, others are mired in the low thirties.

Surprisingly, IAPT has not only struggled hitting the national recovery rate, but even to hit the recovery target for depression and anxiety disorders – the talking therapy service’s raison d’être. The annual IAPT report for 2015-16 showed that nationally 46.7 per cent of people with depression moved to recovery, while 48.8 per cent of people with stress or anxiety disorders did so.

There is also a link between deprivation levels and recovery, with 55 per cent of patients from the least deprived areas recovering compared to only 35 per cent of those in the most deprived areas.

IAPT may be improving overall then, but is not yet as effective in the most vulnerable communities.

It is still not entirely clear why the sector has struggled with the recovery rate target. Some feel that areas with low recovery rates are dealing with higher demand or higher acuity.

Meanwhile, some fear there is a missing step between IAPT and community mental health services. It is possible that while patients suffering psychotic episodes have one referral pathway, IAPT can become the default for everyone falling below that threshold.

This could mean that people with severe and very acute mental illnesses are being rolled into IAPT, when their conditions could be better treated elsewhere. The more acute the person’s condition, the less likely they are to recover after a course of six talking therapies sessions which could skew the recovery rate if IAPT is being used as a catch-all service it was never planned to be.

While there is anecdotal evidence for this from different providers and commissioners, in the national data, there is nothing to suggest this is a nationwide problem (yet).

But it is a worry to people in the sector. Leaders admit that if the recovery rate is going to remain above target, the right people must be accessing the right services.

Coping with aftercare pressures

An HSJ investigation found that the cost of section 117 aftercare for patients who have been discharged after being sectioned has risen by nearly 50 per cent in the last four financial years.

Our analysis found the average cost per CCG of providing “aftercare” for mental health patients following their discharge increased from £1.5m in 2013-14 to £2.3m in 2016-17.

This is a substantial increase, and when coupled with the other pressures being placed on the system, it puts significant pressure on CCGs’ bottom lines.

This growing pressure is beginning to worry senior executives at both CCGs and providers.

A 30 per cent rise in people being sectioned will explain some of the rise, but this is compounded by the fact that many patients are on aftercare packages for a very long time.

In fact, anecdotal evidence suggests some people are never discharged from aftercare.

With aftercare being a statutory duty on CCGs, commissioners have no option but to pay for these packages – which typically can include care and housing but can also include anything to meet the needs of that individual.

If costs to continue to rise, there is a risk that new money earmarked for new services will begin to be eaten up by aftercare. Data analysed by HSJ found some CCGs were seeing their planned increase in mental health spending almost completely taken by spiralling aftercare costs.

This poses a clear risk to national plans for mental health, as CCGs and councils have to use new health and social care cash to meet rising demand.

Paul Farmer, chief executive of Mind and chair of the Mental Health Taskforce, has called for a national protocol to monitor S117, so councils and CCGs have clear instructions on what they monitor and how they monitor it.

This could mean commissioners can make savings by reassessing patients, altering care packages and cutting out waste. But until aftercare is investigated properly, there will be no way to separate the wheat from the chaff.