Improved access to mental health services is in jeopardy if the infrastructure is not up to scratch, writes Paul Farmer
Pressing risks caused by sub-standard mental health facilities have been rightly highlighted in the new prime minister’s funding announcement for NHS building projects, but we must see further investment to address the backlog in this sector.
At Mind we hear day in, day out how the abysmal condition of many NHS mental health facilities is hampering people’s recovery and putting them at risk of suicide and sexual assault. Hard-working mental health staff also face major challenges working in such tough surroundings. Repeated Care Quality Commission reports have added to these accounts, concluding that many buildings are neither safe nor therapeutic, and highlighting the continued use of mixed sex and dormitory wards, which simply have no place in modern healthcare.
In a new and exciting world of technological developments in physical healthcare, it is easy to forget the extent to which the quality of mental healthcare is contingent on the environment in which it’s delivered. Best estimates indicate at least £600 million is needed to upgrade existing buildings, create facilities to meet demand, and improve community-based residential care
We were therefore pleased to see Boris Johnson acknowledge these issues, for example in Manchester, which has the second highest number of dormitory wards in the country, by allocating £72.3m to build a new adult mental health inpatient unit. However, Manchester is only one of many trusts which requires significant investment to be able to deliver modern mental healthcare.
Mersey Care and Coventry and Warwickshire are prime examples of trusts that have had bids for capital funding rejected – even though the most recent CQC report for the latter referenced maintaining building infrastructures as one of their key risks.
This comes against a backdrop of only 13 per cent of capital funding in the most recent allocations going to mental health, and a third of mental health trusts not even bidding. This is despite the Mental Health Act Review and the CQC underlining the need for sufficient resourcing to treat people in environments that promote privacy and dignity, and aid recovery.
The case for investment is clear; the need in mental health is, typically, greater than in other parts of the NHS and therefore accounts for the biggest proportion of the backlog. Analysis by the Royal College of Psychiatrists found that the plethora of historic infrastructure issues for mental health trusts has been getting worse over the past year, with risk increasing and costs accumulating.
Mental health trusts have suffered year-on-year from the highest percentage increase for moderate risk compared to all other groups of trusts. Or, if high and significant risk categories are combined, mental health trusts have had the second highest percentage growth, behind only ambulance trusts.
In a new and exciting world of technological developments in physical healthcare, it is easy to forget the extent to which the quality of mental healthcare is contingent on the environment in which it’s delivered. Best estimates indicate at least £600 million is needed to upgrade existing buildings, create facilities to meet demand, and improve community-based residential care.
With discussion of whether the extra £1.8bn funding announced is even new money, the prime minister must seize the opportunity to make real, sustained investment to address the problems in the mental health estate.
The government’s ambition for world class care must extend to mental health and be matched by appropriate facilities. Significant progress is being made in improving access to mental health services, but this is in jeopardy if the infrastructure isn’t up to scratch. The government must commit to bringing mental health facilities into the 21st century.