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‘Disappointing’ lack of progress in community mental health

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An annual survey of people’s experiences of using community mental healthcare shows “limited progress” overall, with a decline in performance in some service areas, according to regulators.

In response, the Royal College of Nursing said the survey findings were “not surprising”, given the recent fall in mental health nurses over the last seven years or so.

“It is disappointing that the results do not show improvements year-to-year”

Paul Lelliott

The results of the latest survey of community mental healthcare, published today by the Care Quality Commission, suggested that patient experiences across England have not improved and have even declined slightly in key areas.

Although 64% of respondents rated their experiences of community mental healthcare as “seven or above” out of 10 in this year’s survey, it represented a slight decline on the 65% during 2014.

More than 12,100 people took part in this year’s survey, covering their experiences of care outside of hospital by community-based mental health services, such as specialist clinics and at home.

It found that, while 71% of respondents knew who to contact when they experienced a crisis out of hours, fewer were satisfied with the quality of care and support they received when they did so.

This year, 26% of respondents said that they did not feel they got the help they needed from crisis care, compared to 21% in 2014, said the CQC, which commissioned the survey.

In addition, 25% of respondents reported they had not seen workers from their mental health services often enough to meet their needs in the last year – up from 21% in 2014.

“With the number of mental health nurses having dropped by 6,000 since 2010, it’s not surprising”

Catherine Gamble

A further decline was represented by 68% of respondents saying they felt listened to by their healthcare or social workers – down from 73% in 2014. Also, 61% of respondents answered “yes, definitely” to whether they felt they had enough time to discuss their needs and treatment – down from 65% in 2014.

The CQC noted that experiences seemed to vary across different population groups, particularly around overall care, respect and dignity, involvement, access and communication.

There was a marked trend that the longer a person was in contact with mental health services, the worse the experience reported, noted the regulator. However, there was a general trend that respondents aged 50 and above reported more positive experiences.

The CQC highlighted that the survey results had been released for providers to review the experiences of their patients and to improve their services.

It added that it would continue to use the findings as part of its wider monitoring of the quality of mental healthcare and to plan its inspections.

Dr Paul Lelliott, CQC deputy chief inspector of hospitals and lead for mental health, described it as “disappointing” that the results did not show “improvements year-to-year”.

Care Quality Commission

Dr Paul Lelliott

Paul Lelliott

“These services are important because they support the great majority of people who are under the care of specialist mental healthcare providers; including at times of crisis,” he said.

“They are also essential in working with people to ensure that their mental health does not deteriorate to the point that they require inpatient care,” noted Dr Lelliott.

“The finding that a higher proportion of people who sought help in a crisis were dissatisfied with the help provided is a particular concern,” he said.

He warned that he expected service providers to review their results “very carefully” and that the CQC would also be looking “carefully” at the action plans that providers had developed in response.

Commenting on the findings, the RCN said it was “very worrying” that many of the findings included in the survey had not improved since the last time it was carried out in 2014.

RCN professional lead for mental health Catherine Gamble said: “It is of particular concern that the percentage of patients who said they didn’t get the help they needed in a crisis has gone up by a quarter.

“But with the number of mental health nurses having dropped by 6,000 since 2010, it’s not surprising that patients are reporting worse experiences,” she noted.

Royal College of Nursing

‘Disappointing’ lack of progress in community mental health

Catherine Gamble

She added: “Ministers need to recognise that mental health nurses play an integral part in supporting people’s recovery, and that there is still a long way to go before parity of esteem between mental and physical health becomes a reality.”

The regulator noted that the Isle of Wight NHS Trust had performed “much worse than expected” in this year’s survey – the only trust to have done so.

In response, CQC said it had written to the trust to ask how it would act on the survey findings. The trust was rated “inadequate” overall in April 2017 and the provider is currently in special measures.

Meanwhile, the CQC noted it had also written to 2gether NHS Foundation Trust, Humber NHS Foundation Trust, and Mersey Care NHS Foundation Trust for performing “better than expected”.

Vicki Nash, head of policy and campaigns at the charity Mind, said: “Our mental health services are under immense pressure at the moment, and this report shows the stark scale of the challenge they face.

“These findings again highlight the importance of investment in mental health services,” she said. “It’s essential that the £1bn promised by 2020-21 as part of the NHS and government’s five-year plan for mental health services reaches the front line, to bring them up to a basic standard.

“After sustained underfunding, this £1bn is only the beginning – it will take decades of continued investment to ensure that everyone with a mental health problem gets the care they need, when they need it,” she added.

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