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Mental health trusts should have staff retention targets, say MPs

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Trusts providing mental health services should be set new targets to improve staff retention rates, according to a group of MPs who called for urgent action to boost the mental health workforce.

The need to increase the number of mental health nurses and ensure all nurses understand mental illness were among key priorities in a report by the All Party Parliamentary Group (APPG) on Mental Health.

“As it currently stands, the workforce is unable to keep up with increasing demand”

APPG report

The On the Road to Parity report, which looked at progress made to date on the government’s Five Year Forward View for Mental Health, found core services such as community mental health teams, crisis teams and inpatient units were under severe strain.

While investment in specialist services such as perinatal support and early intervention in psychosis had led to improvements, core services continued to struggle, meaning the most severely people were at risk of receiving the worst care, the MPs found.

One service user told the inquiry they had been advised by their GP to lie about severity of their psychosis in order to get help from services designed for mild to moderate conditions.

The report comes ahead of the expected publication of the NHS long-term plan next month.

“It cannot be right, as we heard in the inquiry, that people severely affected by mental illnesses are being told to lie and downplay the severity of their symptoms to get help,” said APPG chair Helen Whately.

“It is absolutely vital that core services for adults with severe mental illnesses are made a priority in the long-term plan,” said Ms Whately, who is Conservative MP for Faversham and Mid Kent.

“It is absolutely vital that core services for adults with severe mental illnesses are made a priority”

Helen Whately

The APPG highlighted a worrying decline in the mental health workforce in the face of increasing demand for services, with a drop of more than 12% in the number of registered nurses working in mental health trusts in the past eight years.

“The mental health workforce was raised again and again as being the biggest challenge to delivering the Five Year Forward View for Mental Health in full,” said the group’s report.

“As it currently stands, the workforce is unable to keep up with increasing demand,” it warned.

The APPG found that the Stepping Forward to 2020-21 workforce plan, intended to ensure there were enough staff in place to enable much-needed improvements in care, had so far failed to deliver.

This plan had promised an extra 8,100 posts for mental health nurses and midwives by 2021, but less than 5% of these new roles have materialised, highlighted the report.

“There has been an increase of only 365 mental health nurses in NHS trusts between March 2017 and March 2018, suggesting we need to recruit an additional 7,735 more nurses in just three years,” said the report.

“To achieve the changes that are required the government should appoint a cabinet level minister for mental health”

Dave Munday

Dave Munday, lead professional officer for mental health at the union Unite, said that if progress continued at the slow rate highlighted in the APPG report, it could take up to 2040 to achieve the promised boost in nursing numbers.

“They have a small window of opportunity to actually put together a package to address this crisis that has been eight years in their making, and steps must be started now following the publication of this report,” he said.

Among a series of recommendations, the APPG called for the system regulator NHS Improvement to set a new target for trusts to prevent the loss of staff.

Under the proposal, all mental health trusts – as well as community and acute trusts providing mental health services – would be expected to demonstrate an annual 4% improvement in retention rates.

The report also highlighted the need to ensure people with mental health problems get appropriate assessment and support in a crisis.

Conservative Party

Helen Whately

Helen Whately

Emergency call handlers in all areas should be able to put people in distress through to a 24-hour service, where they could get an initial assessment over the phone from someone trained in psychological wellbeing, said the APPG.

Such a service should also have mental health nurses or social workers on hand to act as “first responders” to go out and provide face-to-face assessments and crisis management.

“For this to be rolled out successfully, the workforce must be newly recruited instead of being taken from existing mental health services,” said the report.

In addition, it highlighted the need to improve mental health awareness among health professionals including nurses.

“We have heard throughout the inquiry that, despite greater mental health awareness, there are still a significant number of NHS professionals who do not have a sufficient understanding of mental illness,” said the report.

One service user, who provided evidence to the inquiry, said they had been shocked by the lack of training for even the most senior nursing staff.

“My sister is an experienced A&E staff nurse and I was really shocked by the lack of mental health training she’d received,” they said.

They added: “I said to my sister, ‘I can’t believe you’d say to someone who’s come in after a suicide attempt – well why weren’t you thinking about your children?’ And she’s a very senior nurse, in charge of training other nurses.”

The APPG called on the body Health Education England to improve the development and training of frontline care staff, with a specific focus on mental health, learning disability and autism, “so the existing workforce is supported and equipped to deliver direct care and support to those groups”

dave munday cropped

dave munday cropped

Dave Munday

The report also called for “better oversight and responsibility for mental health”, and proposed the establishment of a mental health cabinet committee in the government. However, Mr Munday said he would like the government to go further.

“Whilst the recommendation to have a mental health cabinet committee is a step forward, we still believe that to achieve the changes that are required the government should appoint a cabinet level minister for mental health,” he said.

“This would better address the problems uncovered in the report but also go further to ensure people living with mental ill health are better represented and supported by government,” he added.

Earlier this month – to coincide with World Mental Health Day – prime minister Teresa May announced the appointment of health minister Jackie Doyle-Price to the new role of “minister for suicide prevention”.

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Readers' comments (1)

  • Mental health trusts are now dominated by managers who rate themselves on how much they've managed to cut budget wise. They have lost the art of retaining staff, as to cut budgets they overwork the nurses etc, and when the experienced staff leave because it's not safe, they're replaced by newly qualified lower banded nurses or support workers. This is called improving the skill mix. As a result in some teams there are now no experienced staff to train or support the inexperienced. The patient care worsens as a result. I think they will struggle to change this culture even if the funding increases. The last 2 teams I've worked in have had increased funding, and the managers' style has still driven good staff away. Good mental health managers support staff to retain them - that is rare now.

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