Mental health care in the NHS is “inadequate” and has in recent years led to worsening outcomes such as higher suicide rates, according to a major report by an independent taskforce on improving services.
The criticism comes despite a range of government initiatives to improve services in England over the past five years, said the taskforce’s report called The Five Year Forward View for Mental Health.
Challenges with implementing initiatives across the NHS, coupled with an increase in people using mental health services has stalled progress, it said.
“We are saying to the NHS, to government, to industry, to local leaders and to the public that mental health must be a priority for everyone”
While public attitudes about mental health have improved, as a part of the NHS it has been “deprived” of funds, has had a shortage of qualified staff, and has not been given the same priority as physical health, it added.
The failure to provide adequate mental health care is costing the economy, NHS and society around £105bn a year in England, said the report from the taskforce, which was set up by NHS England in March 2015.
Services must now be “re-energised”, according to the taskforce, which has laid out a total of 58 recommendations to improve mental health care by 2020.
Workforce problems identified by the taskforce included inadequate staffing levels and training gaps, particularly in community settings.
“For too long there hasn’t been enough focus on mental health care in this country meaning too many have had to suffer in silence”
According to the Royal College of GPs, 42% of practice nurses have had not training at all in mental health, while 80% have responsibilities for which they haven’t been trained, noted the report.
Meanwhile, it highlighted that demand for temporary mental health nursing staff had risen by two thirds since the beginning of 2013-14.
In some areas, 10% of appointments in child and adolescent mental health services (CAMHS) are being cancelled due to staff shortages, as referral rates to CAMHS have risen five times faster than the workforce.
“Workforce planning for mental health across the entire care pathway has not been developed and as a result opportunities are being missed to identify how changes in skill mix could help improve delivery, retain staff and tackle the highest vacancy rates,” stated the report.
It called for a costed, multi-disciplinary workforce strategy to be drawn up by 2016, which should be led by national workforce planning body Health Education England.
“We have made monumental strides in the way we think about and treat mental illness in this country in the last few decades. But we must accelerate progress even further”
Standards for prescribing anti-psychotics and other medications, which can have serious effects such as rapid weight gain, are also not always being met, noted the report.
The taskforce recommended that HEE work with the Academy of Medical Royal Colleges to develop standards by April 2017 for all prescribing health professionals that include discussion of the risks and benefits of medication.
Rising suicide rates in England – peaking at 4,882 deaths in 2014 – in which 25% of people had been in contact with a health professional in the last week of their life, must also be tackled, said the report.
It called for the Department of Health, Public Health England and NHS England to support all local areas with multi-agency suicide prevention plans by 2017, contributing to a 10% reduction in suicide nationally by 2020.
Paul Farmer Chief Executive Mind
In acute mental health care, out-of-area placements – in which patients are sent away from their local services due to a lack of beds – should be “eliminated as quickly as possible”.
A new model of acute inpatient care for people aged 16-25 should also be trialled by NHS England and local authorities to maximise opportunities for return to education, training or employment, said the report.
Reforms to the way mental health services are funded are also needed, “rewarding and incentivising step down to lower-intensity settings” instead of the current system of block contracts that reward trusts for low cost interventions, regardless of outcomes.
Taskforce chair Paul Farmer, who is chief executive of the charity Mind, said the report was a “feasible and affordable blueprint” for how to significantly improve care for people with mental health problems.
“We are saying to the NHS, to government, to industry, to local leaders and to the public that mental health must be a priority for everyone in England. We need to prevent problems in the first place, and to respond to people’s mental health problems at the earliest possible opportunity,” he said.
In response, NHS England chief executive Simon Stevens said the health service was “committed to pursuing” major improvements in areas including seven-day mental health crisis care and increases in psychological treatments.
Prime minister David Cameron also backed the report, saying he was committed to putting mental and physical healthcare on an equal footing.
“For too long there hasn’t been enough focus on mental health care in this country meaning too many have had to suffer in silence,” he said in a statement.
Health secretary Jeremy Hunt added: “We have made monumental strides in the way we think about and treat mental illness in this country in the last few decades.
“The real challenge will come in ensuring these recommendations are actually delivered”
“But we must accelerate progress even further. Our shared vision of a seven-day mental health service means people will get the care they need, when they need it, and will help us do much more to prevent mental illness in the first place,” he said.
Royal College of Nursing chief executive and general secretary Janet Davies said the report’s recommendations ”will require careful implementation and investment but they are a real opportunity to provide a range of services that will benefit people now and in the future”.
Unison’s head of health Christina McAnea welcomed the report’s call for extra funding, but accused the governement of so far failing to deliver on its pledges to prioritise mental health.
“We are renewing our call to the government to find new money to ensure no one with mental health issues is left to suffer alone,” she said.
Luciana Berger, Labour’s shadow cabinet minister for mental health, echoed her comments, adding: “The real challenge will come in ensuring these recommendations are actually delivered. For too long this Tory government’s rhetoric on mental health has not matched the reality on the ground.”