Update on the UK Mental Health Services

Mental health services in the UK are increasingly under pressure from reduced levels of funding in general, and also in comparison to what is provided in the physical health sector. These are the key messages presented in a recent report from the King’s Fund:

• An absence of robust data makes it difficult to provide a definitive assessment of the state of mental health services. What is clear is that it is a sector under huge pressure. While increased political support and a stronger policy focus is welcome, parity of esteem for mental health remains a long way off.

• Funding for mental health services has been cut in recent years. Our analysis shows that around 40 per cent of mental health trusts experienced reductions in income in 2013/14 and 2014/15.

• There is widespread evidence of poor-quality care. Only 14 per cent of patients say that they received appropriate care in a crisis, and there has been an increase in the number of patients who report a poor experience of community mental health care.

• Bed occupancy in inpatient facilities is frequently well above recommended levels, with community services, in particular crisis resolution and home treatment teams, often unable to provide sufficient levels of support to compensate for reductions in beds. This is having a negative impact on safety and quality of care.

• The lack of available beds is leading to high numbers of out-of-area placements for inpatients. Out-of-area placements are costly, have a detrimental impact on the experience of patients and are associated with an increased risk of suicide.

• In recent years, mental health providers have embarked on transformation programmes to implement large-scale changes to services, workforce and corporate infrastructure.

• These programmes have been based on reducing costs, shifting demand away from acute services, and delivering care focused on recovery and self-management.

• This has seen reconfiguration of the evidence-based services implemented under previous national programmes, notably the National Service Framework for Mental Health, in favour of care pathways and models of care in which the evidence base on what works is often limited. These initiatives represent a leap in the dark, with little formal evaluation to indicate impact on the quality of or access to care.

• These transformation programmes have usually resulted in cost reductions and have prevented many mental health providers from falling into deficit. This may have come at the expense of patient care. There is evidence of increased variation in care and reduced access to services as a result of the changes.

• These transformation programmes have also resulted in far-reaching changes to the mental health workforce and have led to a significant reduction in the number of experienced nurses. This has resulted in staff shortages and insufficient staff skill mix in some areas of care.

• As their financial position deteriorates, many mental health trusts are considering another wave of large-scale changes. This risks destabilising services further and reducing the quality of care for patients.

• There is a clear need for mental health services to focus on using evidence to improve practice and reduce variations in care. However, it is essential that this is underpinned by stable funding, with no more cuts to budgets

For more detail, please see the source of the above, extracted from the King’s Fund report, Mental health under pressure: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/mental-health-under-pressure-nov15_0.pdf 

- Updates from David Blazey