The Royal College of Psychiatrists which commissioned a consultation into ‘improving acute inpatient psychiatric care for adults in England’ has produced an interim report of its findings. The commission was set up by the Royal College of Psychiatrists to probe the factors behind problems securing hospital admissions for mental health patients in parts of the country.
Five main themes have emerged from the report:
1. The so-called bed or admission crisis is very significantly a problem of discharges and alternatives to admission and can only be addressed through changes in services and the management of the whole system.
2. There is a spectrum of pressure and performance ranging from units with demoralised staff who are trapped in a constant process of crisis management to those where staff work purposefully to deliver high quality care and services.
3. Although the Commission heard many positive stories of care, it is clear that many patients and carers feel disenfranchised and excluded. There is a need for greater engagement and implementation of best practice.
4. There is a significant data and information shortfall, with inconsistent definitions and processes and a lack of agreed outcomes. This makes it very difficult to understand what is happening throughout the system, to measure variation and to bring about improvements.
5. In many services there is a need for greater staff support, training and motivation in order to improve care and services.
The inquiry suggests “the reduction in bed numbers may have gone too far”. Figures indicate that about three patients per ward (16% nationally) are actually clinically well enough to be discharged but are unable to, due to a lack of suitable housing or supported accommodation.
This reflects similarly in the quality of care. Although the commission did hear of many positive stories of clear from patients, others from both patients and carers were said to be “disenfranchised and excluded”. Staff themselves at some units were said to be demoralised and in need of greater support, training and motivation.
These long term effects come in the wake of rising concerns that patients with mental health conditions have not been treated as well in relation to poor physical health problems. Indeed, a recent government-commissioned survey demonstrated that public perceptions of care for people with mental health problems and dementia undermined what would otherwise be a generally positive view of the NHS.
Under the 2010-15 coalition government, it was made into law that mental and physical health conditions must be treated equally. The contract between the Department of Health and NHS England meanwhile insists that beds must always be available to those who need them and that no one in a mental health crisis should be turned away. Despite this however, the situation remains a growing concern. Luciana Berger, shadow minister for public health stated that the results of the inquiry: “Show the profound challenges facing our mental health services. A lack of services in the community combined with serious bed shortages is putting unsustainable pressure on our mental health wards.”
Dr Martin McShane, the director of NHS England’s people with long-term conditions, had this to say addressing the issues: “We are determined to improve mental health services and address the distress and unwarranted costs associated with out of area placements which are unacceptable. This is why we have set up a mental health taskforce to establish a clear plan for the next five years. We have already announced the first waiting times and access standards in mental health for both psychological therapies and early intervention for psychosis; these measures will mean fewer patients need to travel far afield for care.”
A copy of the interim report can be accessed at the following link: