This review looks at the current landscape in adult community mental health.
We commissioned the University of Birmingham's Health Services Management Centre to carry out this research and write the full report.
Purpose of this research
The research team carried out a rapid scoping review of the current landscape in adult community mental health. We commissioned this work to help inform service transformation and inspection.
The research questions included:
- What does good practice, innovation and quality provision look like in adult community mental health (CMH) settings?
- How, why, and for whom does high quality adult CMH provision work?
- How can patient safety in adult CMH be maximised and why?
- How can public safety in adult CMH be maximised and why?
Summary
Background
The 2019 community mental health framework for adults and older adults in England was designed to deliver integrated, person-centred mental health service. The framework faced challenges as the COVID-19 pandemic overwhelmed healthcare systems and funding shifted towards acute care.
Issues remain around access to services, capacity and resources, care coordination, and substantial inequalities. Many of these issues were made worse by the pandemic.
What the research team did
The research team carried out a rapid literature review over a 4-week period.
The review included an initial set of documents provided to the review team by CQC, a grey-literature search, and 5 bibliographic searches of 2 databases: Medline and PsycINFO.
Studies before 2014; non-UK studies and those including people under 18 or over 65 years old were excluded.
The research team used expert peer review (which included people with lived experience, academics and professionals) to refine the search terms, interrogate the findings, and refine the themes. The insights from the expert peer reviewers and the ideas they identified were used to refine the analysis and link back out to the broader literature.
Strengths of this review were:
- Inclusion of a wide range and high quantity of relevant literature drawing on robust systematic searches.
- Input from experts by experience to incorporate multiple perspectives.
- The study selection process was honed via piloting strategies.
- The research team worked closely via Microsoft Teams, enabling them to sense-check decisions and insights, improving rigour.
Limitations of the review were:
- Timescales (the review was conducted in a less than one month period).
- That the research team only searched within two databases (time and feasibility constraints).
- The lack of time to conduct in depth public and patient involvement or engagement consultation, especially not being able to consult families or carers of those with a serious mental illness or those who had been bereaved as a result of a serious mental illness or as a result of losing a loved one with a serious mental illness.
- The possibility of data loss through extracting at such speed and to such a rigid framework.
What the research team found
81 sources of literature were extracted and reviewed.
Themes identified were narratively presented relating to learning from practice, patient and public safety; medicine optimisation in community mental health settings and at the interface with other services; and gaps for research identified within the review.
By looking at the findings, the research team developed 26 initial context–mechanism–outcome configurations (CMOCs) using ‘if, then, because’ statements. These form partial initial programme theories that broadly relate to particular risks identified in considering patient safety, public safety, medicine optimisation, impacts of insufficient capacity on the system, and impacts of inequities which continue to worsen within mental health provision. The 26 CMOCs are intended to synthesise the findings in a way that is useful to inform inspecting practice.
Conclusion
A final initial programme theory was developed: A system under stress in which care is delivered (context), can have unintended negative consequences in generating unprofessional behaviours or conditions that undermine good practice principles, guidance and in cases legislation (mechanisms), resulting in increased risk and ultimately harm (outcome).
Recommendations
There were three key recommendations from this report:
- A culturally appropriate, co-produced measure in order to understand more holistic concepts of risk including from patients, to patients, and by patients to the public should be developed. Understanding and improving this is essential to prevent serious incidents in future
- Urgent action from policy makers to address system capacity issues.
- Work should be undertaken to understand minoritised experiences of this aspect of mental healthcare.