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Community mental health care must improve, warns regulator
Too many people who use NHS community mental health services are not involved effectively in planning their care and do not know who to contact in a crisis.
Following a survey of more than 13,500 people who use community mental health services1 in England published today (18 September), Dr Paul Lelliott, the Care Quality Commission's Deputy Chief Inspector of Hospitals (lead for mental health) has warned services that poor performance on the survey could result in an early inspection and that failure to act on the findings of this survey could affect the ratings they receive from this October.
The survey asked for views from people who receive community mental health services and included people receiving services under the Care Programme Approach (CPA) 2.
The survey found that the majority of staff providing community services 'definitely' listened carefully to people receiving services (73%) and 'always' treated them with respect and dignity (75%). But the results highlight serious problems with other aspects of care, suggesting that services are not engaging as they should with people using the services.
One in five people (20%) do not feel they have seen staff from the mental health services often enough to meet their needs, 23% have not been told who is in charge of their care, 23% have not agreed with someone from mental health services what care they will receive and 26% of respondents have not had a formal meeting to discuss how their care is working in the last year.
Dr Paul Lelliott Deputy Chief Inspector of Hospitals (lead for mental health) said: "It is clear from this survey that many people do not feel well-served by community mental health services. Leaders and staff from mental health trusts should reflect on what they could do differently and better to ensure people are engaged effectively and involved in their care and take action to ensure that people get the help and support they need.
"We have raised this before with mental health trusts, including following last year's survey. The survey will inform our decisions about when how soon we inspect a trust. We will soon start to rate these mental health services and how well they have responded to the results of this survey will play a part in determining our overall judgment of trusts."
Where appropriate, involvement in care and treatment decisions should extend to families and carers. The findings show that only 55% of people said that NHS mental health services 'definitely' involved their family or someone close to them.
Also of concern is that almost one in three people (32%) did not know who to contact out of hours if they have a crisis. Where people did know who to contact and contacted them, 20% of respondents did not get the help they needed 3.
The theme of poor communication is also evident with regard to medication, with only around half of people prescribed new medicines for their mental health needs saying that they were 'definitely' given information about it in a way they could understand (53%).
Central to people's recovery is that they should be able to build a meaningful life for themselves, and should be supported to take control of and manage their own condition. However, less than half of respondents felt that the staff they see through NHS mental health services ‘always’ understand what is important to them in their life (43%); 'always' help them with what is important to them (42%); and 'always' help them to feel hopeful about the things that are important to them (39%).
People receiving care under CPA should also receive help or advice with finding support with employment, housing and finance from mental health services, if they need it. Of those who were under CPA and said they needed this support around a third of respondents would have liked more help or advice with finding support with financial advice or benefits (32%) finding or keeping work (34%) and finding or keeping accommodation (31%). Trusts need to do more to make sure people are given help or advice to find support for these other areas of life where this is needed. Supporting people's wider needs such as housing and finance can greatly aid recovery and these matters should not be treated by healthcare professionals as an optional extra but as fundamental part of helping people on the road to recovery.
The 2014 survey of people who use community mental health services involved 57 trusts in England that provide mental health services 4.
Trusts with high numbers of questions where their performance is 'better than expected':
- Cheshire and Wirral Partnership NHS Foundation Trust
- Humber NHS Foundation Trust
- Cumbria Partnership NHS Foundation Trust
- Camden and Islington NHS Foundation Trust
- 2gether NHS Foundation Trust
- Rotherham, Doncaster and South Humber NHS Foundation Trust
- East London NHS Foundation Trust
- Somerset Partnership NHS Foundation Trust
Trusts with high numbers of questions where their performance is 'worse than expected':
- Norfolk and Suffolk NHS Foundation Trust
- Lincolnshire Partnership NHS Foundation Trust
- The Isle of Wight NHS Trust
- Kent and Medway NHS and Social Care Partnership Trust
- Birmingham and Solihull Mental Health NHS Foundation Trust
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- Last updated:
- 30 May 2017
Notes to editors
1. Community mental health services provide care and treatment for people who require care over and above what can be provided in primary care. These are services that people access outside hospital, such as in outpatient clinics and at home.
2. CPA is the approach for people who have complex needs, require support from more than one professional or team, and may require support for other areas of life, (such as employment, housing and financial advice). People not on CPA are likely to have less need for support and may only have contact with one person.
3. Next month, CQC will release the full findings of a survey carried out earlier this year on the availability and usage of health-based places of safety. These are services that people can be taken to for assessment when they experience a mental health crisis and are detained under the Mental Health Act. Findings published earlier in the year indicated worrying gaps in provision for young people.
4.This year's survey questions have been substantially redeveloped with input from people using mental health services, service providers, mental health support groups, charities, academics, regulators and policy colleagues amongst others in order to reflect changes in policy, best practice and patterns of service. The survey findings will significantly influence CQC’s inspection priorities in mental health over the coming years.
As the questions in this year's survey have changed results from the 2014 survey are not comparable with the results from previous year's surveys.
The results are primarily intended for use by NHS trusts to help them improve their performance. CQC will use the results in its assessments on NHS mental health trusts in England. Data from the survey will also be used as part of CQC's inspections.
A set of tables showing the results for each question is available on the CQC website, together with a national summary highlighting the key findings. We have also published the results for each NHS trust here.
About the national NHS patient survey programme
The community mental health survey is part of a wider programme of NHS patient surveys, which cover topics including maternity, outpatient, children and young people and A&E services, ambulances, and inpatient services. For further information, visit: www.cqc.org.uk/public/reports-surveys-and-reviews/surveys.