Assessment of mental health services in acute trusts

Published: 16 October 2020 Page last updated: 16 October 2020

This report reviews the findings from over 100 acute hospital inspections. We looked at how well the mental health care needs of patients were met and where trusts, and the wider system, need to improve.

What we did

Between September 2017 and March 2019, mental health inspectors provided specialist support on over 100 acute hospital inspections. They looked how well people with mental health needs were cared for across:

  • emergency departments
  • acute medical wards
  • maternity wards
  • children and young people’s services.

What we found

Staff were generally caring and working very hard in challenging circumstances. However, too often it was the system that limited their ability to provide the best possible mental health care to their patients. We found:

  • People faced barriers in accessing help at a time of crisis. A lack of availability of 24/7 community crisis services meant patients were often left with no other option than to attend the emergency department.
  • Acute trust boards did not always see mental health care as part of the overall provision of care. Boards often lacked oversight of how people with mental health needs were cared for while in hospitals.
  • In emergency departments, patients whose mental health conditions put them at a high risk of harm towards themselves or others were not always provided with a safe, therapeutic environment.
  • Staff in acute hospitals were often not clear about the Mental Health Act and the legal process for detaining someone in hospital.
  • Staff felt unsupported and unprepared to meet the mental health needs of their patients. Mental health training for staff varied across the acute hospital trusts.

Steps to improving practice

In our report, we outline the steps that we recommend providers, clinical commissioning groups and local authorities take to improve the quality of care for people with mental health needs. These include:

  • System-wide changes to improve the planning and commissioning of services, and ensure that patients have access to the physical and mental health care they need, when they need it.
  • Trust-level changes to improve care for patients with mental health needs while in acute hospitals. For example, ensuring there is better provision and governance of mental health care within trusts.
  • Support for staff. This includes training for staff that gives them the skills and confidence to meet people’s mental health needs, as well as support for staff wellbeing.