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News Cuts and service changes are harming patient care 04 Cuts and large-scale changes to mental health services are harming patient care and represent a ‘leap in the dark’, according to a new report. Mental health under pressure, a briefing produced by The King’s Fund, shows that the sector is under a huge amount of strain, with around 40% of mental health trusts experiencing a cut in income in 2013/14 and 2014/15. This is in marked contrast to the acute sector, where more than 85% of trusts saw their income increase over the same period. The briefing shows that, driven by the need to reduce costs, trusts have embarked on large-scale transformation programmes aimed at shifting demand away from acute services towards recovery-based care and self-management. This has seen a move away from evidence-based services in favour of care pathways and models of care for which the evidence is often limited. There has also been little formal evaluation of the impact of these changes. One example cited in the briefing is the merger of specialist crisis resolution home treatment teams (CRHTs) and early access to psychosis services into generic community health teams. Evidence suggests that these teams are often unable to provide the level of support required by patients, reducing quality of care and increasing pressure on inpatient beds. Drawing on a range of sources, the briefing highlights widespread evidence of poorquality care: Only 14% of patients say that they received appropriate care in a crisis. ‘‘ Mental health services have often been the first to see their funding cut ’’ There has been an increase of 23% in out-of-area placements for inpatients in the year up to 2014/15. Bed occupancy rates routinely exceed recommended levels. The briefing finds that, as their financial situation deteriorates, many trusts are considering a further wave of large-scale changes, which could further destabilise services and reduce the quality of care for patients: More than two-thirds of mental health trusts were or had recently overhauled services. Of those, more than half had plans to reduce staffing levels or the skills mix in its workforce. A quarter were aiming to use less qualified staff, by replacing nursing with volunteers and support workers. More than 10% said they would be further reducing bed numbers. The report calls on the sector to focus on using evidence to improve practice and reduce variations in care, but says it is essential that this is underpinned by stable funding, with no more cuts to budgets. Helen Gilburt, fellow, (mental health) policy at The King’s Fund and author of the report, said: ‘Historically, mental health services have often been the first to see their funding cut, so many trusts felt forced to look at what savings could be made through transformation programmes to pre-empt this. ‘Trusts looked to move care from the hospital to the community, focusing on selfmanagement and recovery. Few would dispute the intention and rationale for this – the problems arise with the scale and pace of the changes, which lack the necessary checks to evaluate their effectiveness and the impact on patient care. ‘Mental health trusts now need the security of stable funding, supported by a national focus on evaluating the changes to date, improving practice and reducing variations in care.’ Paul Farmer, chief executive of the charity Mind, said: ‘This report lifts the lid on the true state of NHS mental health services. The government has expressed its commitment to putting mental health on an equal footing with physical health but it’s clear that there is an enormous gulf between that aspiration and the day-to-day reality for many. ‘We hear every day from people with mental health problems who tell us that support is getting harder and harder to access as services shrink while demand escalates. ‘Poor mental health can ruin lives, destroy relationships, take away people’s independence and can lead to some taking their own lives. But with the right support at the right time, people can and do recover or manage their mental health in a way that allows them to lead the life they choose. ‘If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line. ‘Failing to deliver the right care isn’t good for people and it’s not good for the NHS. ‘We echo the King’s Fund’s call for more funding for NHS mental health services; after decades of neglect and five years of cuts, services are in urgent need of significant investment.’ Safeguarding reference group to develop guidance for members There have been many changes in workplaces and responsibilities recently and so Unite in Health has decided to reconvene the Safeguarding and Child Protection reference group to assess what this means for practitioners and to develop guidance for members. If you are interested and have appropriate expertise, please contact Rosalind Godson, professional officer, via email to rosalind.godson@ unitetheunion.org for further information.
News Data shows ‘negligible’ public mental health spend Local authorities in England spend The charity argues that mentally healthy and reduce work to our physical health. an average of just 1% of their spending on promoting good the chances of them becoming ‘The personal costs are public health budget on mental mental health and preventing unwell. immeasurable, and the wider health, a freedom of information mental health problems Paul Farmer, chief executive economic cost is huge. request by the charity Mind has developing is just as important as of Mind, said: ‘Our research ‘Prevention is always better revealed. Local authorities have physical health. shows that the current spend on than cure and ignoring the a remit to promote both good The data on public mental public mental health initiatives is problem simply doesn’t make physical and mental health in the health spend was obtained under negligible. sense. We need local authorities communities they serve. the Freedom of Information Act by ‘The fact that local authorities’ to use their budgets to help While local authorities spend Mind, and this also showed that public health teams are allowed people in their communities stay millions of pounds on physical some areas plan to spend nothing to file mental health under mentally healthy and reduce health programmes, most areas at all on preventing mental health “Miscellaneous” when reporting the chances of them becoming of the country spend close to problems this year. on it perhaps explains why. It unwell.’ nothing on preventing mental Responses from many local sends a message that mental Mind’s new guide to health problems. authorities also painted a picture health is not seen as important commissioning better public Local authorities are required of enormous confusion about and not a priority for investment. mental health can be downloaded by the Department of Health what local public health teams ‘It is not acceptable that such a at: /media/2976113/mind_ to report on their public health should do to help prevent people small amount of the public health public-mental-health-guide_web- spending against a set list of becoming mentally unwell. purse goes on preventing mental version.pdf categories, including sexual Mind is calling on the health problems. For more information on the health services, obesity and stop government to send a clear ‘One in four people will ‘Mental Health Challenge’, which smoking services. message to public health teams experience a mental health is an initiative led by the Centre Currently, any spending on to prioritise mental health by problem every year, yet so much for Mental Health to encourage public mental health is reported asking them to no longer label of this could be prevented by local authorities to champion under ‘miscellaneous’, grouped public mental health spend as targeted programmes aimed at mental health, visit www. together with 14 other areas. ‘Miscellaneous’, and instead groups we know to be at risk, mentalhealthchallenge.org.uk. This comes despite the fact give public mental health its own such as pregnant women, people that it is conservatively estimated category. who are isolated, or those living that mental health problems cost The charity has also produced with a long-term physical health health and social care services a best practice guide outlining the problem.’ £21 billion annually, with a further £30 billion lost in economic output. kinds of initiatives local authorities could be commissioning to help people in their communities stay ‘Having a mental health problem can impact on all aspects of our lives, from our relationships and Images_of_Money Economic recession raised the risk of suicide and mental illness The economic recession of David Gunnell, professor of cuts, demotions, reduced hours were not in contact with mental 2008 to 2013 was followed by epidemiology at the University or disputes over benefits – are all health services or their GP. increases in rates of suicide, of Bristol said: ‘Prior to the likely to be important contributors Professor Gunnell added: suicide attempts, and mental recession, rates of suicide in the to the rises.’ ‘Ensuring the provision of illness, according to new UK were declining. Other research has explored adequate welfare benefits could research. ‘Around the time of the impact of the recession on mental mitigate the impact of future Researchers from the University recession, this decline reversed, health, and has found the most recessions on suicide risk. of Brisol used national mortality and similar patterns were seen vulnerable to problems such ‘It’s vitally important that staff statistics, inquest reports of in other European countries and as job losses or debt are those who come into contact with people dying by suicide and in North America. The greatest with pre-existing mental health vulnerable individuals whose interviews with people affected by rise in the incidence of suicide problems or past psychiatric mental health is affected by the recession, including 19 who appeared to be in young men. illnesses. economic difficulties are trained to had made suicide attempts, to ‘The consequences of recession The Bristol researchers recognise and respond to risk, and understand the ways in which the on individuals – unemployment, the found many individuals who are properly informed about the recession affected mental health risk of losing a home, or financial die by suicide in the context of places to steer people affected and suicide. difficulties caused by debt, wage employment or financial difficulties towards for appropriate help.’ 05
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