Despite a damning report from the Care Quality Commission into mental health, there are some reasons for hope.
Increasing demand for services and higher thresholds for admission are leading to long waits for mental health care.
The Care Quality Commission’s (CQC) annual report into the use of the Mental Health Act has uncovered worrying recurring issues of staff shortages, a lack of beds, and inconsistencies in experiences.
It found that people continue to be placed far from home, with out-of-area placements on the rise even though there was a national commitment to end this practice by March 2021; people living in deprived areas are 3.6 times more likely to be detained under the Mental Health Act; and concerns continue around racial inequalities.
As Healthcare Today has continuously highlighted, issues of racism appear to be entrenched in British healthcare. A report from the General Medical Council (GMC) in January, for example, found that deep-rooted inequalities within medicine continue to impact careers and opportunities for ethnic minority and non-UK qualified doctors working in the NHS.
“It’s deeply disappointing to again be highlighting the same issues of overworked healthcare workers, unequal experiences, people being placed in inappropriate environments, and ultimately people struggling to get the care they need,” said Chris Dzikiti, the CQC’s interim chief inspector of mental health.
“For Black people, autistic people, and people with a learning disability, the barriers to appropriate care are even greater,” he continued.
A long way to go
The report found that with nearly 1 in 10 roles in NHS mental health trusts unfilled and a reliance on agency workers, staff don’t always have the capacity to build a positive relationship with healthcare staff. This can mean that staff struggle to de-escalate patients in distress and are developing burnout. Meanwhile, patients report feeling unsafe as there aren’t enough staff on each ward.
With not enough beds, people are being placed in inappropriate environments. This can include children being placed in adult wards, people placed far from home, and, in some cases, people facing more restrictions than necessary, such as not being able to go outside even though it may be safe to do so.
While some wards are clean, tidy, and designed in a way that supports people’s needs, the report highlights some patients talking about noisy, dirty, and loud wards, with one parent describing “blood on the walls” and a “disgusting” toilet.
People’s experiences also remain inconsistent, with black people being detained at four times the rate of white people. Despite this, in the majority of services visited (51%), staff had not received training about racial inequalities.
Additionally, some staff appear to lack the right skills to support autistic people or people with a learning disability. People reported feeling misunderstood or spoken to in ways that felt undignified.
“We have a long way to go to meet the needs of people struggling with their mental health. We need a bigger, more robust workforce, enough beds to meet all needs, and appropriate support for staff so that they can provide personalised care,” said Dzikiti.
Transformative mental health in Yorkshire
While the CQC has rightly called for a system-wide approach to improve mental health care, there are some indications that the issue is being taken seriously.
At the end of January, the University of Huddersfield announced that it was set to open a new research centre to help improve mental health research capacity and capability in the local area to support mental health care provision, thanks to an award of £11 million from the National Institute for Health and Care Research (NIHR).
Following a 12-month analysis, the Centre for Equity in Mental Health (CEMH) is expected to open in April. The university hopes that the award will allow it to become a world leader in mental health research and to transform the mental health research landscape locally.
Headed by Ann Caress, professor of health services research, and Michael Doyle, professor of mental health research, both at the university, they worked with South West Yorkshire Partnership Teaching NHS Foundation Trust and locally based partner Debs Teale of The Debs Effect to assess the provision of mental health services in Kirklees, Calderdale and Wakefield.
They identified issues including long waiting lists for initial appointments, inaccessible services, inappropriate referrals to NHS mental health services, and patients not being signposted to charities or voluntary organisations that could help.
“We know from recent stakeholder engagement work that we undertook across Calderdale, Kirklees and Wakefield that improving mental health is a priority in our localities, but there are many challenges to maintaining good mental health and accessing support when needed,” said Caress.
“The funding from NIHR is both important and greatly valued, as it will be transformative for mental health research and service delivery across Calderdale, Kirklees and Wakefield,” she added.
