Insight into community mental health care in 2017; a five part blog series
The publication of the 2017 Community Mental Health Survey, on 15 November 2017, offers some insights from over 12,000 people that use mental health services in England. Among other findings, the survey illustrates that many service users experience difficulties in accessing the care they need and when they need it.
In this third blog of a series of five, Head of Health Influencing at Age UK, Tom Gentry considers how we can make the most of mental health care for older people.
The latest CQC survey on community mental health services arrives in something of a critical period for mental health. Coming a year after NHS England’s wide-ranging plan for mental health and months after an ambitious workforce plan, committing to 19,000 additional mental health workers by 2020/21, there is certainly momentum at the top behind mental health.
There are certainly a number of significant challenges to address.
1 in 4 adults live with mental health problems (and roughly the same proportion amongst older people), yet mental health services have often fallen behind physical health services. Both in terms of investment and overall outcomes of care, including some particularly distressing examples of people with very severe needs having no access to the hospital care they need.
Amongst older people, there have long been inequalities in access to even lower-level services and support for common problems like depression and anxiety. We produced a report in October last year called Hidden in plain sight that explored these issues in more detail.
In Implementing the five year forward view for mental health, NHS England committed to addressing these issues, allocating more funding to areas such as acute and crisis care; psychological, or talking, therapies; and “liaison” mental health teams that work in hospitals to support people that may be there for physical health needs but also have mental health needs.
However, as Health Education England’s (HEE) workforce plans points out, “the number of people leaving Mental Health [services] has risen from 10.5% in 2012/13 to 13.6% in 2015/16” which mean that “the NHS loses more than 10,000 mental health staff each year”. Age UK’s own report examining health and care services, published in February this year, already observed the significant decline in mental health nurses since 2010/11, second only to community nurses.
In the same report, we noted that investment in the mental health budget had been virtually flat for some years, while others have suggested it had actually gone down. So longer-term under-investment, highly variable services, and the current rates of decline in workforce numbers demonstrate the urgency of this plan.
How is this impacting local services?
Results from the survey suggest that for many people, their needs are still being met with 44 per cent of respondents saying they have seen NHS mental health services often enough for their needs (but down from 47 per cent in 2014) and the majority rating their overall experience as good.
However, there has been an increase in the numbers of people saying they have not seen services often enough, now up to a quarter of respondents, and a rise in the numbers of people who felt they did not have enough time to discuss their treatment and care.
There are number of issues that point to some worrying gaps in delivering person-centred care. Almost a quarter of people said they had not agreed with someone the care they would receive and a further 34 per cent said they had, but only to some extent. 28 per cent of people said they had not had a formal meeting to discuss how their care is working.
Person-centred care means putting care in the context of people’s daily lives and aspirations, but there were worrying deficits here as well. 36 per cent of people (a majority) said they did not get help or advice on finding support for physical health needs. Around 45 per cent of people did not get help with finding support for financial advice and benefits or for finding or keeping work.
For the many older people struggling with loneliness and isolation, it is worrying that 43 per cent did not get any support to take part in an activity locally.
These are all outcomes of care that should be central to achieving long-standing and meaningful improvements to people’s lives. Older people frequently tell us that the most important things to them are to remain engaged with their local community and to retain control over their daily lives. These outcomes should be central to planning and delivering care yet this survey suggests they are not happening for most people.
This survey reveals there are a number of positives in the care people are receiving. However, the declines in some areas, such as access to care, and the continuing gaps in person-centred elements of care suggests the momentum at the top needs to get down to the front line.
In the next blog in this five part series, Mind considers what support and well being is available via community mental health services.
Age UK is the country’s largest charity dedicated to helping everyone make the most of later life. The over-60s is the fastest-growing group in society and there are more of us than ever before. Ageing is not an illness, but it can be challenging. At Age UK we provide services and support at a national and local level to inspire, enable and support older people. We stand up and speak for all those who have reached later life, and also protect the long-term interests of future generations.