Improving Mental Health Care in the NHS

By John Tingle

The Guardian newspaper recently published it’s investigation into Coroners Prevention of Future Deaths Notices (PFDN’s) issued between 2012-2017 involving people receiving NHS care for mental health conditions. The findings from its investigation are shocking; many cases deaths could have been prevented had better care been given. Some errors identified are classic patient safety errors and these included:

  • Poor communication between agencies and/or staff, non-observation of protocols or policies (or lack of protocols or policies.
  • Lack of appropriate care or continuity of care.
  • Poor record keeping, poor communications with the patient or his or her family.
  • Insufficient risk assessment  and delays.

The investigation revealed 45 cases reported by the coroner where patients were discharged too soon or without adequate support. Seventy-two instances of poor or inappropriate care, 41 cases where treatment was delayed.

Children and young people’s mental health
The Care Quality Commission (CQC) is the the independent regulator of health and social care in England and they have recently reviewed children and young people’s mental health services and have found significant systems failures which could well put children and young people at risk of harm. Mental health problems are the report states, quite common in children and young people with estimates suggesting around 1 in 10 being affected.

The report has many positives about service provision. In every one of the ten areas that the CQC visited for the report to carry out fieldwork, examples were found of good or innovative practice. At the same time, they also found a complex and disjointed system with poor planning and coordination between teams. There were differing, conflicting approaches and perceptions to mental illness held by service providers. A system under great pressure is revealed with long waiting lists, variations in care quality and accessibility.
The report found too many obstacles in the way of transforming and improving mental health service provision for children and young people. Problems can be seen at the personal health carer level and also locally and nationally. Improvement needs to made across the whole system and this has been the case for many years. The picture painted once again is that of mental health services care cast as a Cinderella service, the poor relation to physical health acute care in hospitals.

Some of the areas recommended for improvement include:

  • Joint commissioning
  • Referral pathways and eligibility criteria
  • Care coordination
  • Working together day-to-day
  • Keeping children, young people, their parent’s families, and carers informed and involving them in their care
  • Harnessing technology
  • Embedding mental well-being in school life-and valuing the importance of education
  • Supporting and valuing staff.

There are many lessons to be learnt from the tragic cases reported in The Guardian. Similarly in the CQC report on mental health services for children and young people. More resources have been promised for this area of care but a worrying feature is that the problems identified have been around for a long time, a culture change is needed in the area and that is not just about money. Culture changes can take a very long time to develop.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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