Healthcare professional walking down a hospital hallway

An Urgent Need to Improve Mental Health Care in the National Health Service

Mental Health Care in the National Health Service in England has always existed in the shadow of physical care in terms of funding and NHS-government health policy priorities.

Many in the past have termed it the “Cinderella” part of the NHS. This neglect has been chronicled in numerous reports over the years pointing to many problems which include chronic under funding, poor patient safety, abuses of patient rights, poor complaint handling, unnecessary restrictive care regimes, poor patient, health carer communication, and poor patient satisfaction.

The Five Year Forward View for Mental Health

The Five Year Forward View for Mental Health, The Mental Health Taskforce, in 2016 set the scene for a positive transformation of NHS mental health care provision. To support changes, it was agreed with Government that there would be an additional investment of £1 billion per year by 2020-2021.

In July 2016, NHS England published an Implementation Plan, a blueprint of what was going to happen to transform this care area. The Five Year Forward View for Mental Health highlighted the acute problems facing NHS mental health care:

“Some people experience unacceptably poor access to or quality of care. There has been no improvement in race inequalities relating to mental health care since the end of the 5-year Delivering Race Equality program in 2010. Inequalities in access to early intervention and crisis care, rates of detentions under the Mental Health Act 1983 and lengths of stay in secure services persist.”

Avoidable deaths are also discussed in the report and investigating causes and how this needs to improve.

The report and implementation plan appears to have been generally welcomed. An important issue is however  the speed of change and improvement and whether this is taking place on the scale it needs to. When recent reports on safety and health quality in mental health care are analyzed certain issues are flagged up which question the pace and depth of change and call for more concerted improvement efforts to improve matters.

The Parliamentary Health Service Ombudsman (PHSO)  report in 2018, Maintaining momentum: driving improvements in mental health care shows cases of serious care failings in NHS mental health services.

The PHSO states that in 2016-2017 there were 14,106 complaints made to NHS mental health trusts, with around 65% being upheld or partly upheld by the local organization. In 2016-17 the PHSO completed a further 352 investigations into NHS mental health trusts and found failings in 130 (37%) of these cases. Some key patient safety health quality failures themes are identified from casework data:

  • Failure to treat: Failures in diagnosing and treating illness, either mental or physical.
  • Inadequate assessments (including risk assessments).
  • Treatment or care plans: This included incomplete treatment or care plans, not involving the patient in developing a plan and not following a care plan.
  • Communication: Problems in communication with patients and their families about care arrangements.
  • Co-ordination of services: Problems in communication between services and co-ordination of care, as well as discharge arrangements where responsibility transferred from one service to another.

CQC Monitoring the Mental Health Act in 2017/18

In another report on mental health care, the Care Quality Commission (CQC) in 2019 notes some improvement in the quality of care planning and patient involvement but says  that there is considerable room for improvement. Information provision about legal rights to patients and relatives is still the most frequently raised issue from their inspection visits. Quality and safety of mental health wards for adults of working is their greatest concern.

Complaints and Concerns

For the report, CQC analyzed 300 complaints and concerns. They identified some common themes: Medical treatment, medication, staff attitudes, communication, diagnosis and availability of leave.

Complaints were made about poor staff attitudes. Some staff were accused of being apathetic, dismissive, inappropriate or rude.

Communication failures is a major recurring patient safety and health care quality failing and theme in both physical and mental health care. Some issues stated in the report were patients not being involved properly in their own care, about services, not meeting a doctor or having their rights explained.

The reports discussed show the challenges that the mental health care area must surmount if it to shed itself of the, “Cinderella” health care sector image.

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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