The government's pledge to modernise mental health services is failing in London, according to an 18-month inquiry into the capital's mental health care led by The King's Fund.
The inquiry report, London's State of Mind, published today, examines how mental health care in the capital has changed since the first The King's Fund mental health inquiry in 1997. It says that, while there are many examples of good services with each area now having an assertive outreach team, London remains reliant on admitting people with mental health problems to hospital rather than helping them stay in the community. New analysis shows that:
- London has had a consistently high number of mental health hospital beds, with occupancy rates rising to 97 per cent in 2000/01
- compulsory admissions under the Mental Health Act have also remained high, with twice as many as any other NHS region in England
- the number of low- and medium-secure beds (for mentally ill people who can not be managed safely in local environments) has nearly doubled over the period.
These factors, together with evidence that the proportion of people with mental health problems admitted to hospital with drug or alcohol misuse problems is increasing and of serious staff shortages, are causing great pressure on hospital mental health services. Service users taking part in discussion groups as part of the inquiry said that wards had become frightening places.
While there has been growth in the new community services that can help people stay out of hospital, development generally has been too slow, with continuing high caseloads for community mental health teams and big gaps in some types of service such as crisis resolution teams. Likewise, the range of mental health services within general practice remain patchy.
Janice Robinson, co-author of the inquiry report, said:
'We don't want to paint an entirely gloomy picture of mental health care in London - there are many excellent services out there. But it's clear that progress just isn't fast enough and many of the problems and challenges identified in our 1997 inquiry persist, despite efforts to address them. It also seems that too much emphasis on associations between mental illness and dangerousness has meant that much of the early investment of extra money has been concentrated on secure services, potentially at the expense of more community services that can ease pressure on already overburdened hospital wards.'
The inquiry acknowledged the government's commitment to improving mental health services, with the introduction of a national service framework in 1999 and the allocation of £700 million for improving mental health services. But slow progress in service development is matched by evidence that much of the additional funding is not finding its way to frontline mental health services. While expenditure in the NHS as a whole increased by 28 per cent from 1997, spending on mental health services in London increased by only half as much - 14 per cent - over the same period.
As well as gaps in mental health services, The King's Fund inquiry found that people with mental health problems had little support for day-to-day living. Specialist housing and employment opportunities for people with mental health problems were insufficient for London's needs.
The report identified four main barriers to progress:
- Weak commissioning of services - insufficient development and expertise has made it difficult for the commissioners of London's mental health service (primary care trusts) to wield influence over the relatively small number of large mental health trusts that provide services in the capital.
- Problems with tracking funding - it is difficult to track funds allocated to mental health in London; there are also wide variations in spending across London that cannot all be explained by variations in need or levels of service.
- Staff shortages - London's NHS workforce shortages are particularly severe in some parts of the capital's mental health services, such as hospital wards.
- Stigma and prejudice - mental health service users feel that the focus by the government and the media on risk and dangerousness add to the stigma and prejudice they experience, compounding difficulties such as securing suitable housing and employment.
An underlying problem for London is the lack of a strategic approach to mental health care across the capital. There are 31 separate primary care trusts responsible for commissioning mental health services in London, in addition to numerous other agencies, such as local authority housing departments and social services, whose work has a direct impact on the lives of people with mental health problems.
London's State of Mind contains a series of recommendations for progress, with priority on developing a London-wide mental health plan with a focus on increasing community mental health care and specialist housing and improving conditions on hospital wards. The King's Fund has appointed a senior mental health advisor to help ensure the work is taken forward.
Rabbi Julia Neuberger, The King's Fund Chief Executive, said:
'No one organisation can hope to address the complex issues raised by our inquiry. We hope to bring together a range of organisations to help build capacity in mental health services. With them, we aim to find sustainable solutions to the problems faced by managers and staff as well as service users. We also need to dispel many of the damaging associations with dangerousness and risk that are made by people about others with mental illness. We can only do that by presenting the true situation, showing where the difficulties lie and striving towards some solutions for everybody, but particularly for those who experience mental ill health.'
Read the report: London's State of Mind: King's Fund Mental Health Inquiry 2003
Notes to editors:
1. London's State of Mind: King's Fund Mental Health Inquiry 2003, by Ros Levenson, Angela Greatley and Janice Robinson, is available from King's Fund publications on 020 7307 2591, price £20 (£10 for voluntary organisations).
2. The Inquiry will be launched at a breakfast discussion at the King's Fund, 11-13 Cavendish Square, W1G 0AN, between 8am and 10am on Tuesday, 18 November. Lord Hunt of King's Heath, Senior Associate of the King's Fund, will chair the discussion. Peter Horn, Chief Executive of the London Development Centre for Mental Health; Stuart Bell, Chief Executive of the South London and Maudsley NHS Trust; and John Wilkins, Director of Mental Health at the North West London Strategic Health Authority, will respond.
3. Assertive outreach team - specialist multi-disciplinary team designed to meet the needs of the small number of people living in the community with severe mental health problems and complex needs who have difficulty engaging with services, and who often require repeat admissions to hospital. The team provides frequent contact over a long period of time. Crisis resolution team - specialist multi-disciplinary team offering treatment, care and support to people with sever mental health problems suffering an acute crisis. Working to maintain people in the least restrictive environment - usually the person's home - the team works intensively to treat and resolve the acute problems, and to enable the person to return to their usual level of care.
4. For further information, including case studies on good services and invitations to the breakfast discussion, please contact Daniel Reynolds in the King's Fund public affairs office on 020 7307 2581 or 07831 554927.