Mental health services take a 'leap in the dark' on patient care

Large-scale changes to mental health services are a ‘leap in the dark’ and are having a negative impact on patient care, says a briefing published today by The King’s Fund. 

The briefing, Mental health under pressure, shows that the sector is under a huge amount of strain, with around 40 per cent of mental health trusts experiencing a cut in income in 2013/14 and 2014/15. This is in marked contrast to the acute sector, where more than 85 per cent of trusts saw their income increase over the same period. 

The briefing shows that, driven by the need to reduce costs, trusts have embarked on large-scale transformation programmes aimed at shifting demand away from acute services towards recovery-based care and self-management. This has seen a move away from evidence-based services in favour of care pathways and models of care for which the evidence is often limited. There has also been little formal evaluation of the impact of these changes.

One example cited in the briefing is the merger of specialist crisis resolution home treatment teams (CRHTs) and early access to psychosis services into generic community health teams. Evidence suggests that these teams are often unable to provide the level of support required by patients, reducing quality of care and increasing pressure on inpatient beds. 

Drawing on a range of sources, the briefing highlights widespread evidence of poor-quality care: 

• only 14 per cent of patients say that they received appropriate care in a crisis
• an increase of 23 per cent in out-of-area placements for inpatients in the year up to 2014/15
• bed occupancy rates routinely exceeding recommended levels. 

The briefing finds that, as their financial situation deteriorates, many trusts are considering a further wave of large-scale changes, which could further destabilise services and reduce the quality of care for patients. It calls on the sector to focus on using evidence to improve practice and reduce variations in care, but says it is essential that this is underpinned by stable funding, with no more cuts to budgets.

Helen Gilburt, Fellow, (Mental Health) Policy at The King’s Fund and author of the report, said:
‘Historically, mental health services have often been the first to see their funding cut, so many trusts felt forced to look at what savings could be made through transformation programmes to pre-empt this. Trusts looked to move care from the hospital to the community, focusing on self-management and recovery. Few would dispute the intention and rationale for this – the problems arise with the scale and pace of the changes, which lack the necessary checks to evaluate their effectiveness and the impact on patient care.

‘Mental health trusts now need the security of stable funding, supported by a national focus on evaluating the changes to date, improving practice and reducing variations in care.’