Care Quality Commission
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Specialist Community Mental Healthcare Services: Watchdogs praise good performance in some areas, but call for greater involvement of people who use services in decisions about their own care

The Healthcare Commission and the Commission for Social Care Inspection

(CSCI) have today (Monday) published their national review of adult specialist community mental health services. The joint work reflects the shared responsibility for the delivery of these services across health and social care.

The findings show that, since the introduction of the National Service Framework for mental health, there has been a steady improvement in the range and quality of such services for those who need them and Local Implementation Teams (LITs) appear to be an effective vehicle for commissioning and delivering new models of community mental health.

However, the pace of change and improvement has been variable, leaving some people with little or no access to specialist care and treatment.

In 2005/06, each of England?s 174 LITs was assessed on three criteria: the involvement of the people who use services; access to appropriate care and treatment (such as talking therapies); and recovery and social inclusion.

Fifty-four per cent of LITs were found to be performing consistently well (ie. they were assessed as ?good? or ?excellent?) across all three areas.

The remaining 46% scored ?fair? or ?weak?. The report found room for improvement in all LITs as well as noticeable variations in performance between the regions. For instance, in the south west 73.3% of LITs were performing well, whereas in the south east just 37.5% were.

The review found ?considerable underperformance? in each of the three areas assessed. Of particular concern was the fact that people who use the services were not being routinely involved in decisions about their care and treatment. It is crucial that people are given full information about the options available to them and are fully involved in decisions about their treatment and care.

However, services will have been working to improve their performance since the time of this review and we will be using the results of the forthcoming Mental Health Patient Survey and the 2007-2008 Annual Health Check to identify the level of improvement.

Anna Walker, the Healthcare Commission?s Chief Executive, said: ?All areas now have a range of community mental healthcare teams in place, this is certainly a positive step. But the standard of care was highly variable.

?Care must meet the individual?s needs, but only half of those we interviewed had their own care plan, while only half had the number of someone to ring in a crisis. More access to talking therapies is also needed, as well as help finding jobs.

?Nationally, half the teams were performing well, but the other half needed to make significant improvements. We are following up our findings with those not performing so well and identifying where improvements can be made on behalf of their users.?

Paul Snell, CSCI's Chief Inspector, added: "Our findings today make it clear that people who have mental health problems should receive support that addresses all their needs. Services that will make a difference to their lives need to include the right balance of health, social care and help from the voluntary sector. As a whole, all of these are crucial in maintaining people within their community, in employment and training, and ultimately, out of hospital.

?This report is welcomed by both commissions as a way of highlighting the importance of effective community mental health services in breaking the cycle of social exclusion.?

The report recommended that, in order to ensure that people with mental health problems receive the services and support they require, LITs must review their practices and ensure that they are effectively implementing the Care Programme Approach.

The key findings in each of the three criteria assessed were:

Involvement of people who use services:

One in six people suffer from mental health problems, such as depression and schizophrenia, at some stage of their life. In total this costs the UK around £77 billion a year. Community mental health services have a crucial role to play in keeping people out of hospital and in the community where they prefer to be. This reduces financial, social and physical costs. The services are supposed to go further than traditional mental healthcare by providing flexible services that meet people?s needs without restricting their freedom and quality of home life.

For this to work, the people who use the services need to be involved in their development, both at an individual and community level. But this is not happening: the majority are not being routinely involved in decisions about their medication and care.

Individual autonomy is a key component of the ambitious 10-year agenda to improve mental health services; this was set out in the 1999 Mental Health National Service Framework and accompanied by the Care Programme Approach (CPA).

But the review found ?considerable underperformance? in a number of areas relating to choice, some of which can compromise the safety of those using the services. The key finding was that the CPA is not being implemented in a way that puts people first, a situation which could compromise safety.

For instance:

· Only half the people who use services were offered a copy of their care plan

· Just 29% of care plans contained information on an agreed course of action in the event of an individual being unable to make decisions for themselves

· Almost a third of people who use services did not know who their care co-ordinator was

· Over 50% of people who use the services had no say in the medication they were prescribed, while a third received no information on side effects Access to Services:

Access to services remains limited. For instance, the majority of LITs reported that people could see a mental health professional Examples of these professionals include: Primary Care Mental Health Workers and Approved Social Workers, Assertive Outreach and Crisis Resolution, Home Treatment teams and social care provision 24 hours a day, 365 days a year.

However, less than half said they had the relevant phone number to call.

There was also patchy access to effective psychological treatments.

Cognitive behavioural therapy (CBT) and family intervention can be vital to people?s recovery and their social inclusion. The review included a survey of 7,446 people with schizophrenia or suspected schizophrenia.

Under the National Institute for Health and Clinical Excellence (NICE) guidelines, each and every one should be offered CBT. Worryingly, just 46% were.

Recovery and Social Inclusion

People with mental health problems continue to face exclusion from areas of life that many take for granted. Employment rate among sufferers is the lowest out of all the main groups of people with a disability. But nationally, the review found only 50% of those who needed help with finding employment received it.

There were similarly poor performances for physical health checks. People who use mental health services are often vulnerable to poor health through issues of self-neglect, lifestyle, diet and the side-effects of medication. Though a high number of LIT areas were offering physical health checks, very few were ensuring that these were being carried out. A field study, completed as part of the review, found that some people even felt their health needs ?are not taken seriously?.

The commissions noted in the report that direct payments are an important way of people taking control of their own care provision by directly purchasing the services they require. Local councils are responsible for offering and providing direct payments following an assessment of needs.

The review found that the take-up of direct payments remains low, and within this, take-up by people who use mental health services lags behind other groups. It was found that councils demonstrating good progress have well informed staff that are able to provide information about direct payments, and good support systems, providing advice and assistance to people using them.

Notes to editors:

The report in full, along with a media briefing note is available at:

For further information contact David Burrows at the Healthcare Commission on 020 7 448 9439 (07779 990845 after hours), or Andy Keast Marriott at CSCI on 020 7979 2093 (0796 8013067) for social care-related queries.

Information on the Healthcare Commission The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

Further information on the Healthcare Commission can be found at:

Information on the Commission for Social Care Inspection CSCI is the single inspectorate for adults? social care in England, responsible for regulating and inspecting all social care providers - whether in the public or independent sector - and for assessing the performance of local councils in delivering their adults? social services functions.

The Commission?s primary aim is to improve social care by putting the needs of people who use care services first. The Commission is chaired by Dame Denise Platt DBE and has five Commissioners. The Chief Inspector is Paul Snell. CSCI staff work across seven regions in England.

Further information on CSCI can be found at:





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