Care Quality Commission
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CQC publishes the views of 17,000 people using community mental health services

Some people who use community mental health services in England are still not getting the care and support that fully meets their needs, according to a survey published by the Care Quality Commission (CQC) today (Tuesday 14 September).

The CQC survey captures the views of more than 17,000 people aged 16 and over who had contact with specialist community mental health services between July and September last year.

They had been referred to a psychiatric outpatient clinic, local community mental health team or other community-based service. The survey covered 66 NHS trusts.

People were generally very positive about the health and social care workers they had seen most recently for their mental health condition. The vast majority said workers listened carefully to them, gave them enough time for discussion and took their views into account. Also, most people said they were treated with respect and dignity and had trust and confidence in their health or social care worker.

But many reported that they had not been involved as much as they would have liked in some aspects of their care. Significant numbers of people said they would have liked more explanation of, or more say in, their treatment and support, such as their medication or care planning. Nearly half of those surveyed did not know who to contact in a crisis outside normal office hours. Of those who said they wanted some form of talking therapy, 73% had received it but 27% had not.

Some respondents said they would have liked more help with their day-to-day living.  For instance, 63% said they had been asked in the past year by someone in mental health services about any physical health needs they might have, but 37% were not asked. Of those who said they had physical health needs, 33% said they had not had enough support in getting help for them.

The respondents included people assessed as having complex needs, who may need more intensive support and are treated within a framework called the Care Programme Approach (CPA). People on the CPA who took part in the survey (43% of all the respondents) were more positive about some aspects of their care than those who were not on the CPA, but on other aspects there was little difference.

Cynthia Bower, CQC Chief Executive, said: “There is no doubt that the added investment and attention over recent years has improved the quality of community mental health services. There are some very positive messages from service users, particularly about health and social care workers. Theirs is no easy job, so these results are a tribute to them.

“But the results also suggest that in some respects the care offered to both groups of people – those on CPA and those who are not – is falling short of meeting the range of needs that they have.  We know that involving people in their own care and ensuring they understand their treatment, helps people to get better faster. Yet these are the areas that need the most improvement.

“A revision of the national policy on the CPA took place in 2008 and one of the main reasons was to provide clearer guidance to service providers so that they could target support to those who most need it. The positive feedback in the survey from people who are on the CPA about many aspects of their care suggests this is generally being achieved. 

“However, national policy is that all service users should have access to high-quality services to meet their needs. We should not forget that people who are not on the CPA may still benefit from access to basic kinds of non-clinical support, such as help with their physical health, employment and housing, which can make a lot of difference to their lives and can also help improve their mental health.

“It is important that trusts look at the survey results carefully and consider whether, firstly, they are assessing people’s needs properly in the context of the CPA policy, and secondly, whether they are giving them the appropriate level of support.”

The results from the survey are primarily intended for use by NHS mental health provider trusts to help them improve their performance. They also have relevance to those local authorities that employ social workers and social care staff who work within multidisciplinary, community-based mental health teams.

CQC will also use the results in a number of ways, including informing patients and the public of trusts’ results, and using the results in its continual monitoring of trusts’ compliance with new essential standards of quality and safety introduced in April this year. The Department of Health will use the results in measuring performance against a range of indicators.

Key findings of the survey

People were positive about the health and social care workers they were in contact with:

  • 80% said their health or social care worker “definitely” listened carefully to them, 75% felt they “definitely” took their views into account and 73% were “definitely” given enough time to discuss their condition and treatment; 88% said they were “definitely” treated with respect and dignity and 72% said they “definitely” had trust and confidence in their health or social care worker.

Service users were less positive when asked how they had been involved in some aspects of their care and what information they were given: 

  • of those who had been prescribed new medication in the past year, only 43% of respondents said they were “definitely” told about possible side effects of their new medicines and 28% were told “to some extent”, leaving 29% who said they were not told at all;
  • under half (48%) of respondents said they “definitely” understood what was in their care plan, 29% understood it “to some extent”, 15% were not sure and 9% did not understand it;
  • just 57% had had a meeting to review their care plan in the past year (of those who had been in touch with mental health services for at least a year).

Many respondents said they were not given the opportunity to have talking therapies, did not receive as much support as they would like in every-day living, and were unsure who to contact in a crisis:

  • 73% of those who wanted some kind of talking therapy had received it but 27% had not;
  • 63% of respondents said they had been asked about any physical health needs they might have, but 37% said they were not asked. Of those who said they had physical health needs, 33% believed they had not had enough support in getting help for them;
  • of those who needed it, 48% did not get help with finding or keeping work, 43% did not receive  assistance with finding or keeping accommodation, and 40% had not been given help with financial advice or benefits;
  • 44% did not have the number of someone from their NHS mental health service whom they could phone outside office hours.

Notes to editor:

Questionnaires were sent to a random sample of service users who were seen between July and September 2009 by each of 66 NHS trusts providing community mental health services (including combined mental health and social care trusts, primary care trusts that provide mental health services, and Foundation Trusts). More than 17,000 questionnaires were returned, a response rate of 32%. The survey was co-ordinated on behalf of CQC by the National Centre for Social Research (NatCen).

The Care Programme Approach

The survey is the first on mental health services in the community since changes were made to the Care Programme Approach in 2008 following a review by the Department of Health. Previously the CPA applied to all service users, and was delivered on two levels: “enhanced”, for those with more complex needs, and “standard” for all other people.

Now only people with complex needs who need multi-agency support or who are at most risk (broadly those formerly classed as eligible for “enhanced” support) are covered by the CPA. However, the revised policy states that everyone using community mental health services is entitled to receive high-quality care based on an individual assessment of their needs.

The extra support that service users on the CPA can expect to receive includes a care co-ordinator, a multi-agency risk assessment, a written care plan, a review of their care at least once a year, and more advocacy support.

Previous surveys of community adult mental health patients

Previous surveys of community mental health services were carried out from 2004 to 2008.  Following the changes to the CPA, the survey on community mental health services was revised for 2010 and some of the questions were changed. The results also include the views of people over 65, which those of the previous surveys did not. Because of these changes, the 2010 results are not statistically comparable with those of the previous surveys. 

 

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