Care Quality Commission
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Community mental health services show improvements, but concerns remain over social inclusion and access to counselling
Users of community mental health services say there have been some improvements in their care, according to a Healthcare Commission survey published today (Monday 3 September 2007).
The relationships between service users and their psychiatrists continue to improve year-on-year. Meanwhile, a greater proportion of those with more complex mental health needs know who their care co-ordinator is and are being offered copies of their care plan.
Access to out of hours crisis care via telephone has improved markedly in the past year. Last year only 49% of service users said they had an emergency contact number. This has risen to 52%, with the vast majority getting through to someone within an hour.
But this still leaves almost half of service users without access to out of hours crisis care. Meanwhile, more than one in three service users who wanted counselling say they did not get it.
Also worrying was the lack of progress in helping service users access benefits or find work. Almost a third of those who would have liked help with benefits did not receive it.
Likewise, only 49% of those who wanted help finding work were offered it.
Only 20% of people using mental health services reported that they were in paid work. The national employment rate for all people of working age, according to the Office of National Statistics, stands at 74% (1).
Furthermore, only one in two service users who wanted information on local support groups got it.
Community mental health services must also address the needs of carers and those who provide support for people with on-going mental health conditions. It is therefore a concern that 40% of respondents said their relatives or carer had not received enough support from health and social services.
The national survey, co-ordinated by the National Centre for Social Research (NatCen), was carried out in spring 2007 by 69 trusts, and published by the Healthcare Commission. Now in its fourth year, it provides a ‘snapshot’ of the experiences of people using community mental health services in England.
Currently, one in six adults in the UK has a mental health disorder. Mental health services are therefore a crucial part of modern healthcare. Community-administered mental health services are intended to go further than traditional mental healthcare by providing services outside of specialist hospitals, and around individuals’ schedules and needs.
Of the 15,900 people surveyed, 76% felt the services they received were ‘good’, ‘very good’ or ‘excellent’. This is on a par with previous years.
The central plank of community mental health services is the Care Programme Approach (CPA). Under the CPA, service users should have a care plan to identify their needs and explain their care. Seventy-four per cent of those with more complex mental health needs said they had, or were offered, a copy of their care plan – up three percentage points compared to last year.
This plan should be reviewed regularly. And although more service users overall are having yearly reviews (53% compared to 49% in 2004), more than one in four of those with more complex and enduring mental health needs – and are thus in need of more frequent contact – said they had not had a review in the past 12 months.
Anna Walker, Chief Executive of the Healthcare Commission, said:
“The people who use community mental health services appear to be satisfied with the service they get overall. It is particularly pleasing to see the improvement in co-ordinated care for those with more complex mental health needs.
“The general trends are encouraging, particularly given that many trusts are still getting to grips with providing care to service users within their own communities. But this shouldn’t disguise the problems – problems that have been going on for too long.
“For instance, carers and family members can provide invaluable support to people with mental health problems. It’s very important that they in turn receive the support they need; otherwise there is a risk that the burden becomes too great for them to manage.
“There are a number of factors associated with improving social inclusion for service users; these include finding jobs and receiving sufficient support at home and within local communities. These results show there is still much to be done. It is vital that trusts and local partners strengthen the means by which they address this problem. We will be working with other regulators to encourage an effective partnership approach to this issue.”
Each of the 69 trusts has been given a benchmark report, detailing their performance against the national averages. This will enable them to highlight, and address, areas of concern locally.
1) The figure from this survey (20% in paid work) is based on all respondents aged 16-65 for consistency with results presented elsewhere. A further 12% were retired, in full-time education, or in voluntary or casual work: additionally it is likely that many respondents were unable to work because of their mental health condition. The national employment rate from the Office of National Statistics (74%) is based on all people of working age (men 16-64 and women 16-59). While not precisely comparable, the figures nonetheless show that users of community mental health services are, for whatever reason, considerably less likely to be in paid work than the population as a whole.
Notes to editors:
This survey aimed to find out about the experiences of people using community mental health services. These services provide care to people who have been referred to a psychiatric outpatient clinic or local community mental health team.
This survey has run for four consecutive years, starting in 2004, as part of the national NHS patient experience survey programme. It is the largest survey of its kind and detailed findings from it are fed back to trusts to help them make improvements.
Although service users aged 16 and older were included, only those aged 16 to 65 are covered in the published results so that the results could be compared with those from previous years.
The survey was carried out in spring 2007 by 69 trusts (including combined mental health and social care trusts and those primary care trusts that provide mental health services) across England. Only one trust providing such services did not take part in the survey: this was because it has insufficient numbers of service users on its CPA register to enable its inclusion. The survey involved service users on the Care Programme Approach (CPA) that was introduced in 1991 and provides a structure for mental healthcare. Under the CPA all service users should be given a written copy of their care plan, which identifies their needs and explains their care.
Over 15,900 completed questionnaires were received from service users aged 16 to 65 years, giving an overall response rate of 38%. The overall profile of respondents to the survey was similar to previous years: over half of those who responded were women (57%), most were aged 36 years or older (79%), and 7% were from black or minority ethnic groups.
The results from the Joint Review of Community Mental Health services published by the Healthcare Commission in Sept 2006 identified three key issues: access to talking therapies; access to crisis services out of hours; and better information for people who need to use the services. It is encouraging that this survey shows improvements in out of hours service and better information for service users.
The Healthcare Commission will continue to work closely with the mental health sector to ensure that these important issues are effectively assessed and monitored through our annual health check. In addition to this we will also work with our regulatory colleagues to ensure that effective partnerships are monitored through the Comprehensive Area Assessment (CAA).
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.