Almost as if I asked them to, the Healthcare Commission have published a report today called ‘The pathway to recovery – A review of NHS acute inpatient mental health services’ which follows up very nicely my last posting, which was a review of Jeremy Laurance’s book Pure Madness.
Today programme discussion 0850 23 July 2008
Frontier Psychiatrist digest:
(I don’t think that much of this will come as a surprise to anyone who works in acute adult mental health.)
The report assessed all 69 trusts providing acute adult mental health care in England. This covered 554 wards providing almost 10,000 beds for patients between the ages of 18 and 65. The press release says that they did the study as there was concern that recent focus on community mental health services meant that inpatient services do not always get the funding and attention they need.
Overall, eight trusts were rated as ‘excellent’ (accounting for 843 beds – 9%), 20 as good’ (2,808 beds – 28%), 30 as ‘fair’ (3,985 beds – 40%) and 11 as ‘weak’ (2,249 beds – 23%). The report says that while some trusts struggle to meet standards, there are a number of high-performing trusts ‘proving that it is possible to provide personalised, safe and good quality acute mental health care’. However no trust was scored as ‘excellent’ across all key criteria.
The higher performing trusts were those that ‘actively involved inpatients in their care, provided meaningful activities in a therapeutic environment and that planned care around the needs of the service users’. (That sounds like something I might memorize to say at a job interview)
But the report identified areas for action, in particular improving the involvement of patients in their care; despite guidelines to include patients’ views in their care plans, this occurred in only 50% of cases.
There were further concerns about:
one in nine trusts scoring ‘weak’ on criteria relating to safety, with high levels of violence – 45% of nurses and 15% of patients reporting that they were physically assaulted in 2007.
insufficient attention to the sexual safety of patients and overcrowding in some trusts
that, in a six-month period, patients detained under the Mental Health Act 1983 were absent from services without authorisation on 2,745 occasions.
Crisis resolution home treatment (CRHT) teams, which should be involved in deciding whether admission to hospital is the most appropriate course of action, were only involved in 61% of admissions.
Also, 6% of the time people spent in hospital was due to delays in finding accommodation or appropriate support to live within the community.
Anna Walker, the Commission’s Chief Executive, is quoted as saying
‘It is clear that it is possible to provide patients with excellent acute hospital care and that some organisations are doing exactly that. It is also clear that these can be tough places to work and I pay tribute to the dedicated staff who face the challenges on a daily basis’
There are cases where people are not always getting the personalised, safe, high quality care that they need. This is happening at a time of crisis in their lives and it cannot be ignored.’
I’m surprised that only 6% of beds are assessed as being blocked, as from my experience I would have guessed the number at much higher. Or maybe it just feels that way. There are some positive aspects to the report, which will doubtless be championed by politicos, but to my mind mental health care is still woefully underfunded in the UK and many psychiatrists would echo Dinesh Bhugra’s assertion that he would be unwilling to have a family member stay in some UK acute psychiatric wards.
As usual the problems come down to a lack of investment both in staff training and facilities.