The NHS Benchmarking Network recently published its annual report on mental health services in the UK. Covering 100% of specialist NHS mental health services for adults in England, and some in Scotland and Wales, it provides some of the most comprehensive information on their activities and how they are resourced.
The report makes sobering reading. It shows that mental health services are working harder than ever to meet growing levels of demand, in parts of the system with diminishing resources.
Inpatient services account for just 11% of mental health service activity, the rest being carried out by a range of community services. Yet they account for almost half of spending on mental health care for adults and there are growing concerns about the availability of beds, especially for people in a crisis, and the use of out-of-area placements when a local bed cannot be found.
The network’s report shows that such concerns may be well founded. They found that over the past three years, the number of adult inpatient beds has fallen by 17%, yet the number of admissions to hospital has stayed the same, and so have lengths of stay in hospital. This has been achieved through higher than ever rates of bed occupancy, now at an average of 94%. This is significantly above the recognised ‘safe’ rate of 85% bed occupancy. At the same time, in the last year alone there has been a 10% rise in use of the Mental Health Act and 9% of people who are discharged from hospital are readmitted within three months.
The network also found that the number of people using community mental health services is now just over 2% of the adult population – one in 50 of us. Community mental health services provide the vast majority of care and support available. They cost a lot less than inpatient services yet waiting times for almost all types of community team are rising and this is putting pressure on the amount of contact teams can have with individual service users.
A picture is emerging, from this and numerous other reports, of mental health services for all age groups struggling to meet people’s needs. Funding for NHS mental health care fell in real terms by an estimated 8% in the five years to 2015, according to data various observers have obtained under the Freedom of Information Act – in the absence of reliable national figures about mental health investment since 2012.
“In the last year alone there has been a 10% rise in use of the Mental Health Act; 9% of people who are discharged from hospital are readmitted within three months.”
Yet there are signs of progress in the Benchmarking Network’s report, too. Despite growing pressures on inpatient services (for example), the number of serious incidents in hospital has fallen, and local Crisis Care Concordat agreements are bringing about improvements in emergency responses in many areas. The network also found that most Early Intervention in Psychosis teams are able to see people within two or three weeks of referral – although some young people still have to wait substantially longer.
The figures only tell some of the story. Behind each one is a wealth of experience of people living with mental illness. In seeking solutions to the growing concerns about pressure on mental health services, it is vital that the people they exist to serve are involved as equal partners in designing and redesigning the support they are offered. All mental health services will benefit from being developed and delivered jointly with the people who use them, a partnership of equals in finding the most effective ways of enabling people to recover.