For five years, the NHS Benchmarking Network has been collecting data about mental health services in the UK. This week it published its report on adult mental health care for 2016. Based on data provided to it by every mental health trust in England and Wales, it paints a picture of a set of services that continue to work under high pressure every day.
For the first time since its mental health survey began, the Network this year reports a rise in the number of hospital beds for adults, which increased from a median of 19 per 100,000 people last year to just under 20 in 2016. This follows a 15% fall in the previous four years, and it is mirrored by a rise in the number of admissions this year and in the amount of time people stay in hospital (at an average of 33 days). As a result, average bed occupancy is now also slightly higher than last year, at 94%; a figure that rises to 102% if people on leave but still officially occupying beds are included, compared with a recommended ‘safe’ level of 85%.
The Network’s report goes on to find that lengths of stay are also rising in other types of psychiatric bed: in medium secure units it is now 620 days and bed occupancy there is at 94%. All in all, it is apparent from the report that more people with mental health conditions are being admitted to hospital than last year and they are staying for longer. And worryingly, the number of people detained under the Mental Health Act also rose once again, this year by 7%.
Beyond hospital, the report also looks at levels of activity in community services, where most people using mental health services get most of their support the majority (and sometimes all) of the time. Here, the report points over time to evidence of an overall reduction in both the number of people of working age they are supporting and the amount of contact they have. There are, of course, big variations between local areas and between different types of service: for example crisis resolution team activity fell by 4% compared with last year while early intervention team caseloads rose by 10% following the introduction of new access and waiting standards.
The report also shows a significant increase in liaison psychiatry services in general hospitals, where activity rose by 69% between 2014 and 2016. This is a result both of growing evidence of the health and financial benefits of liaison psychiatry and a major national focus on these services.
The Benchmarking Network’s findings for 2016 can be seen in the context of other evidence about the pressures currently facing mental health services. Evidence collected by The King’s Fund and others has shown that in many areas, mental health services in England have not kept pace with the rest of the NHS in terms of CCG investment, and there are wide variations in both funding for mental health support and the performance of local services.
The Network’s findings also provide a stark warning about the challenges the NHS and its partners face in delivering the promises of the Mental Health Five Year Forward View. While there is welcome growth in Early Intervention in Psychosis services and liaison psychiatry, reductions in crisis resolution and other community mental health services could hold back progress in improving the support people get outside hospital, particularly when they need help most urgently.
Today’s report shines a light on the position of mental health services today. If we are to make progress in improving access to support that meets people’s needs and wishes, the picture will need to change significantly over the next five years.