By Andy Bell
The health of mental health services in the NHS is the source of some controversy and considerable speculation. Media attention is closer than ever before as the importance of expanding and improving NHS mental health support is increasingly clear.
Centre for Mental Health teamed up with the NHS Benchmarking Network earlier this year to look at what we can tell from data they have been collecting about specialist mental health services for adults in England and Wales since 2012. And in a new briefing paper we have explored what their data can tell us about the way services have been developing in that time and the challenges and opportunities they now face.
The number of acute inpatient hospital beds fell each successive year, except the last… But the number of admissions did not fall appreciably, and a growing proportion of people in hospital were detained under the Mental Health Act.
The data collected by the Network relates to mental health services provided by specialist NHS mental health trusts in England, Health Boards in Wales and some independent providers. It provides information about the way those services have evolved up to the publication of the Five Year Forward View for Mental Health in England in 2016.
The years between 2012 and 2016 provide a complex picture for mental health services. This was a period of unprecedented expansion in England of the Improving Access to Psychological Therapies programme, for the first time offering psychological therapy to adults with common mental health problems in every part of the country. At the same time, specialist mental health services for people with longer term and more complex mental health difficulties faced significant financial challenges prior to the pledge of significant extra investment in 2016.
The picture for specialist mental health services during those years is therefore mixed. The number of acute inpatient hospital beds fell each successive year, except the last, and nursing staff numbers reduced similarly. But the number of admissions did not fall appreciably, and a growing proportion of people in hospital were detained under the Mental Health Act.
During the same period, specialist community mental health services as a whole saw a slight fall in the number of people they supported and in levels of activity. Within that overall picture, the story for different types of team was quite different, and it changed over time. So while Community Mental Health Teams (CMHTs) saw slightly fewer people each year, Assessment and Brief Intervention teams (ABTs) grew. And both Crisis Resolution and Home Treatment (CRHT) and Early Intervention in Psychosis (EIP) teams began to expand towards the end of the period in response to government policies designed to enhance both crisis care and early intervention for people with a psychosis.
What the data from NHS trusts cannot tell us is the level or nature of activity in primary care for people who are not (or no longer) in contact with community mental health services. This is an area that many CCGs are investing in as an alternative to existing service offers.
There has never been a more important time to get behind the collective effort that is now needed to boost mental health support across the NHS and social care
The data we have reviewed does, however, points to the importance of successfully implementing the Five Year Forward View for Mental Health in England and of acting on the recommendations of the 2016 Commission on Adult Acute Psychiatric Care.
With fewer acute inpatient beds, we need to have a range of effective community services in place – fully integrated with social care – to prevent people being placed in hospitals far from home or facing delays in getting home. We need to build evidence of what effective primary and community mental health care looks like to support local areas in their decision-making. And we must ensure that investment pledged for the Five Year Forward View for Mental Health reaches services and brings about the changes it called for.
There has never been a more important time to get behind the collective effort that is now needed to boost mental health support across the NHS and social care, to deliver the promise of the Five Year Forward View and to ensure timely and effective help is available to all who need it wherever they live.