The number of acute inpatient beds for adults with mental health problems in England and Wales fell by 15% between 2012/13 and 2015/16 while specialist community mental health services also reduced by about 6%, according to a new briefing published today by Centre for Mental Health with the NHS Benchmarking Network.
The briefing, Adult and older adult mental health services 2012-2016, analyses data collected by the NHS Benchmarking Network since 2012/13 up to the publication of the Five Year Forward View for Mental Health.
The briefing finds that while psychiatric acute inpatient beds for adults fell by 15% between 2012 and 2016, and staffing levels fell by 20%, the number of people admitted and the time they stayed in hospital did not change. This means that bed occupancy levels have risen to an average of 94%.
During the same time, community mental health service provision fell slightly: the number of people on community team caseloads reduced by 6%, staffing levels fell by 4% and contacts reduced by 7%. By contrast access to psychological therapies rose rapidly, reaching some 900,000 people a year by 2015/16.
The report finds big changes in the types of community team that are in place across the country. ‘Generic’ community mental health teams (CMHTs) remain the most common type of community service, but fell slightly between 2013/14 and 2015/16. Early Intervention in Psychosis (EIP) and Crisis Resolution and Home Treatment (CRHT) services both increased towards the end of the period in response to a growing policy focus on early intervention and crisis care. Assertive Outreach teams fell sharply while there has been a substantial growth in Assessment and Brief Intervention teams.
The report also finds that the proportion of people admitted under the Mental Health Act rose from 25% in 2012/13 to 35% in 2015/16, and that at least half of inpatients are detained under the Act at some point during their hospital stay.
It is simply not sustainable to keep cutting community services at the same time as reducing bed numbers.
Centre for Mental Health chief executive Sarah Hughes said: “Mental health services have been under significant financial pressures in the last five years. While reductions in bed numbers continue a long-term shift from hospital to community care, any reductions in community services are a major cause for concern. It is simply not sustainable to keep cutting community services at the same time as reducing bed numbers.
“The Five Year Forward View for Mental Health in England sets out a clear ambition to improve community mental health services and increase investment in mental health care across the spectrum. Today’s report shows that this is a vital mission. We need to see investment in evidence-based community mental health services to provide people with the best available support where and when they need it. And we need to ensure that high quality primary care support is offered to people who do not need specialist help from community mental health services.”
Despite these achievements many providers are struggling to keep up with ongoing increases in demand for both community and hospital care.
Berkshire Healthcare NHS Foundation Trust Chief Executive and Chair of the NHSBN Mental Health Reference Group, Julian Emms said: “Mental Health providers have worked hard to implement appropriate services in recent years. This includes redesigning services to rely less on beds and support more people in the community. Since 1999’s National Service Framework there has been a significant movement away from beds with many hundreds of thousands of people now supported by specialist community teams.
“Almost a million people are also now able to access psychological therapy services in primary care. Despite these achievements many providers are struggling to keep up with ongoing increases in demand for both community and hospital care.”
The system needs to meet the needs of a multi-morbid society in cash-strapped times.
Dr Parashar Ramanuj, co-author of the report and a psychiatrist at the Royal National Orthopaedic Hospital, said: “For far too long, providers, commissioners and policymakers have been focused on bed numbers - there are either too many or too few. What this report shows is that the focus has to change to the community. It demonstrates that mental health care is delivered in a system; and the system needs to adapt to meet the needs of a multi-morbid society in cash-strapped times. The question has never been about whether we have enough beds, but if we have enough community provision. That is after all where the majority of mental health care is received, even if the spotlight of delivery has been focused elsewhere.”