How a failing safety net is impacting the NHS’s mental health services

‘Mental health services: Addressing the care deficit’ is a new report by NHS Providers based on a survey of chairs and chief executives of all mental health trusts, carried out in November 2018.

The report makes for an interesting read, writes Liz Zacharias, senior consultant at multidisciplinary management consultancy, Campbell Tickell. 

It provides confirmation of what we find when working with mental health providers and commissioners, namely that, as well as clinical, workforce and system pressures on mental health services, there are increasing burdens on the system. This is due to changes in the benefits, a lack of affordable housing, fragmented commissioning arrangements and cuts to preventative and allied services, such as drug/alcohol support. These all contribute to the creation of a system which lacks the strong safety-net for the people it most seeks to help.

The survey aimed to gain a deeper understanding of the current operating environment and its impact on the mental health NHS provider sector. Responses were received from 36 mental health leaders from 32 trusts across all regions, representing 59% of the NHS mental health trust sector.

Findings

The survey shows there is a substantial care deficit in mental health that must be addressed and that demand for services is outstripping supply. The main factors contributing to and maintaining the significant ‘care deficit’ across mental health services emanate not only from raised awareness, but critically from socio-economic factors. These include the impact of the rollout of universal credit, increased deprivation, unemployment and housing issues. Below are the external factors that trust leaders identified as having an impact on increasing demand:

• 92% – said changes to benefits/universal credit, with 63% saying the impact was high, making it the most significant factor;
• 98% – said financial hardship;
• 97% – said housing;
• 97% – said loneliness and isolation;
• 91% – said cuts to local services;

The other main issues impacting on mental health provision were:

• An enduring workforce shortage that undermines the front-line’s ability to staff services efficiently and effectively;
• Mental health funding constraints, with funds not always reaching the front-line services that need it most;
• The impact of cuts to wider public services. In particular, those commissioned by local authorities, such as drug and alcohol services. The respondents point to cuts in services funded by local authorities also meaning that preventative approaches and early intervention services are less available

View NHS Providers infographic displaying socio-econimic drivers of demands

Workforce Challenges

To tackle workforce issues the survey calls for a national plan, with an appropriate focus on the mental health workforce together with adequate funding to meet requirements.

Respondents identified a two-fold pressure on the workforce.

Firstly, a lack of staff in the right place: only 9% of trusts say they currently have the right staff in the right place, while nearly two-thirds of leaders were very concerned about the numbers and skills of staff they will have in two years time.  Moreover, respondent said that current staff capacity was also being diverted to support service users, with a greater number of non-clinical issues such as negotiating the benefits system.

Funding Challenges

Despite the funding promised in the 10-year NHS plan, respondents warn that the rise is not adequate to close the care deficit.  Indeed, 95% of respondents do not believe overall investment will meet current and future demand.  Further, an overwhelming majority (81%) of trust leaders said they were not able to meet current demand for community child and adolescent mental health services (CAMHS) and 58% said the same for adult community mental health services.  Regarding overall community provision, 85% do not think there is adequate mental health community services to meet local needs.

Mental Health Care Models

Trust leaders had mixed views on the impact of integrated care systems (ICSs), sustainability and transformation partnerships (STPs). However, they did think that new care models for mental health would help both overcome the fragmentation of commissioning and service provision in mental health and drive greater value from the investment in services.

Priorities

NHS mental health leaders identified the following priorities:

• Continuing to focus on reducing the number of out of area placements and addressing inpatient capacity problems, while recognising the sustained demand;
• Meeting providers capital investment needs so that urgent improvements can be made to estates;
• Promoting careers in mental health and retaining the current financial incentives to recruit mental health professionals;
• Continuing the progress already made on data quality and collection, to give a better understanding of mental health activity, access and outcomes to ensure better commissioning.