Community Mental Health Services needs to improve

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Published: 29 September 2006

Community Mental Health Services needs to improve

The Healthcare Commission has urged specialist community mental health services to improve access to talking therapies, out-of-hours crisis care and information for people who use services.

Publishing its first national review of adult community mental health services, the Commission praises services for generally performing well, but adds that long-standing problems still remain.

The inspectorate decided to assess adult community mental health services because of the high impact this could have on improving the nation’s mental health.

At any one time in the UK, one in six adults is affected by mental distress and more people are currently not working because of mental health problems than any other issue.

Community mental health services play a crucial role in modern mental health care, as they provide services that are designed around the needs of the individual, in their own community not in hospital.

Care in the community helps people get better quicker. These services are very important as they focus on crisis prevention & recovery.

Community mental health services are planned by Local Implementation Teams (LITs), which are responsible for ensuring services are delivered to a high standard.

LITs bring together local NHS organisations, local authorities, voluntary and independent sector organisations, community groups, people who use services and carers. They provide care & treatment for a range of conditions, including depression.

The review assessed all 174 LITs in England against national standards covering:

· access to services

· whether care arrangements address a range of needs and

· the involvement of people in decisions about their care

The asessment included the first national audit of the Nice guidelines for schizophrenia (2002), which are designed to reduce health & social inequalities and ensure consistent standards of care & support.

Overall, 9% of LITs were rated as “excellent”, 45% as “good”, 43% as “fair” and only 3% as “weak”. LITs which scored excellent consistently performed well on all components of the review.

The Healthcare Commission says that it will use the review data in its annual rating of mental health and primary care trusts.

The Commission found:

· The availability of crisis services out of hours is variable.

The majority of LITs (87%) have crisis resolution teams that are able to provide out-of-hours services, but only 49% of people who use services report having the phone number of someone from their local NHS mental health service who they can contact out-of-hours.

Also, 59% scored poorly when it came to providing access to crisis accommodation out of hours.

· People need greater access to talking therapies.

National guidance states that all people with schizophrenia or suspected schizophrenia should be offered appropriate talking therapies.

The review found that only 50% of people sampled had access to talking therapies and in 20% of LIT areas this figure was significantly lower.

· The management of medicines for patients with schizophrenia needs to improve.

Medicines management is an essential component of a safe and effective mental health service, but 84% of LITs rated fair or weak on the management of medicines for patients with schizophrenia.

For example, 89% of services had not adequately recorded side effects or how well patients had responded to drugs on individual’s care records.

· Monitoring of physical health checks of people within mental health services needs to improve.

The review found that in 28% of LITs the frequency or need for physical health checks was not recorded on care plans.

· Access to information presents a mixed picture.

Just 47% of LITs received the top score when it came to people being offered a written copy of their care plan.

However, only 5% received the top score for telling patients about possible drug side effects and only 6% scored maximum points for giving patients a say in the medication they take.

28% of LITs scored poorly when it came to telling patients the name of their care coordinator (NHS National Patient Survey 2006)

· Not enough people are getting help with employment.

National performance is weak in this area. Overall, the national survey of patients (2006) reported that, only 50% of people who said they needed assistance with finding employment received it and in 96% of LITs the figure was the same result or less than this.

The improvement review found that 36% percent of people had received an assessment of their work and training needs in the previous 12 months.

· Provision of services for black and minority ethnic groups could improve - Community development workers are responsible for ensuring that community mental health services are culturally appropriate:

66% of LITs scored “weak” on the number of workers they had in place.
41% scored “weak” on ethnic diversity training for staff and
over 50% scored “fair” on developing and implementing plans to deliver the requirements set out in the Government’s Delivering Race Equality strategy

A national report on the findings is due out later in the year.

Anna Walker, the Healthcare Commission’s Chief Executive, said:

"The majority of people who suffer from mental illness receive their treatment in their own community, not in hospital.

They want to remain in the community and this helps them get better. But for care in the community to work for the mentally ill, more access is needed to talking therapies and out-of-hours crisis care. Mental health crises don’t keep office hours and the service must be flexible enough to tackle this.

This review shows us where in the country the strengths and weaknesses lie.

We will be working with the weak performers to improve quality of their services and bring them in line with those who are excellent.”

All of the LITs and trusts reviewed have now received individual reports highlighting their scores and areas for improvement.

The follow-up stage is beginning, which will see around 10% of LITs targetted for follow up work to produce an improvement plan.

This review of community mental health services is the fourth review to be published as part of the Healthcare Commission’s new improvement reviews programme. The improvement reviews form part of the Commission’s new system for assessing NHS performance, the annual health check.

Further information

Improvement review of adult community mental health services

Nice guidelines for schizophrenia (2002)

DH – Mental Health

DH - Mental health CGWT

Choosing talking therapies?

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