Mental health provision comes under scrutiny as report reveals thousands in "institutionalised" care

July 20, 2017

Mental health services across the nation have come under fire after a new report revealed that thousands of patients are being locked in secure wards.

The Care Quality Commission’s recent report revealed that as many as 3,500 patients are being held on secure wards, often miles away from their friends and family.

Inspectors raised concerns about the long-term rehabilitation of the patients, arguing that the long-stay wards in question were in danger of institutionalising patients rather than preparing them to return to an independent life.

The report also highlighted the “great variation” between wards that use physical restraint to manage challenging behaviour, and the CQC will be strengthening its assessment of this practice.

Sophie Corlett, director of external relations at mental health charity Mind, said: “There are some worrying things in here from the point of view of people receiving services, some that you would really not expect to be seeing in 2017.

“We have had many years of knowing that being in long-stay, locked accommodation is of no use to you, is expensive to the nation and is a human rights abuse, effectively to take away your liberty and to give you no therapeutic future.

“To see that there are 3,500 people in effectively institutionalised settings in 2017 is unacceptable.”

Despite this, the overall assessment of mental health provision in England was encouraging, with 68% of core services provided by NHS trusts and 72% of independent mental health locations being rated as good.

A further six per cent of NHS and three per cent of independent core services were rated as outstanding.

Mental health report reveals that thousands of patients are at risk of becoming institutionalisedIn addition, nearly all staff members were praised for being caring and compassionate, with 88% of NHS staff being rated as good, and nine per cent being outstanding.

Meanwhile 93% of independent staff were rated as good, and five per cent as outstanding.

Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission said: “These outstanding mental health services provide world-class care, whether in hospital or in the community; the challenge is how to ensure that everyone, no matter where they live or who they are, has access to services of this quality. The good news is that mental health services in England have the raw material to achieve great things.

“We have rated almost every service as good or outstanding for caring - ratings that were informed by our own observations and with interviews with many thousands of staff and patients.

“Those who deliver and commission care must learn from the services that are getting it right. And we will continue to highlight good practice, drive improvement and act on behalf of people to ensure that everyone gets the help they need when they need it.”

However, the report did highlight a number of serious concerns about the sector - including restrictive practice - that included safety, clinical information systems, and staff shortages.

According to the report, four per cent of NHS core services and five per cent of independent mental health core services were rated as inadequate for safety, with only 59% and 61% respectively being rated as good.

It discovered that “too many” wards battled a number of obstacles, including high numbers of detained patients who pose a risk to themselves and others, old and unsuitable buildings, staff shortages and a lack of basic training.

The decline of nursing staff is well-known across the country, with national figures revealing a 12% fall between January 2010 and January 2017.

This struggle is also amplified by insufficient resources and increasing demand. Figures show that the number of inpatient psychiatric beds reduced by four per cent between 2014-15 and 2016/17, while the number of detentions under the Mental Health Act increased by 26% between 2012/13 and 2015/16.

However, the report has highlighted a number of ways to bolster care, while reducing demand on vital services.

These suggestions include making patients more active in their own care to promote recovery and reduce dependency on services; investing more in local services so less people have to move away from family and friends; and investing in information technology to help services become more time efficient and provide better care.

Health professionals welcome the report and consider it as a turning point in mental health provision.Health professionals say mental health provision is at a crossroads

Dr Lelliott said: “The mental health sector is at a crossroads. The Five Year Forward View for Mental Health, published last year, along with the newly introduced waiting time standards, point the way to a future where people have easy access to high quality care close to home and are able to exercise choice. To achieve this vision, the sector must overcome an unprecedented set of challenges – high demand, workforce shortages, unsuitable buildings and poor clinical information systems.

“Some services remain rooted in the past – providing care that is over-restrictive and that is not tailored to each person’s individual needs. This can leave people feeling helpless and powerless. But the best services are looking to the future by working in partnership with the people whose care they deliver, empowering their staff and looking for opportunities to work with other parts of the health and care system.”

Sophie Corlett added: “Mental health has been underfunded and under-resourced for many years, with dire consequences for people with mental health problems. The Five Year Forward View for mental health gives us the opportunity to get this right, to start building the kind of NHS mental health services that will carry us into the future. This report shows that some providers are leading the way, but it is clear that we still have a long way to go before everyone with a mental health problem gets the help and support they need.”

Add new comment