A report provided findings from a process of stakeholder engagement in London regarding the future of mental health provision in the city.
Source: Helen Gilburt, Nigel Edwards, and Richard Murray, Transforming Mental Health: A plan of action for London, King's Fund
A report provided the findings from an assessment of current provision of child and adolescent mental health inpatient provision (tier four provision). The mapping exercise had found that, for England as a whole, it was not possible to conclude definitively whether the current level of bed provision was sufficient to meet the need. The report said that shortages in the south west and areas such as Yorkshire and Humber had resulted in patients being admitted to services a long way from home. The assessment exercise had also found evidence of patients being inappropriately admitted to specialised units, partly as a result of gaps in tier three services and other local health and social services provision, as well as weaknesses in commissioning and case management.
Source: CAMHS Tier 4 Steering Group, Child and Adolescent Mental Health Services Tier 4 Report, NHS England
A report said that mental health was a priority area in Scottish healthcare, and that the focus on data collection, monitoring, and evaluation, and on improvement and delivery, was a particular strength. It said that better indicators could be developed to monitor specialist community services.
Source: Alessia Forti, Mental Health Analysis Profiles (MhAPs): Scotland, Organisation for Economic Co-operation and Development (OECD)
An article examined recent trends in hospital and community treatment in England for eight mental health diagnoses, over the period 1998 to 2012. It said that mental health bed numbers had declined significantly, and both the numbers and lengths of hospital stays had declined for a range of severe illnesses including schizophrenia, bipolar disorder, and depression. It said there could be significant needs that were not met through community services and called for a review of policy, as well as further epidemiological study of morbidity, mortality, and health needs associated with mental illness in the community.
Source: Ben Green and Emily Griffiths, 'Hospital admission and community treatment of mental disorders in England from 1998 to 2012', General Hospital Psychiatry, Volume 36 Issue 4
A report examined progress against the aims of the 2008 Independent Living Strategy. It said that there was no evidence of significant progress in improving choice and control and, although there had been an increase in the use of personal budgets for social care, there were also limitations to the effective delivery of services, and the restrictions in how personal budgets or direct payments could be used inhibited choice and control. The report also raised concerns including: services for older people; mental health services; employment prospects and support; access to appropriate accommodation; and declining levels of income.
Source: Jenny Morris, Independent Living Strategy: A review of progress, In Control/Disability Rights UK
A think-tank report examined the experiences of vulnerable children and young people in their contact with statutory child protection and mental health services, and the interface between the voluntary sector and statutory services in these areas of work. It said that there were examples of good practice, but children in some cases were being 'spectacularly failed' by some statutory services, and child protection and statutory mental health services in some parts of England were in crisis and not fit for purpose. The report said that there was a lack of accurate data on the scale and nature of the risks. It made recommendations, including for the establishment of a Royal Commission to advise on the redesign of services.
Source: Adele Eastman, Enough is Enough: A report on child protection and mental health services for children and young people, Centre for Social Justice
A paper provided initial findings from research that examined mental health services commissioning processes from the perspective of the public sector bodies responsible for its implementation and the third sector organizations (TSOs) who engaged with commissioners. It said that, although practice had changed to some extent, there was also considerable continuity, particularly in the importance of relationships. Many TSOs were said to welcome regular tendering as an opportunity to expand their services, but large scale changes within commissioning organizations (such as in health or social services) appeared to lead to disruption in the commissioning process and in relationships. The report concluded that commissioning was yet to fulfil its expected potential in improving outcomes for people with mental health problems, and in efficiency improvements, but it was not possible to infer whether this was caused by its, as yet, incomplete implementation, or whether the underlying principles were fundamentally flawed. It warned that, without the necessary capacity, time, and expertise, commissioning was unlikely to succeed.
Source: James Rees, Robin Miller, and Heather Buckingham, Public Sector Commissioning of Local Mental Health Services from the Third Sector, Working paper 122, Third Sector Research Centre (University of Birmingham)
A report (by an official advisory body) provided an update to a 2011 evidence report on service user experiences in adult mental health services.
Source: Service User Experience in Adult Mental Health: Evidence Update May 2014, National Institute for Health and Care Excellence
A report provided an outline of the Royal College of Psychiatrists' position on the separation of mental healthcare between in-patient and community and within the community. It said that decisions about the best model of service delivery should be based on evidence that the model would deliver better care for patients, and that changes should be piloted and evaluated before wide-scale service redevelopment occurred. The report said that the principles underpinning any change should be: to ensure ease of access by patients to services; to deliver evidence-based treatment; to reduce the risk of poor commitment and improve continuity of care; and to ensure that patients were not referred and assessed by different parts of the service before being provided treatment. It discussed the implications for different geographical areas and for the organization and delivery of services, and raised issues relating to continuity of care and the need for specialist and crisis services.
Source: Nick Kosky, Laurence Mynors-Wallis, Chris Fear, and Guy Undrill, Service Models in Adult Psychiatry, Royal College of Psychiatrists
A report examined progress made during the five years since the publication of the Bradley Report, which reviewed the extent to which offenders with mental health problems or learning disabilities could be diverted from prison. The report said that there had been progress in developing liaison and diversion services in police stations and courts, but such work could only be effective if local health, social care, housing, and other vital services were also available to meet often multiple and complex needs. The report called for further work to provide greater consistency in the provision of mental health support in prisons, and the extension of the liaison and diversion operating model to all stages, including prevention, treatment, and resettlement, with 'through the gate' support for offenders as they left prison. It also recommended: training in mental health and learning disability awareness for frontline staff in all criminal justice services; better adherence to the Youth Justice Liaison and Diversion model; consistent availability of Appropriate Adults and intermediaries; a review of appropriate accommodation for offenders with vulnerabilities; and further research.
Source: Graham Durcan, Anna Saunders, Ben Gadsby, and Aidan Hazard, The Bradley Report Five Years On: An independent review of progress to date and priorities for further development, Centre for Mental Health
A paper examined existing approaches to risk assessment and management in mental health settings, and discussed ways to move towards recovery-oriented risk assessment and safety planning, based on shared decision-making and the joint construction of personal safety plans.
Source: Jed Boardman and Glenn Roberts, Risk, Safety and Recovery, Centre for Mental Health/NHS Confederation Mental Health Network
A report said more research was needed into the nature and prevalence of mental health problems among children and young people from black and minority-ethnic communities, in order to support the planning, commissioning, and provision of appropriate mental health support in England. It said it was also important to recognize the specific needs of different ethnic groups and individuals, and to understand the barriers that deterred young people from accessing mental health services. The report called for commissioners and service providers to work with children and young people to develop evidence-based and culturally appropriate services, including early intervention services.
Source: Paula Lavis, The Importance of Promoting Mental Health in Children and Young People from Black and Minority Ethnic Communities, Race Equality Foundation
A report examined the need for greater numbers of highly trained social workers that specialized in mental health. The report considered issues regarding recruitment, education, and training, and the role of social workers within integrated mental health teams. It proposed the creation of a fast-track graduate recruitment programme (provisionally known as 'Think Ahead') to attract high calibre graduates into mental health social work, and considered how evidence from graduate recruitment schemes in similar fields might inform the design of the proposed new programme.
Source: Jonathan Clifton and Craig Thorley, Think Ahead: Meeting the workforce challenges in mental health social work, Institute for Public Policy Research
A report examined the mental health of people with learning disabilities. Drawing on a survey, it reported a range of findings and recommendations, including that: people with learning disabilities said that they did not feel believed, listened to, or supported when they felt down, and wanted to have more control around their mental health; family members and friends had reported difficulties in accessing support and specialist referrals, to the detriment of people's well-being; professionals had said that not enough was being done to support the mental health needs of people with learning disabilities; and that mental health services needed to improve and to make reasonable adjustments to ensure access.
Source: Christine-Koulla Burke, Feeling Down: Improving the mental health of people with learning disabilities, Foundation for People with Learning Disabilities
An article examined the literature around joint working in health and social care for older people and people with mental health problems in the United Kingdom. Updating an earlier literature review, it said there were signs that some joint working or integration initiatives could deliver outcomes desired by government, and some evidence to suggest benefits to service users or carers. However, the authors concluded that the available evidence did not support the current or previous government's faith in the strategy of health and social care integration.
Source: Ailsa Cameron, Lisa Bostock, and Rachel Lart, 'Service user and carers perspectives of joint and integrated working between health and social care', Journal of Integrated Care, Volume 22 Number 2
A report examined women's experiences of poor mental health and well-being, and their experiences within the mental health system in England, with a focus on women who had experienced sexual violence, black and minority-ethnic women, and women affected by HIV. It said that, overall, the integration of need in policy processes and structures was inconsistent, and that there was a clear need for a consistent, gender-specific approach in the commissioning and delivery of mental health services. The report made a range of recommendations.
Source: 'I Am More Than One Thing': A guiding paper by Imkaan, Positively UK and Rape Crisis England and Wales on women and mental health, Imkaan/Positively UK/Rape Crisis England and Wales
An article examined the impacts of user involvement in mental health, drawing on a study of three National Health Service foundation trusts in the United Kingdom. It said that change in the NHS and in social care had altered what service users and their organizations could achieve, but service user involvement had become embedded into the new systems. It said that 'traditional' styles of confrontation and campaigning had given way to more corporate and professional modes, but this posed many challenges for organizations. 'Ordinary' service users were found to have some involvement in service planning and delivery and were supported by staff. In addition, it said that new opportunities and forums had arisen for user involvement, including the possibilities for involvement in NHS foundation trusts, but issues of appropriate styles of behaviour and negotiation arose. The article noted the potential for personalization to offer service users more control of their own care, but the study found little evidence that this was happening and there was uncertainty and confusion surrounding its development. The authors recommended further research on the applicability of personalization to the field of mental health.
Source: Diana Rose, Marian Barnes, Mike Crawford, Edward Omeni, Dee MacDonald, and Aaron Wilson, 'How do managers and leaders in the National Health Service and social care respond to service user involvement in mental health services in both its traditional and emergent forms? The ENSUE study', Health Services and Delivery Research, Volume 2 Issue 10
A report provided the findings from an evaluation of the City and Hackney Primary Care Psychotherapy Consultation Service (PCPCS), an outreach service that supported family doctors in managing patients with complex mental health and other needs that resulted in frequent health service use. It said that: the service improved health outcomes and resulted in reduced health service use; it led to financial savings that were equivalent to around one third of the cost of the PCPCS treatment; and the service was highly rated by local family doctors.
Source: Michael Parsonage, Emily Hard, and Brian Rock, Managing Patients with Complex Needs: Evaluation of the City and Hackney Primary Care Psychotherapy Consultation Service, Centre for Mental Health
A report examined economic evidence to support the business case for investment in effective, recovery-focused services for people with schizophrenia and psychosis. The report said that there was a range of clinically effective interventions, and it called on local and regional commissioning and pathway development to draw on the evidence in order to achieve savings that could be reinvested in care.
Source: Martin Knapp, Alison Andrew, David McDaid, Valentina Iemmi, Paul McCrone, A-La Park, Michael Parsonage, Jed Boardman, and Geoff Shepherd, Investing in Recovery: Making the business case for effective interventions for people with schizophrenia and psychosis, Rethink Mental Illness
A report examined the causes of low take-up of maternal mental health-related services by migrant women in the United Kingdom. It said that the diverse group of migrant women faced practical barriers and cultural factors which might prevent them from seeking help and, while services tended to be focused on helping migrant women to overcome these, they risked obscuring cultural factors and attitudes to mental health. It called for appropriate training for mental health practitioners, as well as for urgent further research to acquire accurate data on the needs of the newer migrant population, to inform the development of appropriate services.
Source: Zahira Latif, The Maternal Mental Health of Migrant Women, Race Equality Foundation
A paper examined challenges facing mental health and mental health services, including demographic changes and economic challenges. It said that by 2030 there would be approximately 2 million more adults in the United Kingdom with a mental health problem, and that over the next ten years the National Health Service could experience a funding gap of between £44 and £54 billion. It called on service providers to develop innovative new models of care, including more use of technology, and for leaders to consider the future workforce, shift towards more community-based services, and prevent further budget reductions.
Source: #MHN2014: The future of mental health, Discussion Paper 16, Mental Health Network, NHS Confederation
An article examined the organizational characteristics of mental health services for marginalized groups in 14 European capital cities (including London), and examined the associations between organizational quality, service features, and country-level characteristics. It said that the quality of services was influenced by socio-economic contextual factors, particularly national income, and that such factors should be considered in international comparative studies.
Source: Diogo Costa, Aleksandra Matanov, Reamonn Canavan, Edina Gabor, Tim Greacen, Petra Vondrackova, Ulrike Kluge, Pablo Nicaise, Jacek Moskalewicz, Jose Manuel Diaz Olalla, Christa Strassmayr, Martijn Kikkert, Joaquim Soares, Andrea Gaddini, Henrique Barros, and Stefan Priebe, 'Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries', BMC Health Services Research, Volume 14 Issue 49
A paper examined how to identify indicators of high-quality mental health services and how the presence of those indicators would lead to key recovery outcomes. It said that it was important to distinguish between quality indicators at an individual level and those at an organizational level, and made a number of recommendations for local providers, health and social care commissioners, and government.
Source: Geoff Shepherd, Jed Boardman, Miles Rinaldi, and Glenn Roberts, Supporting Recovery in Mental Health Services: Quality and outcomes, Implementing Recovery Through Organisational Change Programme (ImROC), Centre for Mental Health/Mental Health Network, NHS Confederation
An article examined user involvement in mental health services in the United Kingdom, focusing on the power over discourse. It said that, although there were opportunities for 'discursive contestation' in mental health service development, the ways in which these opportunities emerged meant that the potentially transformative influence was nullified, and the process further marginalized women service users and other groups. The article considered the implications for the development of user involvement in service commissioning.
Source: Lydia Lewis, 'User involvement in mental health services: a case of power over discourse', Sociological Research Online, Volume 19 Issue 1
A report examined the impact on young people of budget cuts to Early Intervention in Psychosis (EIP) services, which were designed to help young people aged 14-35 to recover from a first episode of psychosis. It said that services in England were finding it difficult to survive, with 50 per cent having seen budgets reduce in the past year, 58 per cent having lost staff, and 53 per cent reporting a decline in the quality of their service. The report said that young people's chances of recovery from psychosis were being compromised by delayed access to EIP services. It called on the government to introduce a maximum waiting time of 28 days and for health commissioners to ensure that full EIP services were available.
Source: Lost Generation, Rethink Mental Illness/Iris Network
A concordat was signed by organizations from the health, social services, emergency services, and local government sectors in England. The concordat was a shared, agreed statement of intent and common purpose regarding policy-making and spending decisions for services to anticipate and meet the needs of people who had mental health crises. It covered: access to services that prevent crisis; urgent and emergency access to crisis care; the quality of treatment and care while in crisis; and recovery and ongoing prevention. It discussed commissioning and set out a timed action plan.
Source: Mental Health Crisis Care Concordat: Improving outcomes for people experiencing mental health crisis, Department of Health
Links: Concordat | Summary | DH press release | ACPO press release | CMH press release | MHF press release | NHS Confederation press release | NHS England press release | RCN press release | Turning Point press release | Guardian report
A report examined the impact of the introduction of a market system (Any Qualified Provider) for the provision of psychological therapies in primary care in England. The AQP programme was introduced to allow for patient choice, and aimed to raise both service quality and efficiency through competition between providers. The report said that some waiting lists had been reduced, but raised a number of concerns, including the use of payment by results, the emergence of perverse incentives, levels of payment, the use of zero value contracts, concerns about the method and impact of outcome measurement, and concerns over the impact on smaller organizations. The report made recommendations for policy-makers, commissioners, and ongoing research.
Source: Steve Griffiths, Joan Foster, Scott Steen, and Patrick Pietroni, Mental Health's Market Experiment: Commissioning psychological therapies through Any Qualified Provider, Centre for Psychological Therapies in Primary Care, University of Chester
A government department published a policy paper on mental health in England. It set out 25 areas for action, including: patient choice in where they receive care; waiting time standards from 2015; an expansion in talking therapies; rolling out talking therapies for children and young people across the country by 2018; better support for young people as they move into adult services; and the allocation of up to £43 million from the Care and Support Specialized Housing Fund to support the construction of a small number of specialist housing projects.
Source: Closing the Gap: Priorities for essential change in mental health, Department of Health
Links: Report | DH press release | Written ministerial statement | MHF press release | NHS England press release | PHE press release | RCN press release | Turning Point press release | BBC report | Guardian report | Telegraph report
An article examined the ENRICH programme, which aimed to develop the knowledge base for reducing differences in pathways to mental healthcare for black and minority-ethnic groups in England. It reported on three studies that aimed to: understand ethnic differences in pathways to care; evaluate the process of, and predictors for, detention under the Mental Health Act; and examine the suitability of generic early intervention services for different ethnic groups.
Source: Swaran Singh, Zoebia Islam, Luke Brown, Ruchika Gajwani, Rubina Jasani, Fatemeh Rabiee, and Helen Parsons, 'Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study', Programme Grants for Applied Research, Volume 1 Number 3
An article examined results from EPOS (The European Prediction of Psychosis Study), a prospective, multi-centre, naturalistic field study in four European countries (Finland, Germany, The Netherlands and England), designed to acquire accurate knowledge about pathways to care and delay in obtaining specialized high risk care. It noted average delays of over a year between initial onset of problems and seeking help, and over two years between the initial help-seeking contact and reaching specialized high risk care. The article said there was a need for early detection and intervention programmes, and enhanced public awareness of early psychosis.
Source: Heinrich Graf von Reventlow, Seza Kruger-Ozgurdal, Stephan Ruhrmann, Frauke Schultze-Lutter, Andreas Heinz, Paul Patterson, Markus Heinimaa, Peter Dingemans, Paul French, Max Birchwood, Raimo Salokangas, Don Linszen, Anthony Morrison, Joachim Klosterkotter, and Georg Juckel, 'Pathways to care in subjects at high risk for psychotic disorders: a European perspective', Schizophrenia Research, Volume 152 Issue 2