Community mental health care needs to improve, especially in terms of involving people in their own care plans and decisions about medication, a survey by regulator the Care Quality Commission (CQC) has concluded.
The CQC’s 2013 survey of community mental health services, which took in the views of more than 13,000 service users, found that the majority either do not have a care plan or do not fully understand it, which suggests that people are not being adequately involved in decisions that are made about their care, according to the CQC.
Nevertheless, two-thirds of respondents were positive about their experience of mental health care, rating their overall experience as 7 or above on a scale of 0-10.
In the survey, people were asked about the care and support they received from mental health services outside hospital, such as those offered by outpatient clinics, crisis home treatment, assertive outreach, early intervention for psychosis, and generic community mental health services. It included those with complex mental health needs who are within the Care Programme Approach (CPA) framework as well as those who do not.
Lack of care plans
The survey found that 14% of respondents on CPA said they do not have an NHS care plan. Of the remainder, fewer than half (46%) ‘definitely’ understand their care plan, down from 48% in 2012.
When asked if their care plan covered what they should do in a crisis 58% of respondents on CPA responded ‘yes definitely’ – down from 60% in 2012. Less than half of those not on CPA (49%) responded ‘yes definitely’.
Meanwhile, almost half (47%) of respondents not on CPA said they had not had a care review in the last 12 months, while 26% of those on CPA had not had a review in the past year.
Although the majority of respondents know who their care coordinator is and were generally positive about them, results had declined from 2012:
• 72% said they could ‘always’ contact their care coordinator (or lead professional) if they had a problem, down from 74% in 2012
• 60% said their care coordinator (or lead professional) organised the care and services they need ‘very well’ down from 61% in 2012.
The survey also shows that some people are not being adequately involved in decisions about their medication, with almost a third (32%) saying their views were only taken into account ‘to some extent’ when deciding which medication to take and less than half (43%) of those who had been prescribed any new medication were ‘definitely’ told about possible side effects.
But, in line with last year’s survey, most people responded positively to questions about the health or social care worker they saw most recently, with the majority (70%) (although down from 72% in 2012) saying they ‘definitely’ had enough time to discuss their condition and treatment, 78% saying they were ‘definitely’ listened to carefully and 72% of people saying their views ‘definitely’ were taken into account.
Focus on care
David Behan, CQC chief executive, said: “The survey describes some very positive experiences and flags where services can and must improve.
“People should always be at the heart of decisions about their own care. Care planning helps to make sure that people feel in control of their lives and illness and it can be vital in aiding their recovery. It is unacceptable that fewer people have adequate care planning than last year. It is also unacceptable for care plans not to include adequate crisis care management or for people to be poorly informed about the drugs they take.
“One of CQC’s key objectives this year is to focus on the care being provided to people by mental health services. The results of this survey will help our inspection teams under the Chief Inspector of Hospitals Prof Sir Mike Richards home in on the poorest providers and be able to challenge this poor performance through inspection.
“Trusts should look at their own results carefully and consider whether, firstly, they are assessing people’s needs properly in the context of CPA policy, and secondly, whether they are giving them the appropriate level of support.”