One year on from the introduction of NHS England’s Five Year Forward View for Mental Health, Julie Penfold asks - what's next?
Published in February 2016, the ‘Five Year Forward View for Mental Health’ set out a clear agenda for the reform of mental health care in England.
The accompanying report from the independent Mental Health Taskforce (chaired by Paul Farmer) stated: “For far too long, people of all ages with mental health problems have been stigmatised and marginalised – all too often experiencing an NHS that treats their minds and bodies separately”.
A year on, what have we learned and what’s next for improving mental health services in England?
Prevention seems to be key. Gregor Henderson, Public Health England’s national lead for wellbeing and mental health highlighted at the Westminster keynote that suicide prevention is an area of particular focus for Public Health England (PHE).
“The target is to reduce suicide rates by 10% by 2021,” said Henderson. “One of the main pieces of architecture (to facilitate this) is supporting local areas in multi-agency action planning to prevent suicide.”
A suite of guidance and resources will launch soon and will include:
- Mental Health Joint Strategic Needs Assessment toolkit
- Mental Health Promotion and Prevention Return on Investment tool
- Local prevention planning guidance
- Training for mental health champions to support them as prevention focused leaders
Henderson added that the guidance will be continually updated and shaped by those that are using it. He also demonstrated that good progress is being made.
The results of a PHE survey carried out in December showed that 95% of all local areas have, or are planning to have, active multi-agency suicide prevention plans in place by the end of 2017.
Inspecting mental health services
At the end of December 2016, the CQC completed its first round of new-style inspections of all mental health services in England.
Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead on mental health described this new approach as being more in-depth, making greater use of clinicians and experts who have had experience of using services within inspection teams.
The CQC found:
- Only one trust (Norfolk and Suffolk NHS Foundation Trust) was rated as inadequate but has since come out of special measures following re-inspection
- 60% of services were rated as requiring improvement
- Only 40% were rated as either good or outstanding
“The core service that appears to have performed best is the community mental health services for people with a learning disability,” said Lelliott. “I would add a caveat to that finding, that we only inspect the providers of specialist community services.” It’s not a judgement on the quality of care received, he added.
A big disappointment for Lelliott was the finding that many inpatient environments were substandard. This includes unsafe settings, buildings not being well maintained and significant problems with mixing of genders on inpatient wards.
The CQC also found some wards do not provide same sex accommodation, which Lelliott said was a longstanding problem. “This is an issue that cannot be ignored.”
Other big themes to emerge from the first round of CQC inspections were issues around:
- Nurse staffing levels
- Risk assessment and risk management
- Access and waiting times
- Medicine management
The CQC will be publishing its report on the state of mental health care in England later this year.
Lelliott also revealed the CQC’s wider priorities for mental health. “First, we will beef up our assessment of mental health care in the general hospital setting.”
“Second, we will ensure that we incorporate into our inspection approach the emerging recommendations that are coming out of the work of the Five Year Forward View. For example, we want to make sure that we are inspecting against the access and waiting times standard that NHS England is developing, at the earliest possible time.”
Children and young people’s mental health
Professor Dame Sue Bailey, Chair of the Children and Young People’s Mental Health Coalition spoke at the Westminster keynote about the prevalence of children’s mental health problems. Key statistics include:
- One in 10 five to 16-year-olds has a mental disorder
- 50% of mental health problems are established by the age of 14
- It takes around 10 years from first experiencing problems to receiving help
- 32% of girls and 11% of boys aged 15 self-harm
“I’d like to introduce a novel idea of actually listening to children,” said Professor Bailey. “They want easier access to mental health support when, where and how they want to access it. They want easier access within schools – such as counsellors. They want to learn how to look after their own mental health and know where to go for help.”
Even with increased funding, Professor Bailey argues that “we can’t help all young people” – and feels empowering children and young people to help themselves is the way forward.
To improve the care and support offered to people affected by mental health issues, services must look at how they tackle suicide prevention and how they respond to patients and families in a crisis situation. They should also consider how they can better engage with children and young people.