Staff shortages mean that people with mental health problems are being cared for in emergency departments, according to the regulator’s annual report
"We know many people’s mental health deteriorates while waiting and can reach crisis point before they get help, meaning they are left with no alternative but A&E, detained against their will for treatment, or fall through the cracks between different overstretched agencies. This cannot go on. The UK government must urgently raise the standard of mental health care.” Vicki Nash, associate director of policy and campaigns, Mind
“The urgency for improved access to mental health care services and products is greater now than ever before. Demand is growing at an unprecedented pace while solutions are complex to adopt within a fragmented system. At FCC, we are looking beyond what is currently in place and so heavily relied upon to find new and innovative ways to support people, both short and long term, and that aren’t so reliant on medication, face-to-face or invasive treatment. If the workforce is under-strength or not being supported enough to deliver services, this will just create a downward spiral with increased demand and less staff to treat people.” Dr Lauren Evans, director of research and innovation, FCC
The quality of mental health care has declined in the past year, according to the Care Quality Commission’s annual State of Care report.
The report, which also recorded a decline in the quality of maternity care and ambulance services, said that the “quality of mental health services is an ongoing area of concern, with recruitment and retention of staff still one of the biggest challenges for the sector”. Almost one in five mental health nursing posts are vacant, and staffing gaps are leading to over-use of restraint, seclusion and segregation, the report said, adding: “We’ve worked with our expert advisory group for autistic people and people with a learning disability to develop a clearer and stronger position on these practices, including restraint, seclusion, and segregation. We expect all providers of health and social care to recognise restrictive practice and to actively work to reduce its use.”
Staff shortages had also led to people being cared for in inappropriate environments, such as emergency departments, the report said. One acute trust told the CQC that there had been 42 mental health patients waiting for over 36 hours in the emergency department in one month alone. “When people do get a bed in a mental health hospital, the quality of care is often not good enough,” the report said. Safety was also an area of concern, with 40% of providers rated as inadequate or requiring improvement.
As well as long waits, the report said, people “are often facing the prospect of being sent far from home for care and treatment.” It noted that despite a government commitment to ending out-of-area placements, as at May 2023, there were 775 out-of-area placements across England. “Placing people in hospitals far from home and away from friends, family and support networks can affect their recovery and increase the risk of a closed culture developing,” the report said. “When people do get a bed in a mental health hospital, the quality of care is still not good enough, with areas of concern including the use of dormitories and mixed sex wards.”
Vicki Nash, associate director of policy and campaigns at the mental health charity Mind, said that the report painted “a damning picture of the situation in mental health services.” She added: “Sadly, the scale of the crisis comes as little surprise to those with experience of mental health problems or working on the frontline. The findings sound alarm bells across the board – from quality and safety of care, through to waiting lists, capacity and staffing. These failings are systemic, and, despite repeated calls for investment and improvement, services are now buckling under the pressure.
“It is clear the mental health system is broken – people seeking help are being let down and even losing their lives in the process. They might be one of the eight million people struggling with their mental health who can’t access support, among the 1.8 million on waiting lists for community care or receiving hospital treatment that is substandard and unsafe. We know many people’s mental health deteriorates while waiting and can reach crisis point before they get help, meaning they are left with no alternative but A&E, detained against their will for treatment, or fall through the cracks between different overstretched agencies. This cannot go on. The UK government must urgently raise the standard of mental health care.”
Nash said that the report laid bare “the real human cost of political inaction and delay” and noted that the UK government was running out of time to pass the Mental Health Bill, which would strengthen rights and protections for people with mental illness. She added: “Politicians cannot continue to stand by while people with mental health problems and their loved ones are being repeatedly failed by a system meant to care for them.”
The CQC’s finding that the quality of mental health services has deteriorated over the past year comes as no surprise. Repeated news stories have shown that demand on mental health services has increased sharply, while NHS trusts and boards have found it harder to recruit and retain staff. The government now needs to take an approach that tackles the problem from both directions – reducing demand on acute services by improving community care, and renewing efforts to train new staff and retain existing staff.