Mind has issued a response to the CQC’s State of Care report, which this year focuses particularly on inpatient mental health services, which have seen a reduction in quality.
Findings include:
7% of child and adolescent mental health inpatient services were rated inadequate (2018: 3%)
8% of acute wards for adults of working age and psychiatric intensive care units were rated inadequate (2018: 2%)
The report also outlines how the majority of mental health inpatient services rated inadequate or requiring improvement also had a lack of appropriately skilled staff.
Responding to the report, Paul Farmer, Chief Executive of Mind, the mental health charity, said:
“It is disturbing that the CQC continues to highlight the same issues with the quality of mental healthcare, time and time again, just when people need them the most.
“We have repeatedly said that additional investment needs to reach the frontline to counteract years of underfunding and increased demand for mental health services. But the report shows access to community mental health services is not keeping pace with demand. The promise of more money at a national level is not enough – people are still reaching crisis point because they are aren’t getting the help they need.
“We know that even when people are able to get help, it is delivered in sub-standard facilities which limits the quality of their care. It is deeply unsettling that inspections repeatedly reveal outdated and dangerous infrastructure. We cannot expect people with mental health problems to be treated in these conditions, nor should we expect NHS mental health staff to work in them. And yet the Government has barely given mental health a mention in recent capital spending announcements.
“The Government must also urgently address the diminishing workforce, which is driving the overall decline in the quality of mental healthcare. As demand increases, under-supported staff are leaving in droves. This report shows that understaffed and under-resourced services don’t deliver quality care.
“Though investment through the NHS Long Term Plan is welcome, it is clear that in real-terms mental health services have been left languishing at the bottom of the pile, including, worryingly, those for children and young people and psychiatric intensive care units. The public rightly expects mental health services to be as much of a priority as those for physical health but this message isn’t getting through to local decision makers. The Government must invest in infrastructure and workforce, and the NHS Long Term Plan must be delivered in every local area if we are to see meaningful change for people trying to access support right now.”
On 30 September the Government pledged a large amount of investment for hospital projects across England, at the start of the Conservative party conference.
The plans include a £2.7bn investment for six hospitals over five years but no mention was made of mental health buildings.
Responding to the Health Secretary’s speech, Vicki Nash, Head of Policy and Campaigns Mind, the mental health charity, said:
“Pressing risks caused by sub-standard mental health facilities have been completely ignored in today’s funding announcement for NHS hospitals.
“Long-neglected NHS mental health buildings are interfering with people’s recovery and putting them at risk of suicide. The continued use of mixed sex and dormitory wards puts people in danger of sexual assault. It can’t be right we expect people with mental health problems to continue to use inadequate and often dangerous infrastructure, and we should not expect NHS mental health staff to work in these conditions.
“When the Prime Minister first announced money for building projects, we called for the mental health estate to be among the first to benefit. Its omission in the Health Secretary’s speech makes it seem like mental health has been pushed to the back of the queue. This follows previous announcements around building projects which have seen mental health barely get a mention.
“Having a key government announcement of funding for hospitals with no inclusion of mental health is woefully out of touch. The public now rightly expect mental health facilities to be as much of a priority as those for physical health.
“There is no time to waste, the Government must urgently bring the NHS mental health estate into the 21st century. Unless, of course, it has now decided that mental health is no longer such a burning injustice.”
Caroline, who is 10 weeks pregnant, clutches a colourful antenatal zip-file folder from the NHS. It has pregnancy advice written all over it, telling her to eat healthily and stay active. But she is in an unusual position for a soon-to-be mother – she’s a rough sleeper.
The project is the first of its kind, with no other soup kitchen having ever opened up a mental health clinic on site.
Alex Brown, the director of the Soup Kitchen, first made the suggestion. He felt that by giving free mental health support to homeless people you could help them get off the streets.
Michael Brown, a Soup Kitchen trustee and the founder of the advertising company MKTG, helped by setting up a crowdfunding page to raise money for a part-time therapist. They needed £30,000 and it exceeded this target in late 2017. There were further steps to take before launching but they opened their doors with a party last week.
Last week Caroline was being helped by Dr Dobrochna Zajas, a cognitive behavioural therapist. She and her colleague Dr Brett Grellier have been offering specialist therapy, using techniques tailored for those who have been through trauma.
Three in five young people (59 per cent) have either experienced a mental health problem themselves, or are close to someone who has, according to major new research by Mind that shows the sheer scale of the pressures faced by young people.
The survey from the mental health charity also shows that one in seven (14 per cent) young people say their mental health is currently poor or very poor and outlines the breadth of the challenges they face. It also highlights how secondary schools are promoting and supporting their wellbeing.
When it comes to accessing support within school, there were problems with knowing where to go, and then getting the right kind of help. Mind’s survey also found:
Almost two in five (38 per cent) of all pupils said they wouldn’t know where to go to access support within school and half (52 per cent) said they wouldn’t feel confident approaching teachers or other school staff if they needed help.
Around one in five young people (21 per cent) had accessed support for their mental health within school. Of these, almost one in two (43 per cent) said they didn’t find the support helpful and two in three (63 per cent) said they weren’t involved in decisions made about that support.
In terms of receiving help outside the school gates, less than one in three pupils (28 per cent) who had experienced a mental health problem had used mental health services. This means a huge gap in the numbers of young people needing help and those actually accessing support from the NHS.
Louise Clarkson, Head of Children and Young People at Mind, said:
“We spoke to thousands of young people to try to better understand the scale of poor mental health across secondary schools in England and Wales. There were some really positive findings, with most pupils saying that, on the whole, they thought their schools believed good mental health was important and promoted wellbeing. But we also heard from many young people experiencing problems with their mental health. Despite the high levels of poor mental health among young people, many are not accessing support and those that are aren’t always getting what they need.
“It’s not schools at fault – we know they are under increasing pressure to provide wellbeing support for pupils at a time of rising demand and gaps in NHS mental health services. We know that many are doing the best job they can with limited resources and staff need the right expertise and support from other parts of the system. The Prime Minister’s recent announcement about training for teachers is welcome but it’s only one part of the picture – school staff need to know that if they are starting conversations about mental health with a young person, there are services in place to refer them onto.”
The surveys were carried out as part of a pilot project in 17 secondary schools in England and Wales. Funded by The BRIT Trust and WHSmith, Mind has been working with secondary schools since September to pilot a new approach to improving the mental health of the whole school community, including pupils, all school staff and parents.
Mental health information for young people is available for free from National Mind’s website. Mind is inviting young people from England and Wales to share their views and help better understand the barriers they face to accessing support and what some potential solutions might be. Anyone interested in taking part can click here.
A £14.5m programme to help reduce the number of student suicides at universities and colleges in England has been unveiled by the higher education regulator.
Nicola Dandridge, the head of the Office for Students (OfS), has said too many students are having their experience “blighted by mental ill-health” and more should be done to tackle the issue.
One of the projects awarded funding includes an Early Alert Tool, led by Northumbria University, which will identify students at risk of mental health crisis by mining data sources, like social media.
The scheme, which focuses on early warning signs, has been launched in response to figures showing that only one in three people who die by suicide are known to mental health services.
The OfS the sector’s watchdog, has awarded £6m in funding to universities and colleges, with co-funding of £8.5m, to combat a rise in student mental health concerns.
The proportion of full-time UK undergraduate students reporting mental health concerns when they enter university has more than doubled over the last five years, according to recent figures.
At least 95 university students took their own lives in the 12 months to July 2017 in England and Wales, the most recent figures from the Office for National Statistics (ONS) show.
Ten projects have been given funding as part of the collaborative programme, which includes a scheme at the University of Nottingham that will focus on international students.
So many young people are self-harming that it risks becoming normalised and increasing the number who kill themselves when they are older, a study reveals.
One in five girls and young women in England aged 16 to 24 have cut, burned or poisoned themselves, according to research that mental health experts said was “very worrying”.
The findings, published in the Lancet Psychiatry journal, show that self-harm has risen across both sexes and all age groups since 2000. In the population as a whole it almost trebled from 2.4% then to 6.4% in 2014.
The number of people overall cutting themselves jumped from 1.5% to 3.9% over those 14 years.
Growing numbers of people are harming themselves as a way of coping with feelings of anger, tension, anxiety or depression. However, a lack of NHS services and people’s unwillingness to seek help means that more than half of those who self-harm do not receive any medical or psychological care.
The Care Quality Commission (CQC) is calling for an independent review of every person who is being held in segregation in mental health wards for children and young people and wards for people with a learning disability or autism. These reviews should examine the quality of care, the safeguards to protect the person and the plans for discharge, the regulator says.
CQC makes the recommendation in its interim report published today, in which it shares early findings from its review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism.
The review, which was commissioned by the Secretary of State for Health and Social Care Matt Hancock, also highlights the need for a better system of care for people with a learning disability or autism who are, or are at risk of, being hospitalised and segregated.
From an information request sent to providers CQC was told of 62 people who were in segregation. This included 42 adults and 20 children and young people – some as young as 11 years old. Sixteen people had been in segregation for a year or more – one person had spent almost a decade in segregation. The longest period spent in segregation by a child or young person was 2.4 years.
CQC has so far visited and assessed the care of 39 people in segregation, most of whom had an autism diagnosis.
Reasons for prolonged time in segregation included delayed discharge from hospital due to there being no suitable package of care available in a non-hospital setting. For some, the commissioners had found it difficult to find a suitable placement.
The safety of other patients or staff and inability to tolerate living alongside others were the most common reasons providers gave for why people were in segregation. In some cases, staff believed that the person’s quality of life was better in segregation than in the less predictable environment of the open ward.
Some of the wards were not suitable environments for people with autism and many staff lacked the necessary training and skills to work with people with autism who also have complex needs and challenging behaviour.
A coroner has called for universities to destigmatise mental health issues after concluding that a student took his own life after facing dismissal from his course and the prospect of losing his accommodation.
First-year Bristol University student Ben Murray, 19, fell from a bridge after receiving a note telling him he was going to be dismissed for missing lectures and an exam.
The senior coroner Maria Voisin said that more work needed to be done to make sure students felt they could declare their mental health issues without fear of missing out on a place at university.
Murray, who was studying English, is one of 12 students at Bristol who have killed themselves or are suspected of taking their own lives since September 2016.
During his inquest at Avon coroner’s court, Murray’s parents, James and Janet, said the university had failed their son.
They believe Murray was troubled and asked for help from the university but nobody saw him face to face to address his concerns.
On Thursday, Voisin ruled that Ben died from multiple injuries as a result of suicide. She said: “It is clear from the act that lead to Ben’s death that he intended to take his life.
“There were a number of issues in his personal life that support this evidence. His place had been withdrawn and he owed a significant debt for his accommodation.
“I will be writing to Bristol University, the Department for Education, the minister of suicide prevention[Jackie Doyle-Price] and Ucas [which helps process university applications].”
The coroner continued: “Bristol University have clearly made many fundamental changes to their practices since Ben’s death, and they should be praised for that. But there needs to be a move towards de-stigmatising mental health.
“Currently, only 37% of students [with a mental health issue] disclose it on their Ucas form or to their uni. More students need to be assured that disclosing this will not affect their place.”
Frank Field MP, Chair of the Work and Pensions select committee, has criticised the Government for not devoting enough time or energy to their response to a report published by the committee about Universal Credit. The committee refers to the response as “skimpy and disappointing”.
Responding to Frank Field’s comments, Sophie Corlett, Director of External Relations at Mind, said:
“The Work and Pensions Select Committee report yet again highlighted the many difficulties people face under Universal Credit. We know thousands of people with mental health problems are struggling to cope every week with this new benefits system. We’ve heard repeatedly from people at crisis point still being required to look for work or risk losing their benefits. We’re also concerned about what will happen to people still receiving older disability benefits moving over to the new system. We have repeatedly asked the Government to address issues and guarantee that no one receiving benefits will be worse off if they are unable to make a new claim.
“Many people are slipping through the net during the move to Universal Credit – because they’ve moved house, for example, or been in hospital for treatment. The Government should be taking steps to address these issues, so it’s worrying that the Work and Pensions committee don’t feel the Government is listening to its recommendations to improve the way Universal Credit works.
“If the Government is determined to forge ahead with Universal Credit, it needs to take responsibility in tackling urgent problems affecting thousands of people – issues requiring serious attention, not scant responses.”
After years languishing in the dark, mental illness is finally getting its moment in the spotlight. Frustrating political football it may be, but one thing can’t be denied – it’s making headlines more than ever. Focus, largely, has been on young people – crises in child and adolescent mental healthcare and in student populations have been both persistent and significant. But mental illness doesn’t end with reaching adulthood – often, in fact, it doesn’t end at all.
New research from the British Journal of Psychiatry into self-harm in older people puts this into stark perspective. A meta-analysis of 40 studies found that yearly self-harm rates were about 65 per 100,000 people, with risk of repetition and of suicide also higher than average. Self-harm is still seen as a problem among younger demographics; and while that remains true, this data proves that the issue is even more complex and diffuse than we thought.
The findings are not wholly surprising. In 2014, the World Health Organization found that suicide rates were highest in people aged over 70 in almost all regions of the world. The Royal College of Psychiatrists (RCP) also found that 40% of older people in GP clinics experience mental ill-health; this rose to 50% in general hospitals and 60% in care homes. And, as the Mental Health Foundation points out, the UK population is ageing rapidly – since 1974, the number of older people in the UK has grown by 47%. By 2027, the Office for National Statistics predicts, 20.7% of the UK population will be aged 65 or over, compared with 15.9% in 2007. The problem, clearly, is not going away.
