Earlier this month, the NHS Benchmarking Network published its report on mental health service provision in England and Wales. In the absence of official data about the performance of these vital services, the report provides some significant insights into both inpatient and community services for both adults and children.
The report is available at http://www.nhsbenchmarking.nhs.uk/CubeCore/.uploads/PressReleaseMentalHealthBenchmarking201413112014.pdf
The Benchmarking Network brings together data collected from all NHS mental health trusts in England and all local health boards in Wales. It provides information about levels of activity, about use of their services and about the people they employ. In doing so, it paints a picture of services working under pressure and finding ways of managing in difficult circumstances.
For working age adults, the survey finds that on average mental health trusts had 5% fewer beds in 2013/14 than they did the previous year. But hospital admissions remained unchanged from the year before (at 232 per 100,000 population) and lengths of stay rose slightly (to an average of 32 days).
The report suggests that this was achieved by increasing levels of bed occupancy, from an average of 89% to 93%. By contrast, safe practice standards suggest occupancy rates should be about 85%. The report also found a worrying rise in the number of reported incidents of restraint and of violence but a fall in the use of seclusion, with wide variations between trusts in all of these.
Demand on community mental health services for adults is also rising, particularly for crisis resolution services, which increased by 5%. In just under three-quarters of cases, teams responded within four hours to calls for help.
The report examined early intervention in psychosis services, soon to be the subject of new waiting time standards. It found big variations in waiting times, from between one and six weeks for routine referrals, with an average just above the new standard of two weeks. The maximum waiting time for each services was an average of nine weeks. This suggests that investment will be required to ensure these services can meet the new standards when they are introduced next year.
The report also looked at the balance of care between community and inpatient services. It found that 89% of care is provided in the community, yet community services have just 62% of the workforce and 54% of the money allocated to mental health services.
The greatest pressures of all, however, appear to be facing child and adolescent mental health services (CAMHS). Here, the report found that both activity levels and staffing for community services rose in 2013/14 compared with the year before, despite extensively reported budget cuts. But maximum waiting times for access to community CAMHS are rising, from an average of 15 weeks to 16 for a routine assessment.
In all, the report demonstrates ways in which mental health services are managing with rising demand and diminishing resources. But it also shows wide variations from one area to another in how quickly people get seen and what they experience. And it demonstrates the continued need to refocus on earlier intervention and supporting personal recovery.