The System Is Broken
The Care Quality Commission have today published their report Right Here Right Now which outlines the results of their research into how people feel they have been treated by various agencies when they have experienced a mental health crisis.
The report should send shockwaves across all of the agencies involved as well as those charged with commissioning their services. I can only hope it detonates something and accelerates the glacial rate of change we have seen so far.
The report is a lengthy tome but a condensed version contains enough highlights (or low lights) for the casual reader.
It comes as no surprise to me that less than four in ten people found that their experience within A&E (and only slightly higher with regards specialist mental health services) could be described as positive.
GP’s, the ambulance service and the police were all perceived to be more caring and empathetic. This should, however, be a huge concern to sufferers, service providers and commissioners when you think that the very agency charged with the actual responsibility for managing people in crisis came out second worst – with those who step in and fill the gaps, often with little or no training, seemingly doing so much better.
The key findings of the report will also come as no surprise to anyone who has suffered or anyone who works in this field – by choice, preference or otherwise.
- the quality of care depends upon where you live and when you call.
- Many people have experienced problems accessing help WHEN they need it and even in getting the RIGHT help.
- People feeling they are being judged and not treated with respect or compassion.
- People cannot access care at all times.
- Quality of service is inconsistent and doesn’t reflect the needs of the local population.
- There are implications for safety, particularly in relation to treatment of self-harm.
In 2013/14 over one and half million people were in contact with NHS trusts providing specialist mental health services. An average of 1 in 4 patients of a full time GP requires treatment for a mental health condition. Nearly 3 million adults suffer with depression and 500,000 people on GP registers have a “serious mental illness”.
These are significant numbers and it is alarming that the survey revealed that almost a third of people did not know who to contract in a crisis.
The report identifies problems with MH teams struggling to provide an adequate home care function. Access to inpatient beds is becoming increasingly difficult.
Access to, and the quality of, services after 5pm is not good enough and the rate and frequency of attendance at A&E is likely to be a sign that local services are not working well together and people are not getting the specialist help they need.
In 2013/14 Section 136 of the Mental Health Act was used by the police over 24,000 times. In 2012/13 just under 13% of Section 136 detentions were for people who had already been detained under the same Act in the previous 90 days. The report states that this is a sign that people are not receiving support from local services after being discharged from hospital.
Feedback from people who came into contact with the police showed the service in a more positive light than many of the specialist mental health services.
The report speaks positively about street triage schemes (again using reduction in 136 detentions as the supposed evidence of success) but then reports that health based places of safety are still turning people away or forcing them to wait for long periods because they are already full or under resourced.
In short, services are simply not able to meet demand or the needs of people in crisis in their local area.
The findings of the report will come as no surprise to anyone working in any of the services mentioned within it. It should, however, be a source of shame and embarrassment for the nation as a whole.
There is nothing new in the report at all to an experienced front line member of these agencies. What is new is the fact that this is now being laid bare to the public. Not only in statistical and numerical terms but also in a language which pulls very few punches and finally states, loudly and clearly, what so many of us have been saying for so long.
This report is necessary and overdue. It is startling yet unsurprising. It describes a system which is creaking at the seams and which is utterly unfit for purpose. And whilst it is the system which is primarily at fault the report has a lot to say about the manner in which people in crisis are being treated by other people – and it simply isn’t good enough.
Much faith is being placed on the Crisis Care Concordat and it is this which is being promoted as the vehicle through which positive change will be affected.
There have been many reports recommending change in mental health service provision over the years. Many of the recommendations within those reports are yet to be fully acted upon. Only time will tell whether this report, and indeed the Concordat itself, are worth the paper they are printed on.
Right Here – Right Now presents a picture of a service which is almost completely broken and the people who most need help either don’t know where to get it or it simply doesn’t exist anyway.
Of the three overall recommendations the report makes, it is the first which sums up what needs to be done:
“Ensure that all ways into crisis care are focussed on providing accessible and available help, care and support for all those who require it at the time they need it.”
This doesn’t mean one agency passing the buck to another. It doesn’t mean any one agency charging off in their own direction. It doesn’t mean maintaining the status quo and hoping this all blows over and demand goes down. It doesn’t mean adopting the “Ostrich Strategy.
It means everyone working together, in a properly financed and resourced system which places the patient first. It means having an ability to respond rapidly which doesn’t rely almost entirely on the blue light services. It means that we need to understand demand and have better things in place to prevent crises arising in the first place. It means having adequate facilities to cope with crises when they do occur and proper management and support for people after the event.
This report can be summed up quite neatly thus
“The system is broken. It is time for a new one.”