community mental health professionals treat patients with "dignity
by Angela Hussain
psychologists and mental health nurses treat their patients who
use community services with "dignity and respect" more
than 80% of the time, according to an NHS watchdog survey.
Healthcare Commission questioned more than 19,000 patients from
94 NHS trusts. It was part of the commission’s first review
of England's adult community mental health services.
The review, released on Friday, praised services for “generally
performing well”. But it did find the NHS was failing to provide
adequate out-of-hours crisis care, “talking therapies”,
such as cognitive behavioural therapy and counselling, and information
to service users about their care.
survey found 77% of service users rated their care in adult community
mental health settings as "excellent", "very good"
or "good". But 9% rated their care as "poor"
or "very poor."
the survey found 81% of service users felt their psychiatrist had
treated them with respect and dignity (compared to 80% in 2005);
86% felt their community psychiatric nurse had treated them with
respect and dignity (compared to 85% in 2005);and 86% felt other
healthcare professionals (including social workers, occupational
therapists and psychologists) treated them with respect and dignity
(compared to 84% in 2005);
half (51%) of users did not have the telephone number of someone
from their local NHS mental health service who they could contact
out of office hours if in a crisis.
half (49%) of service users did not have a care review in the last
or psychological therapy had been received by 39% of patients. But
35% of those who had not received it said they would have liked
were concerned that only 50% of people diagnosed with schizophrenia
had access to talking therapies, such as cognitive behavioural therapy.
This is despite the National Institute for Health and Clinical Excellence
recommending in 2003 that all people diagnosed with schizophrenia
should be offered such therapies.
review found almost all (89%) services had not adequately recorded
how patients had responded to drugs on patient care records.
The review also evaluated the effectiveness of England’s 174
Local Implementation Teams (LITs) which are responsible for planning
local community mental health services in England. Representatives
of NHS trusts, local authorities, voluntary and independent sector
groups, service users and carers serve on LITs.
Inspectors reported that only 9% of LITs were “excellent”,
while 45% were “good”, 43% “fair” and 3%
number of physical health checks was not recorded on care plans
28% of LITs
Commenting on the patient survey results, Anna Walker, chief executive
of the Healthcare Commission, said they were "good news”.
Andrew McCulloch, chief executive of the Mental Health Foundation,
said the review showed adult community mental health services as
“shamefully inadequate”. He claimed patients are being
“denied a basic level of care”.
"There has been no improvement in the last couple of years
to community mental health services and the current round of [financial]
cuts are set to see these standards worsen," he said.
“The demand for talking therapies comes as no surprise; they
are effective. The government has a duty to provide a range of treatment
options available to people with mental health problems, Medication
is being relied upon because of a lack of alternatives."
Louis Appleby, the national director of mental health, told the
BBC there were about 1,700 more clinical psychologists, and nearly
1,000 more primary care therapists working in the NHS in recent
"But in a way these new therapies - cognitive therapy is the
main one - are a victim of their success.
"There's growing research evidence that they can be used for
a whole range of conditions, so of course the demand and the need
is much greater, and it's far outstripping what we can provide at
Paul Farmer, chief executive of Mind, said: "We're concerned
about the large number of people who don't have access to basic
treatments, like cognitive behavioural therapy, which is simply
not available in many areas of the country."
Sane's chief executive Marjorie Wallace said: "This report
shows that the community care policy still fails thousands of mentally
ill people and their families.
"It is disturbing that this strong indictment of out-of-hours
community care should come at the very time that mental health budgets
are being slashed."
director of public affairs Paul Corry said: "It is very encouraging
that most service users say NHS staff treat them with dignity and
respect in the community. However, this is only one part of the
access to support such as cognitive behavioural therapy for depression
is just as essential as receiving physiotherapy for a back injury.
Yet talking therapies are sometimes seen as 'soft option' by hard-pressed
staff looking for ways to cut back NHS expenditure."
Commission's review of NHS adult community mental health services
Commission's survey of patients/service users
12, 2006: £30m being cut from mental health services,
May 5: More
than 10 per cent of mental health trusts are cutting services, admits
Louis Appleby - Appleby responds to Tory criticisms that in-the-black
mental health trusts cut services to assist other financially-cripped
27, 2005: One quarter of mental health trusts performing to "highest
level" - but five mental health trusts gained no stars
in NHS watchdog assessment
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