October 2, 2006
by Angela Hussain

Psychiatrists, 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.

The 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.

The 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."

Specifically, 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);

However, 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.

Plus, half (49%) of service users did not have a care review in the last 12 months.

Counselling or psychological therapy had been received by 39% of patients. But 35% of those who had not received it said they would have liked to.

Inspectors 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.

The 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% “weak”.

The number of physical health checks was not recorded on care plans in 28% of LITs

Commenting on the patient survey results, Anna Walker, chief executive of the Healthcare Commission, said they were "good news”.

But 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."

Professor 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 years.

"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 the moment."

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."

Rethink's 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 picture.

"Getting 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."

Healthcare Commission's review of NHS adult community mental health services
Healthcare Commission's survey of patients/service users

See also:
May 12, 2006: £30m being cut from mental health services, claims report
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 trusts
July 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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