04 / 12 / 2018
Right treatment, right time
Rethink Mental Illness, November 2018
In the wake of the Government’s Prevention is better than cure vision and in anticipation of a renewed focus on access to mental health services in the forthcoming long-term plan, Rethink Mental Illness has produced a sober state-of-play analysis of mental health services. Following a survey of over 1,600 people of their experiences of care and treatment, the report reaches the conclusion that those most affected by mental illness are often waiting the longest for treatment and receive the worst care. In short, this report is a timely reminder of the gaping prevention and access gap in mental health services that still needs to be bridged to reach the promise of parity of esteem.
The report highlights that whilst public perception of mental illness has made significant strides over the past decade, access to treatment is struggling to keep up with demand leaving many people with mental health problems falling thought the gaps. People are waiting over three months for an assessment and over six months for treatment to begin.
The report suggests priortising funding for timely and “high-quality” mental health support, support which is close to home and immediately accessible. Key findings from the survey include:
- On average people are waiting for 14 weeks for an assessment, with one in ten waiting six months and one in twenty waiting a year or more
- On average people are waiting 19 weeks for treatment, with one in six waiting six months or more
- At least 20 people who partook in the survey had either attempted or thought about suicide due to the lack of services
- One in three people asked for a service that they were told was unavailable, over a quarter of people felt that they were not refereed to an appropriate service and nearly half of the respondents felt that they did not receive sufficient time with a secondary care practitioner
Rethink Mental Illness tie these findings together with a bleak picture of access to mental health services - lack of early intervention, missed outreach opportunities, restricted and time-limited support, delayed and unsatisfactory treatment and a lack of referral options in primary care.
For people with severe mental illness, these gaps have a significant impact on outcomes – delay in accessing services increases the likelihood of self-harm and failure of early, and crucially, continuity in intervention impairs prognosis and often makes treatment gains to date redundant. In addition, these gaps have a knock-on impact on wider services – the lack of community support in mental health services leads to delayed discharges in hospital discharges, the failure of early intervention can lead to inappropriate intervention from A&E or the Police. The result according to Rethink Mental Illness is one of the most shocking inequalities of our age, that those with a severe mental illness are more likely to die 15-20 years earlier than the general population.
Rethink Mental Illness considers the variation between services, stating that if it were to rate them, they would be good in areas and ‘requires drastic improvement’ in others. Whilst specialist services such as IAPT, EIP and perinatal care have received funding and resources, core services have not and it’s this patchy service provision and lack of continuity of service which is failing the system as a whole. There are significant gaps at key stages in mental health support and falling through one of these gaps can lead to lifelong implications of being hospitalised or detained. Rethink Mental Illness attribute this patchy system to the following failures:
- No clear pathways with waiting time standards
- Funding is restricted to specific services
- An insufficient workforce – HEE workforce strategy set out the need for 19,000 more mental health professionals
- Insufficient data to hold commissioners and providers to account
- Local commissioners do not involve people with lived experiences in their decisions
Having found mental health services to be insufficient and failing those who need it most, Rethink Mental Illness call for:
Whilst the above list is merited and addresses some of the issues raised in the report, the report should perhaps be seen as a call-to-arms and championing of mental health services during a once-in-a-generation opportunity to transform access for those who require it most through the long-term plan. The report is at its most forceful in its prescription of the failings in mental health services rather than cure and its findings argue themselves - which is no bad thing. The report has rightfully highlighted gaping gaps in mental health service provision and identified areas for piers to bridge the gap – but that bridge to parity of esteem with physical care is still not fully formed despite the waves of evidence, included in this report, of the cost to those who need it most. The right treatment at the right time cannot come soon enough.
- NHS England to develop clear pathways for people with severe mental illness. Setting out clear access standards and waiting times (two weeks for treatment for psychosis for example) and ensure that care is not time limited
- A concerted approach from the Department of Health and Social Care, NHS England and Heath Education England to develop a strategic workforce programme with measurable deliverables
- A funded cross-government mental health strategy to identify and fund improvements to public health and social care services
- NHS England to increase funding for mental health services by 5% over the next 5 years and 5.5% over the following five years
- All arms-length bodies, commissioners and providers to embed co-production principles in delivery of services with people with lived experience