Date Published: 11 September 2008

Survey indicates improvements in community mental health services

A Healthcare Commission survey of people using community mental health services in England has just been published and indicates continued improvements in care.

A larger percentage of service users say that they have confidence in mental health professionals, receive copies of their care plan and have a number to contact out-of-hours when in a crisis situation than in the past. Overall, most respondents continued to rate their care highly.

• 78% described their care as "excellent", "very good" or "good".
• 13% described their care as "fair".
• 9% described their care as "poor" or "very poor".

These figures are consistent with previous surveys. However, the survey also indicates that improvements need to be made before before community mental health services are fully accessible to everyone who needs them and they include all service users in decisions about their care.

More about the survey and data gathered

The Healthcare Commission coordinates an annual survey of service users in NHS trusts providing community mental health services in England. In 2008, these included mental health trusts, as well as foundation trusts and primary care trusts providing community mental health services, and more than 14,000 people responded. The survey invited feedback from people who were receiving care under the Care Programme Approach (CPA), which was established in 1991 for those who regularly access mental health services. The CPA sets out guidelines for how care should be coordinated and how service users should be involved in decisions. Under the CPA, all service users should know who their care coordinator is and should receive a copy of a care plan, which they should have been involved in developing and agreeing. They should also have regular care reviews to discuss their care and treatment with health professionals.

In 2008, 74% of respondents say they know who their care coordinator is, up from 67% in 2004. Over the same period, the proportion of service users who say they received a copy of their care plan increased from 49% to 59%. The proportion reporting not having had a care review in the last year has fallen from 51% in 2004 to 45% in 2008. The results of the survey also suggest that more attention needs to be paid to involving people in their care. In 2008, almost a quarter (24%) of people say they were not involved in deciding what was in their care plan, suggesting no significant improvement over previous years. Furthermore, 16% of service users say their diagnosis was not discussed with them.

The survey results indicate the need for improvement in access to counselling services such as talking therapies. Of the 62% of service users who did not receive any counselling almost a third of those (32%) would have liked to. There was continued improvement in the number of people who say they have the number of someone from their local NHS mental health service to call out-of-hours, up from 49% in 2004 to 55% in 2008. However, this still leaves 45% of service users without access to a crisis number to call out-of-hours.

A greater share of service users report that they are definitely involved in decisions about their medication, up from 40% in 2004 to 44% in 2008. But almost a third (32%) of those who had been given new prescriptions over the previous year say that they were not told about possible side effects - although this has fallen from 35% in 2004.

The survey also showed continued improvement in service users’ relationships with healthcare professionals. A greater proportion report that they have confidence in their psychiatrist, up from 59% in 2004 to 63% in 2008, and that their psychiatrist “definitely” listens carefully, from 68% in 2004 to 72% this year. Likewise, 75% report that they “definitely” had trust and confidence in their community psychiatric nurses (CPNs), up from 73% in 2004.

What will change

Since the survey, the Care Programme Approach has been revised by the Department of Health. As of October, a new system will be introduced in which only those people who are considered to have "more complex mental health needs" will be part of the programme. While many of those currently on standard CPA will no longer be part of this formal approach, an assessment of their needs, the development of a care plan and a review of that care by a professional involved, will continue to be good practice for all.

Commenting on the survey results, Anna Walker, chief executive of the Healthcare Commission, said:

“The survey shows steady improvement in how service users rate key aspects of their care. This is good news for trusts and good news for the people who access community mental health services. But more must be done to improve access to care, in particular to talking therapies and out-of-hours crisis care, and to involve people in decisions about their treatment.”

Speaking about the changes to the Care Programme Approach, she said:

“People may need to access a range of community mental health services from a number of healthcare professionals, so it’s critical that the care is coordinated and accessible. We also know that treatment is more effective when people are involved in their care and are supported to make decisions about their treatment.

While the improvements are to be commended, the survey shows that there remains a significant number of service users who say that their care is not coordinated and that they aren’t involved in decisions about their treatment.

When the new system comes into effect, trusts should ensure that the principles of the CPA should continue to apply to every service user and that the improvements made over the last few years are sustained and built upon. Service users’ care should be co-ordinated by one person, they should be involved in decisions about their care and they should have access to a range of therapies and services.”

The Healthcare Commission welcomed the government’s announcement last year of an extra £170 million to improve access to talking therapies for people with a wide range of mental health problems. It has stated that it will use the survey results to assess mental health trusts in the 2007/2008 annual health check performance rating. In 2008/2009, the annual health check will use a broader set of indicators to assess the performance of mental health trusts, looking at many of the issues identified in this survey. The indicators include a focus on coordinated care in mental health, access to crisis resolution services, mental health data quality, and will continue to incorporate the views of service users.

The survey was co-ordinated on behalf of the Commission by the National Centre for Social Research (NatCen).

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