Mental health services need reform and investment across the board

The shortage of acute inpatient mental health beds has been a recurring theme in the sector for some years now, and a recent report has highlighted how this is being exacerbated by a lack of other services. It reinforces again the need for widespread reform of – and greater investment in – mental health services.

The interim report from the Lord Nigel Crisp-chaired Independent Commission, set up by the Royal College of Psychiatrists to investigate concerns about a shortage of acute adult psychiatric beds, found that this is largely caused by problems with discharges or alternatives to admission.

The Commission argues that the problem is not just to do with numbers of beds or admission processes but that many patients being treated on acute wards could be treated in other settings if only they were available. Common alternative services required are crisis houses, rehabilitation services and services for patients with a personality disorder.

Additionally, about 16% of patients are clinically well enough to be discharged from inpatient care, but cannot be because of other factors – in nearly half of cases this is a lack of suitable housing, ranging from local authority housing to supported accommodation.

For me, this shows that the effects of cuts in mental health services in recent years – aggravating the historic underinvestment in the sector – are now starting to show and are having an adverse impact across the sector. 

Although I think cuts to inpatient beds in recent years cannot help either. For example, NHS figures show that there has been a 5.9% cut in mental health beds in Greater Manchester’s three mental health trusts in the past five years, yet the number of people admitted has increased by 23% in that time.

But Lord Crisp’s report did, rightly, highlight that change is required in the whole service. This is not the first time that this sort of call has been made. Sadly, I suspect it won’t be the last.

I suspect that most people in the sector will have roughly the same ideas about how to improve service provision. Greater investment will be at, or near, the top of the list, along with better integration with other services, such as housing, and a more holistic and personalised approach. 

The Commission’s final report will come in due course with its recommendations – doubtless containing the above and more – which will probably be positively received by the government, along with statements about how change must happen. But whether it does, or if this just becomes another report full of good ideas that sits on a shelf remains to be seen. But I have my suspicions.

In the meantime, staff who work in inpatient services, who were praised by Lord Crisp for their skills and determination, will continue to do their best, sometimes in spite of the system. And some people who urgently need care will continue to not get what they need, when they need it because of the system.