Much room for improvement in community mental health services

The Care Quality Commission’s (CQC) 2013 survey of community mental health services has revealed some positive results, but also shows that the government’s principle of ‘no decision about me without me’ is still some way from being a reality.

As is usual with such things, the CQC’s annual survey of community mental health services – i.e. those provided outside of inpatient care – proved a mixed bag.

On the positive side, most people who use community mental health services seem to be relatively happy with the support they receive: 67% rated their overall experience as 7 out of 10 or better. But it has to be noted that this is a new question in the survey, so it can’t be seen if this is an improving situation or not.

But the survey also revealed that there is much that can be improved, especially in terms of personalising care. Of respondents on the Care Programme Approach (CPA) – the framework for people with complex mental health needs who require multi-agency support – 14% said they do not have an NHS care plan. Of the remainder, fewer than half (46%) ‘definitely’ understand their care plan, down from 48% in 2012.

Additionally, almost a third of all service users (32%) said their views were only taken into account ‘to some extent’ when deciding which medication to take and less than half (43%) of those who had been prescribed any new medication were ‘definitely’ told about possible side effects.

It demonstrates again that the government’s aim of ‘no decision about me without me’ as laid out in the 2011 mental health strategy ‘No health without mental health’ is still some way off becoming a reality. People with mental ill health are more likely to respond to treatment if they have played an active role in deciding what it will be. As far as possible, service users should be partners alongside professionals in making such decisions, but it clearly isn’t happening enough.

But it seems that the CQC is determined to tackle this inequality in the coming year: the regulator has said that one of its focuses will be mental health services, and the results of this survey will inform its inspectors’ work. This has to happen because, as the CQC’s chief executive, David Behan, said: “It is unacceptable that fewer people have adequate care planning than last year.”

He’s right. While there are many pressures on mental health service providers – funding cuts, staffing levels etc – care planning has to be got right more often. Personalising care is the goal of government policy and the regulator has to ensure that all providers are doing this.

The results of the 2014 survey will make interesting reading. If they reveal another fall in adequate care planning then the regulator – as well as the providers – will have some difficult questions to answer. The gauntlet has been thrown down.