Budget cuts have worsened quality of mental healthcare, think tank warns

BMJ 2015; 351 doi: (Published 12 November 2015) Cite this as: BMJ 2015;351:h6121
  1. Gareth Iacobucci
  1. 1The BMJ

Changes to mental health services in England driven by budget cuts are negatively affecting the care of patients, a report from a leading think tank has warned.

In a briefing published on 12 November the King’s Fund said that the sector was under huge strain, with around 40% of mental health trusts having had their income cut in 2013-14 and 2014-15.1 In contrast, more than 85% of trusts in the acute care sector saw their income rise over the same period.

The briefing said that the cuts had prompted many trusts to embark on large scale transformation programmes aimed at shifting demand away from acute care services towards recovery based care and self management. But it warned that there was little evidence for the changes being made and that evaluation of the effect they were having on services was lacking.

The briefing said that there was “widespread evidence of poor-quality care” as result of the changes. As one example of poor service delivery it cited the merger of specialist crisis resolution home treatment teams and early access to psychosis services into generic community health teams. “These teams are often unable to provide the level of support required by patients, reducing quality of care and increasing pressure on inpatient beds,” it said.

Evidence of the strain on mental health services was highlighted by the fact that only 14% of patients said that they had received appropriate care in a crisis, it said. In addition, it cited a 23% increase in the number of placements of inpatients outside their own area in the year to 2014-15 and an increase in bed occupancy rates that are routinely exceeding recommended levels.

The briefing said that many trusts were considering further large scale changes as a result of their worsening financial situations, which it warned could further destabilise services and reduce the quality of care. It called on the sector to focus on using evidence to improve practice and reduce variations in care but said that this would work only if it were underpinned by stable funding from the government.

Helen Gilburt, mental health policy fellow at the King’s Fund and the report’s author, said, “Mental health trusts now need the security of stable funding, supported by a national focus on evaluating the changes to date, improving practice, and reducing variations in care.”

Stephen Dalton, chief executive of the NHS Confederation’s mental health network, said that the report showed the urgent need for new funding for mental health services. “It [the briefing] exposes the institutional bias that exists in the NHS and local authorities when it comes to funding for mental health,” he said. “Many commissioners of NHS services don’t have the capacity to do the right thing and fund what works. If this government is serious about prioritising mental health, they need to ensure new funding gets directly to providers of care and not channelled through layers of bureaucracy where it is lost.”

The president of the Royal College of Psychiatrists, Simon Wessely, also echoed the report’s sentiments. “As a profession we are dedicated to providing and delivering excellent care for our patients. We can only do this if provided with the necessary supportive framework within which to work,” said Wessely. “We hope that the forthcoming spending review reflects this.”


Cite this as: BMJ 2015;351:h6121

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