Mental health services are in crisis, according to NHS leaders responsible for running them.
It’s an easy headline to make of the NHS Providers report if you want to go down that route. I’m not sure myself that’s entirely helpful or accurate, and I’ll explain why.
Before I do that, there’s no getting away from the fact that the survey feedback from NHS mental health chief executives certainly makes for worrying reading in places. Issues around increased demand, workforce shortages and stretched resources will be very familiar to everyone working across health and social care.
Issues around increased demand, workforce shortages and stretched resources will be very familiar to everyone working across health and social care.
Chief Executive
There are also a whole host of issues which affect the wellbeing of our local communities such as access to housing and supported accommodation, loneliness and isolation – this is particularly an issue when people become disconnected from their support as they have to move to get access to affordable accommodation. That, in turns, increases demand for specialist NHS mental health services and pressure on primary care and physical health services.
The complex, multi-faceted nature of these challenges shine a light on where we need to continue improving as a health and social care system in order to provide the very best care to the communities we serve. Talk of the need to align physical and mental health care more closely is not new. Nor is the need for better partnership working between the NHS, local authorities, the third sector and emergency services.
Talk of the need to align physical and mental health care more closely is not new. Nor is the need for better partnership working between the NHS, local authorities, the third sector and emergency services.
Chief Executive
We have achieved a lot in these areas and we now have an NHS long term plan which emphasises their importance. But we have more to do. The societal and system pressures we face - underlined by the survey - require bold, collective and concerted action.
This means we all need to put our shoulders to the wheel and get behind the NHS long term plan. Less competition and more collaboration is the (very welcome) order of the day. But it’s not enough for the NHS to simply talk to itself. We need to engage openly and honestly with all our partners, the people who use services and our staff.
But it’s not enough for the NHS to simply talk to itself. We need to engage openly and honestly with all our partners, the people who use services and our staff.
Chief Executive
The extremely tough financial climate our local authority partners are having to weather, for example, should be seen as a shared problem rather than something happening over there in another sector. Solutions such as more co-located services can potentially help us make better use of our resources, further improve partnership working and - most importantly - make the experience of health and social care feel less disjointed to those who need it.
We need to be co-producing creative solutions with our partners in housing. It is simply unacceptable that people who are medically fit to be discharged from a psychiatric ward end up stuck in hospital because there’s nowhere else for them to go. This is the same issue in the acute sector too. Relatedly, we need to be ambitious and open minded about how we work differently with partners across the third sector, rather than simply expecting them to fall into line with our plans.
We need to be ambitious and open minded about how we work differently with partners across the third sector, rather than simply expecting them to fall into line with our plans.
Chief Executive
Alongside all of this, we need to build upon the work we have done in the mental health sector to empower the voice of the people who use our services and their families. In doing so, we must recognise we have more to do to promote genuine equality for all in relation to the diverse needs of both the people who use our services and our staff.
Our thinking about the way we frame these challenges needs to change. For example, winter pressure within A&E is a very serious issue that needs attention. But we shouldn’t be using the number of people who walk through the door of A&E as the sole metric for assessing demand (whether during winter or at any other time). Healthcare doesn’t begin and end in hospital. There are equally pressing, though less visible, pressures within primary care and community services that require local and national attention.
Healthcare doesn’t begin and end in hospital. There are equally pressing, though less visible, pressures within primary care and community services that require local and national attention.
Chief Executive
None of this may sound like a particularly good reason to be cheerful or, indeed, mitigation for talk of a crisis in health and social care. However, what I would say to that is that the nature of the conversations we are having is changing. There is very real recognition that the mental health needs of our local communities is a shared concern rather than a niche interest for specialist services. The commitment to mental health in the long term plan demonstrates this.
There is very real recognition that the mental health needs of our local communities is a shared concern rather than a niche interest for specialist services.
Chief Executive
Public attitudes towards mental health have shifted in recent years, demonstrated by increased awareness and more discussion about stigma and discrimination. This is beginning to translate into real, meaningful action in terms of national policy, investment and service change. New partnerships are being formed to transform how care is provided in a way that perhaps - perhaps - may not have happened as readily within a system operating in times of plenty.
All of this provides grounds for optimism in my view. Talk about a crisis can become something of a self-fulfilling prophecy. Instead, I hope we can find ways to harness our resilience, creativity and shared passion for high quality care to find ways to surmount the challenges we face, rather than falling victim to them.
About the author
