Watchdog warns of big gaps in community mental health services

The Healthcare Commission has warned significant improvements in community mental health services are needed to meet best practice and national guidelines, in a report today.

The study of mental health trust performance in 2007-8, published the day before the watchdog merges into the Care Quality Commission, found significant gaps in provision despite improvements in community care since 2005-6.

While trusts are expected to ensure users have 24-hour-a-day access to support, just 54.7% of users had access to an out-of-hours contact in 2007-8, though this was an increase from 49.5% in 2005-6.

Four in ten do not receive copy of care plan

The commission found 59% of users received a copy of their care plan in 2007-8, a requirement under the 1999 national service framework for mental health, up from 52.9% in 2005-6.

Though National Institute for Health and Clinical Excellence guidance states all people with schizophrenia who experience ongoing psychotic symptoms should be offered psychological therapy, a review of 7,000 case notes found 45.2% of eligible patients received it in 2007-8, a similar figure to 2005-6.

And there was a fall from 81.9% to 80.3% in the proportion of people with schizophrenia whose care plans contained a directive of how they wanted to be treated in the event of an acute episode. Nice has recommended that this should be universal.

Users have more of a say in treatment

There were marginal improvements in the proportion of service users who said they had enough of a say in their care and treatment (from 63.5% to 64.2%) and in decisions about their medication (from 62.4% to 63.5%).

There was also a significant rise, from 64.3% to 77.2%, in the proportion of people with schizophrenia receiving an assessment of their work status, as recommended by Nice.

‘Truly shocking’

Commenting on the report, Mind chief executive Paul Farmer said “Considering that everyone is meant to have round-the-clock access to crisis care, it is truly shocking that nearly half of mental health service users don’t even have a contact number to call when they are in need. Crisis care is the A&E of mental health treatment – it’s like not knowing how to dial 999.”

He added: “Care plans should be given out automatically, and making sure this happens is one of the simplest improvements healthcare professionals can make. At a time when healthcare is moving towards greater patient choice and involvement, the most basic level of involvement still isn’t happening.”


The commission published the report alongside a study which found evidence of age discrimination in the provision of mental health services.

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