‘Admirable goals but little on how we achieve them’: a social worker reviews the government’s mental health action plan

By The Masked AMHP

Working as I do within a mental health service whose budget restraints have required a 20% reduction in staffing levels and savings of £40 million, I started to get quite excited when I read the 25 point wish list in ‘Closing the Gap’, the government’s new mental health action plan.

The first one, for example, promises “high-quality mental health services with an emphasis on recovery”. These will, apparently, be commissioned “in all areas, reflecting local need”. Then there is the assurance that “poor quality services will be identified sooner and action taken to improve care and where necessary protect patients” and “carers will be better supported and more closely involved in decisions about mental health service provision.”

I was also encouraged by the statements relating to the integration of physical and mental health care, especially the promise that the way frontline services respond to self harm will be changed. And what isn’t there to like about the proposals to improve the quality of life of people with mental health problems? For example, the document states that “people with mental health problems will live healthier lives and longer lives”.

A lack of detail

On the face of it, it is very encouraging that the government has identified and promoted these 25 priorities for improving care for adults and children with mental health problems. But closer reading of this document does not reveal any significant detail about how these targets are to be met.

Indeed, the document appears to hope that much of the improvement to services will come simply from increasing the collection and scope of statistics.

For example, there will be a new Mental Health Intelligence Network (didn’t this government once express its distaste at quangos?) which will be tasked with obtaining “comprehensive information about mental health and wellbeing to provide a greater insight into mental health problems, how they vary with age and in different parts of the country, and what the most pressing needs are in each area. It will also gather information about the services being provided – and how effective they are.”

They will also be collecting data on waiting times. This data will then be published “so that everyone can see clearly the waiting times for different services and in different areas. This in itself should act as a catalyst for change.”

It seems the government is expecting a lot from its statistics. I know from my own professional experience that it is often very difficult to gather meaningful statistics relating to the quality of services. Too often, the information gathered is the information that is easiest to gather. This data does not necessarily reflect the quality of care and treatment experienced by service users.

There are other aspects of this document that concern me. One is the promise of new money being provided to develop “housing projects for people with mental health problems or learning disabilities”.

The government acknowledges that “having settled accommodation can be invaluable for people living with a long-term mental health problem. When people live in a place that helps them feel safe and secure, it can support recovery and reduce the likelihood of further episodes of mental illness.” This is all fine, but I am concerned that they are concentrating on specialist accommodation, rather than ensuring that people can live in their communities and be supported by them.

When current government policies such as the “spare bedroom tax” are having a disproportionate effect on people with disabilities, including people with mental health problems, it seems to me more appropriate to spend money on enabling people to stay in their own “settled accommodation” rather than forcing them to move away from their support networks.

Any signs of encouragement for AMHPs?

Is there anything encouraging in ‘Closing the Gap’ for Approved Mental Health Professionals and social workers? Is there anything likely to address the nationwide problems impacting on AMHP practice, such as bed shortages?

Right at the beginning of the report, the problem of “people of all ages being transferred sometimes hundreds of miles to access a bed” is acknowledged. However, there is nothing explicit in the report that suggests how this might be addressed.

One of the other priorities is that “No-one experiencing a mental health crisis should ever be turned away from services”. To address this, there are plans to introduce a national ‘crisis care concordat’. This is intended to “set out clearly what kind of support people in mental health crisis should receive, no matter where they are in the country or which public service they turn to – or which service those who care for them turn to”.

There is a particularly interesting paragraph here:

“When police take an individual to a “place of safety” under the Mental Health Act, the Concordat sets clear expectations as to how mental health services should respond. It also makes it clear that police custody should not be used as a place of safety and that emergency departments should be able to quickly get hold of a psychiatrist when a patient is or appears to be suffering from a mental health crisis. Wherever possible, the goal is through early intervention to avoid hospital admission for the mental health problem – and instead provide alternative care and support.”

AMHPs are, the report states, expected to have a “pivotal role…not only in arranging Mental Health Act assessments quickly, but also in ensuring that the least restrictive option is put in place and that the person’s rights are safeguarded.”

Unfortunately, the report does not explain how these admirable goals are to be achieved. Again, it seems as if there is a belief that setting up networks or concordats will in themselves lead to these necessary changes in practice and service provision.

Mental health service users, and mental health professionals, have long been forced to “mind the gap” lest they fall down it. While a promise to close that gap is encouraging, the government will have to do more than just place a rickety plank over it and hope that people won’t fall off.

Follow The Masked AMHP on Twitter and read his blog here.