Seven areas across England are set to pilot digital services for mental health patients, which will include innovative apps to improve care and online access to real-time patient records.
NHS England has announced new funding for seven mental health trusts to enable these organisations to pioneer world-class, digital services to improve care for patients experiencing mental health issues.
This will include, for the first time, all key professionals involved in a patient’s care having access to real-time records – from triage and initial assessment, through to admissions or referrals, as well as transfer between services and follow up care.
The trusts will also develop remote, mobile and assistive technologies to empower patients to manage their conditions and enable family and carers to provide the best possible support.
The trusts will have up to £70 million to invest in digital services – consisting £35 million with additional match funding from themselves of £35 million – in order to become ‘Global Digital Exemplars for Mental Health’.
This is intended to ensure that the organisations become world-leading in the use of IT, providing knowledge and expertise to the wider NHS in order to reduce time and costs for others.
This is all part of the NHS’ plan to harness technology to improve services and become more efficient.
With this in mind, Mersey Care NHS Foundation Trust is developing an app, with Stanford University, to anticipate and respond to serious self-harm and suicide risks.
A prototype has been developed and researchers are preparing a feasibility study to explore the usability of the technology and how the digital platform performs against treatment as usual.
Meanwhile, Worcestershire Health and Care NHS Trust has moved from multiple patient record systems to one system across the organisation.
Mobile access to the patient record system will be rolled out to enable staff in the community to access and update a patient’s records.
They will also be improving their overall digital infrastructure, including improving wifi access across its estate, and will be developing mobile apps to improve services for patients and carers.
And Northumberland, Tyne and Wear NHS Foundation Trust is looking to deliver digital patient services including online consultations and enabling patients to access their records, complete assessments and provide feedback on-line.
The Trust’s digital offering will complement traditional face to face services.
Finally, Oxford Health NHS Foundation Trust will be working in partnership with the University of Oxford to develop an online platform for people experiencing a range of conditions (including post-traumatic stress disorder, depression and anxiety) to receive tried-and-tested psychological therapies on their computer or mobile phone.
Professor Keith McNeil, NHS Chief Clinical Information Officer, believes that the initiative will have a massively positive impact on the NHS.
“As clinicians, we must embrace technology to help us deliver the best care to our service users, just as it helps us in so many other areas of our lives. Digital technology has the potential to transform people’s experience of mental health services and challenge the unacceptable boundaries between physical and mental health. I am excited by this investment across a wide range of services and technologies and the opportunity it presents to provide both improved experience and outcomes for service users across the country.”
A survey of psychiatrists has suggested that NHS services are failing the soaring numbers of children who have had a breakdown, self-harmed or attempted to commit suicide.
72% of consultant psychiatrists who specialise in treating children and adolescents say that NHS care for under-18s experiencing a crisis in their mental health is either inadequate (58%) or very inadequate (14%).
And only 9% of those who responded concluded that these services are currently good.
253 of the UK’s 750 consultant psychiatrists working in Child and Adolescent Mental Health Services (CAMHS) took part in the survey.
And the the results paint a worrying picture of how NHS services are falling behind the requirements of children and young people with serious psychological and psychiatric conditions.
Peter Hindley, the chair of the Royal College of Psychiatrists’ faculty of child and adolescent psychiatry, which undertook the research, suggested that the findings of the survey should be of serious concern.
“These are worrying findings. They are from very experienced clinicians who look after the most troubled young people in the country, children and young people who are having mental health crises and who are in a desperate way. They tell us that NHS care for children and young people in mental health crisis is very patchy. These young people feel very upset, very distressed, they may have self-harmed, they have very negative self-thoughts, possibly including suicidal intent, and they feel hopeless and that they can’t go on. Some may recently have tried to take their own lives”.
It is clear from recent evidence that pressure on mental health services for children in the NHS system is increasing significantly, with figures from NHS Digital concluding that the number of under-18s attending A&E in England due to a mental health crisis has risen by more than half in the past five years.
Bed-blocking is also an obvious problem in this area, with services for children having been significantly hampered by lack of inpatient beds.
Luciana Berger MP, a member of the Commons health select committee and ex-shadow minister for mental health, indicated her belief that the figures are indicative of a huge malaise in this aspect of the healthcare system.
“This feedback from clinicians working at the frontline exposes the depths of the crisis facing child and adolescent mental health services in England. Where else in the NHS do 72% of our doctors tell us that the services being provided are inadequate or very inadequate? This worsening situation is totally unacceptable and compromises the recovery and future life chances of some of the most vulnerable young people in our country”.
Spending on early intervention schemes among councils fell from £3.2bn a year in 2010-11 to just £1.4bn in 2014-15, while even Jeremy Hunt has acknowledged that mental health services for children are the greatest area of weakness in the NHS.
Face-down physical restraint is still being used in mental health wards in England, despite the government and NHS indicating that the practice should be frowned upon.
The usage of the practice is considered particularly dangerous as it can restrict the breathing of a patient.
Yet despite new guidelines indicating that face-down restraint should be phased out, the incidence of it occurring in the mental health system dropped only slightly over the last two years.
In 2013-14, 22.4% of recorded incidents of restraints were face-down, falling to 18.5% by 2015-16.
Nonetheless, despite the fact that the NHS has requested this form of restraint to be significantly reduced, some trainers of healthcare staff believe that it can be the only appropriate way of ensuring that both staff and patients are kept safe.
The total number of recorded restraints rose by 16.6% from 2013-14 to 2015-16, indicating the dangers that staff face in the mental healthcare system, although it is believed that improved reporting could also contribute to this discrepancy.
Figures were collated following a Freedom of Information request by Norman Lamb, the Liberal Democrat MP for North Norfolk and former Health Minster, who introduced the new guidance in April 2014.
Naturally Lamb will be disappointed with the fact that face-down restraint seemingly remains a central part of the medical healthcare system.
And the MP commented on the issue, suggesting that there is considerable room for improvement.
“I find it immensely distressing, to be honest with you, because I know the impact that it has on individuals. We have an obligation to those individuals to do better than this.”
NHS England’s national clinical director for mental health, Prof Tim Kendall, however suggested that there has been some improvement, even if the rate of change has not been as rapid as might have been hoped.
“We are going in the right direction, but there’s a lot of other things that we need to do. When you go to an inpatient unit, you are commonly being restricted. And that’s bound to produce a reaction in people, and it’s important for all of us to make sure that doesn’t end in restraint.”
Kendall also suggested that trying to stop the practice sent an important signal about “humanising and ethicising and professionalising” mental health services in England.
“For those trusts not changing things in a positive way, or worse [where] still things are not improving, they really need to take note of this. These are real human rights and ethical issues that they should be thinking about.”
A new fast-track scheme will attempt to ensure that more graduates enter social work in community mental health teams.
The Department of Health is backing this new initiative, with £10 million to be invested in the social work-focused scheme.
However, it must be noted that £10 million is not a huge amount of money in health terms, and there must be question marks regarding how successful it will be in attracting graduates.
And the number of graduates actually being targeted by the initiative could be considered pretty paltry.
The scheme run by charity Think Ahead aims to recruit 300 graduates by 2018 to work with nurses and psychiatrists.
Each graduate entering the scheme will be subjected to specialist training on supporting individuals and families with mental health problems.
And the good news for graduates entering the scheme is that they will be paid throughout the training course, and will qualify as social workers a year earlier than would be normal.
The scheme has already attracted 2,300 applicants, with 100 places to begin working in July. Funding will provide 200 further places by 2018.
Sarah Carr, who chairs the National Service User Network, indicated that the FastTrack program will have a significant influence on social work in the United Kingdom.
“Support from a social worker with the right skills and expertise can be transformational for people living with mental health problems. The programme gives graduates the skills to empower the individuals they work with – so that they can manage their mental health, stand up for their rights, and find their own paths towards personal recovery.”
The social worker profession has particularly struggled in recent years, with many vacancies not being filled satisfactorily, and continual caps in local government funding.
Social workers also face massive pressure from heavy workloads, and it is hoped that this fast-track scheme can ease the burden on the existing quotient of professionals.
Mental health minister Alistair Burt opined that social work is an extremely demanding and important profession, and hence hoped that the fast-track scheme would enable more people across the country to lead independent and fulfilling lives.
“This is a great initiative to attract the brightest and best into the profession,” Burt commented.
Each year in the Health and Social Care sector around 5% of workers suffer from an illness they believe to be work-related, while 2% of workers sustain a work-related injury.
A major health commission has concluded that the practice of transporting mentally ill adults across long distances should be terminated immediately.
The Independent Commission, chaired by ex-NHS chief executive Lord Crisp, concluded that some cases were potentially dangerous.
It is not unknown for patients to travel as far as 50km in order to access care, and this occurs on a regular basis for routine appointments.
The reasoning behind this issue is a lack of acute beds in patient services are available in some geographic regions.
Based on recent reports, it is obvious that bed blocking is contributing to this phenomenon.
The report, which is backed by the Royal College of Psychiatrists (RCP), recommends changes to how services are commissioned.
With this in mind, the Independent Commission dictates that no acutely ill patient should have to travel significant distances to receive care, and that this should be implemented by October 2017.
At the same time, a maximum four-hour wait for acute psychiatric care – in hospital or the community after an initial assessment – should be introduced.
The aim being to guarantee that patients with mental health problems are treated equally to those with physical problems.
Commenting on the issue, President of the RCP, Prof Sir Simon Wessely, reflected that the current situation is simply unacceptable, and suggested that there was an overwhelming consensus on the issue.
“Everyone agrees that it is a scandal that patients with serious mental disorders who need admission can end up being sent anywhere from Cornwall to Cumbria in a search for a bed. And yet it continues. The answers lie not in just providing more beds, although there are definitely places where that might help in the short term, but assessing the entire system.”
The report was led by former chief executive of NHS England Lord Nigel Crisp.
It concluded that access to acute care for severely ill adults mental health patience was inadequate all over England, and that the lack of service in some parts of the country was nothing short of dangerous.
Finding beds for patience in need is becoming increasingly challenging, and this is clearly the major area of concern for the health service.
Minister for Mental Health, Alistair Burt, was of the opinion that the reports could play a significant role in shaping the evolution of mental health facilities in the NHS going forward.
“NHS England will soon be publishing its independent Mental Health Taskforce report, backed by the £1bn investment announced by the prime minister earlier this year,” Burt reaffirmed.
It is expected that by the end of the decade, over 2 million people in England will utilise mental-health services in the NHS on an annual basis.
Prime Minister David Cameron has conceded that the nation must focus more strongly on mental health, after a review indicated that the care afforded the mentally ill in the UK is often inadequate and underfunded.
Indeed, the report indicated that the depletion of mental health care in the UK is leading to “thousands of tragic and unnecessary deaths”.
The report emanated from a taskforce that was set up by NHS England, and discovered much hugely damning information that reflects disastrously on the current provisions for mental health difficulties in UK.
In particular, it concluded that 75% of people with mental health problems received absolutely no help whatsoever.
The fallout from this research is that the government has conceded far more needs to be done to assist mentally ill people, and has committed a further £1 billion in funding annually by 2020.
It is hoped that this extra expenditure will make it possible to treat around 4 million further patients by the end of the decade.
But the funds are to come out of the £8.4bn the government has promised to the health service during this Parliament.
Cameron commented on the subject thus: “We should be frank. We have not done enough to end the stigma of mental health. We have focused a lot on physical health and we haven’t as a country focused enough on mental health.”
But Royal College of Psychiatrists president Prof Sir Simon Wessely warned it would take “sustained work” to end the “decades of inequality”.
The investment will reportedly enable 600,000 people to gain access to talking therapies for conditions such as anxiety, depression and stress.
Other processes and programs have also been put in place, including support for severe mental health problems, teams being placed in all A&E units, and additional support for pregnant women and new mothers.
Community crisis care teams will also be rolled out nationwide, as the report found that only 50% of the country currently has access to this critical resource.
Paul Farmer, the chief executive of the mental health charity Mind, was optimistic about the findings of the report, although it must be noted that he has something of a vested interest having led the taskforce!
Farmer said the strategy should act as a “landmark moment” for mental health care, which was currently “very patchy”.
“We are saying to the NHS, to government, to industry, to local leaders and to the public that mental health must be a priority for everyone,” Farmer asserted.
Similar initiatives have been made by governments in Scotland and Wales, as it becomes increasingly clear that there is something of a mental health epidemic in the United Kingdom.
According to the Mental Health Foundation, every year in the UK 70 million workdays are lost due to mental illness, including anxiety, depression and stress related conditions.
And depression is a growing problem, with up to 10 times more people suffering from the condition now that in 1945.
An esteemed report has found that hundreds of lives are being needlessly lost to suicide owing to government failures in addressing mental health difficulties.
The Mental Health Taskforce, set up a year ago under the leadership of Paul Farmer, Chief Executive of mental health charity Mind, blames chronic underinvestment and poor NHS management for the problems.
Following an official NHS review, it is expected that David Cameron will be recommended to invest a further £1 billion in addressing mental health issues in the NHS.
The think tank which produced the report has cited the attitude of the Prime Minister as being particularly obstructive to the issue being dealt with efficiently and effectively.
In this context, the Mental Health Taskforce calls on the Prime Minister to meet the “clear need for leadership” to introduce vital reforms, and calls for all new Government policies to be assessed for their impact on depression and anxiety.
Figures relating to mental health clearly indicate that the issue has not been satisfactorily addressed and mitigated against in recent years.
In particular, it is known that mental illness is the largest single cause of disability, accounting for 23% of NHS activity, yet this only attracts only 6% of research spending.
The scope of mental health problems in the UK is extremely worrying, and this is perhaps underlined most succinctly by the fact that 25% of adults suffer at least one diagnosable mental-health problem annually.
Suicides continue to rise, and it has already been documented that this is a particularly huge problem for young men.
In fact, suicide is the largest cause of death for men aged between 15 and 49, with the total number of suicides averaging nearly 4,500 yearly in the UK.
One in ten children have a ‘diagnosable mental health problem’, half of all adult syndromes are already established by the age of 14, and one in five women fall ill psychologically in the first year after giving birth.
Yet research indicates that the NHS is continually fails to serve the needs of these people, and significantly increased expenditure in this area is definitely required, at least according to the task force.
“Suicide is not inevitable, and we need action to ensure that suicide is never the result of the NHS not meeting someone’s needs,” the report concludes.
The Taskforce says that by 2020 there should be 70,000 more children and young people able to access to mental health care, and calls for £150 million to be spent on tackling eating disorders such as anorexia and bulimia.
With a £1 billion programme of spending recommended by the organisation, a central pillar of the new government approach should be £280 million of extra expenditure on anxiety and depression.
Mental health assessments with people coming into contact with the criminal justice system should also be routine.
Figures from the NHS’ health and social care information centre indicate that the number of specialist mental health nurses in the UK has plummeted by more than 10% in just five years.
This recession of mental health staff is particularly serious considering the fact that it has occurred mainly in hospitals and mental health units treating some of the sickest patients.
And this fact has been confirmed by official NHS data.
The number of qualified nurses working in psychiatry slid from 41,320 in 2010 to 36,870 in 2015.
Luciana Berger, Labour’s shadow minister for mental health, expressed concern about the figures and the treatment of mental health in the NHS.
“These shocking figures raise serious concerns about the future of our mental health services. At a time when there is growing demand and staff are being asked to do more for less, cuts to the number of nurses working in mental health are completely unacceptable.”
And diminishing number of qualified mental health employees comes at the worst possible time.
Official figures indicate that the number of people in contact with NHS mental health services increased by more than 40% over the same period.
It seems certain that the economic climate in the UK is massively contributing to this, and thus critics of the Conservative government are provided with a double-pronged weapon to attack it.
At a time when the funding of the NHS is clearly a major issue, there must now be a question mark over the ability of the NHS to meet mental health demands in both the present and future.
Needless to say, the Royal College of Nursing expressed extreme concern about the situation.
“There are serious questions about how mental health services can be delivered when the number of mental health nurses is still declining,” said Howard Catton, head of policy at the Royal College of Nursing. “These nurses are the quiet heroes of mental health services, helping people in crisis and keeping people as well as possible.”
It is not only in mental health where staffing issues are apparent. Recent data has indicated that doctors are rapidly dropping out of the NHS, while shortages of nurses have also been reported in recent weeks.
The arguments over junior doctors’ contracts and nurses’ bursaries are expected to create further fallout as well.
Nurses’ bursaries are being abolished as part of the Department of Health’s (DH) plan to boost NHS England’s budget by £8bn by 2020-21.
Increasingly, it looks as if the government will have to rethink many of its existing policies, or face the consequences.
New figures acquired by the Scottish Liberal Democrats suggests that thousands of patients are being obliged to seek mental health treatment outside of their specific board areas.
Almost 1,500 adults were sent to another area in 2014-15 as an outpatient or day patient.
The data has been acquired and released following a Freedom of Information request, with the Lib Dems suggesting that there is something of a struggle to cope with mental health demand in Scotland.
Responding to the accusations of the Liberal Democrats, the government in Scotland stated that mental health is an absolute priority.
In addition to the number of adults who are being refused appropriate treatment in the region, figures also indicated that minors were being treated further afield than is ideal as well.
The figures suggested that more than 150 children under 18 were also sent outside their area last year.
Commenting on the data that was acquired by the Liberal Democrats, Jim Hume, health spokesman for the Scottish Liberal Democrats, commented that there are clearly major problems for mental health services in Scotland.
“Whilst there are sometimes good reasons behind why a patient is sent out of their health board for treatment, it’s clear that mental health units across the country are struggling to cope with demand on their services. It is welcome to see that the number of under 18-year-olds receiving mental health treatment as inpatients outside their health board of residence dropped last year. But there are still far too many young people having to travel away from home for treatment.”
Yet the Scottish government responded to these accusations by pointing out that it had significantly invested in the NHS system in this area.
Mental Health Minister Jamie Hepburn outlined some of the financial provisions made by the Scottish government towards mental health.
“Last month’s budget included an extra £50m for mental health over the next five years – increasing the mental health fund from £100m to £150m to extend capacity, improve access to services and promote innovation and new ways of treating people.”
Hepburn was also of the opinion that the rising demand for mental health services must be taken into consideration when assessing the data collated by the Liberal Democrats.
“Demand for services is increasing significantly. The number of people seen by child and adolescent mental health services has risen by 27% in the last year – more than 900 extra patients in the quarter ending September 2015.”
Hepburn also defended the decision-making process that leads to people being treated for mental health issues outside of the immediate region.
“On occasion people will be treated outside their board areas. Care and support is provided in the most appropriate environment, regardless of board boundaries. In some cases it can be appropriate for a patient to travel outside their health board area where specialist or urgent care is required. Such circumstances are kept to a minimum and always dictated by clinical need and benefit to the patient.”