Improving In Patient Mental Health Services
The Healthcare Commission review of acute inpatient care, Pathway to Recovery, marks a milestone in the ongoing effort to achieve a step change in the quality of inpatient mental health services.
Of the 554 wards surveyed, 37 per cent were rated excellent or good, showing that the increased attention and government spending over the last 10 years has paid dividends. The 23 per cent that were rated weak reminds us all just how far there is to go to achieve improvements across the board.
There are clearly some areas for improvement that are non-negotiable. Staff and service users’ right to a safe, therapeutic environment needs to be achieved in every ward, not just a majority. But, in a broader sense, what marks the difference between a high-performing ward and a struggling one?
Increased investment is just one part of the story. While more investment creates more opportunity, it is the staff attitude and approach to care that drives meaningful improvement and innovation.
The commission concluded that the higher-performing trusts were those that actively involved inpatients in their care, provided engaging activities in a therapeutic environment, and planned care around the needs of the service users. Despite guidelines to include service users’ views in care plans, this is currently only occurring in half of cases.
To drive improvement, acute inpatient care needs to be an essential part of the move towards a more integrated way of thinking about mental health.
We have recently had the Future Vision coalition, led by the NHS Confederation, reinforcing the need for a more integrated, inclusive model of care. While it is sometimes easier to see this model working in the context of community-based support and services, inpatient services will always be a core element of specialist health services, caring for people at their most vulnerable.
Inpatient service users also have the right to expect the things that we know contribute to mental well-being and a full life, such as good physical healthcare, access to fresh air and exercise, and family and social contacts. We also know that better co-ordination is needed across hospital and community services.
There are numerous examples of how involving service users in their care has produced measurable improvements.
A project run by Greater Manchester Mental Health foundation trust achieved significant reductions in service users going missing from wards. It targeted the peak times that service users were going missing through increased activity and engagement. “Plan your day” meetings were held with service users at the start of each day to involve patients in setting out the activities and groups they would participate in. The evidence is that involvement works.
The National Institute for Mental Health in England produced an electronic handbook to accompany the Healthcare Commission’s review of acute inpatient care. Onwards and Upwards aims to help local services build on the review to sustain improvements in acute care. It includes information and links to the key policies that provided the standards for acute care and suggests action points for improving services. It also provides pointers on good practice and information about sustaining improvements in acute mental health.
Over the next period, and through the results of the autumn assessment process, the acute care programme will continue to work with the Healthcare Commission to build on the report findings and engage with local commissioners and service providers, supporting better service user outcomes for all.