CQC calls for improvements in community mental health care

Too many people who use community mental health services are not being involved in decisions about their own care.
A major national  survey of more than 13,000 people who use community mental health services in England published today (17 September) by the Care Quality Commission (CQC) shows the care people receive in the community needs to improve. Of particular concern is people’s lack of involvement in their care plans and having their views taken into account when deciding which medication to take.

The 2013 survey of people who use community mental health services asks about the experiences of more than 13,000 people during the past 12 months. The survey involved 58 trusts in England who provide mental health services.

People were asked about the care and support they received from mental health services outside hospital, such as those offered by outpatient clinics, local teams providing crisis home treatment, assertive outreach, early intervention for psychosis, and generic community mental health services.

Care for people who have complex mental health needs and require multi-agency support is coordinated within a framework called the Care Programme Approach (CPA). Policy guidance states that people who are on CPA should also receive support with day-to-day matters such as employment, housing and financial advice. The survey includes people who received care under CPA as well as those who do not.

The survey results show that that some respondents said that they do not have a care plan, and many of those that do have one, do not fully understand it, this suggests that people are not being adequately involved in the decision that are made about their care. Responses suggest that some care plans do not explain what people should do if they have a crisis and too few people have had a care review meeting in the last twelve months to discuss their care:

• Fourteen per cent of respondents on CPA said they do not have an NHS care plan. Of the remainder, fewer than half (46%) ‘definitely’ understand their care plan (down from 48% in 2012).
• When asked if their care plan covered what they should do in a crisis 58% of respondents on CPA responded ‘yes definitely’ though this is down from 60% in 2012. Less than half of those not on CPA (49%) responded ‘yes definitely’. Some respondents say they have not had a care review in the last 12 months to discuss their care:
• Almost half (47%) of respondents not on CPA said they had not had a care review in the last 12 months.
• The proportion of people on CPA who said they have not had a care review meeting in the last 12 months has increased from 24% in 2012 to 26% this year.
• Although the majority of respondents know who their care coordinator is and were generally positive about them, results had declined from 2012:
• Seventy two per cent said they could ‘always’ contact their care coordinator (or lead professional) if they had a problem, down from 74% in 2012.
• Sixty per cent said their care coordinator (or lead professional) organised the care and services they need ‘very well’ down from 61% in 2012.

The survey also shows that some people are not being adequately involved in decisions about their medication, with almost a third (32%) saying their views were only taken into account ‘to some extent’ when deciding which medication to take and less than half (43%) of those who had been prescribed any new medication were ‘definitely’ told about possible side effects.

However in line with last year’s survey, most people responded positively to questions about the health or social care worker they saw most recently, with the majority (70%) (although down from 72% in 2012) saying they ‘definitely’ had enough time to discuss their condition and treatment, 78% saying they were ‘definitely’  listened to carefully and 72% of people saying their views ‘definitely’ were taken into account.

In a new question, respondents were asked to rate their overall experiences on a scale of 0-10 Most people (67%) responded positively rating their overall experience as a ‘7’ or above.

David Behan, CQC chief executive, said: “This survey provides valuable intelligence about the experiences of people who are being supported by community mental health services. The survey describes some very positive experiences and flags where services can and must improve.

“People should always be at the heart of decisions about their own care. Care planning helps to make sure that people feel in control of their lives and illness and it can be vital in aiding their recovery. It is unacceptable that fewer people have adequate care planning than last year. It is also unacceptable for care plans not to include adequate crisis care management or for people to be poorly informed about the drugs they take.

David Behan continued: “One of CQC’s key objectives this year is to focus on the care being provided to people by mental health services. The results of this survey will help our inspection teams under the Chief Inspector of Hospitals Prof Sir Mike Richards home in on the poorest providers and be able to challenge this poor performance through inspection.

“Trusts should look at their own results carefully and consider whether, firstly, they are assessing people’s needs properly in the context of CPA policy, and secondly, whether they are giving them the appropriate level of support.