Mental health services in England are under “a huge amount of strain” as large-scale changes have had a negative impact on patient care, says a briefing paper by health think-tank The King’s Fund.

Highlighting “widespread evidence” of poor care, the report notes that just 14% of mental health patients say that they received appropriate care in a crisis, while the number of out-of-area placements for inpatients last year leaped 23%.

Also, around 40% of mental health trusts experienced a cut in income in 2013/14 and 2014/15 - in direct contrast to acute trusts, where more than 85% saw their income increase over the same period. 

The briefing shows that trusts have embarked on large-scale, cost-cutting, transformation programmes aiming to shift demand away from acute services towards recovery-based care and self-management, i.e. from hospitals into the community. But this has spurred a move away from evidence-based services to care pathways with limited evidence, the King’s Fund says.

Moreover, as the financial situation continues to deteriorate, many trusts are considering another wave of large-scale changes, “which could further destabilise services and reduce the quality of care for patients,” the briefing warns. 

While “few would dispute the intention and rationale” for moving care from the hospital to the community, “the problems arise with the scale and pace of the changes, which lack the necessary checks to evaluate their effectiveness and the impact on patient care,” notes Helen Gilburt, Fellow, (Mental Health) Policy at The King’s Fund and author of the report.

What mental health trusts need now is “the security of stable funding, supported by a national focus on evaluating the changes to date” to improve practice and cut variations in care, she said.

More funding

Paul Farmer, Chief Executive of Mind, said the report “lifts the lid on the true state of NHS mental health services,” and said the charity echoes the King’s Fund’s call for more funding. “After decades of neglect and five years of cuts, services are in urgent need of significant investment,” he stressed.

Stephen Dalton, chief executive of the Mental Health Network, said “despite the rhetoric about giving equal importance to physical and mental health this hasn't translated into any new money”. 

"On the contrary, funding for mental health services has gone down. Many commissioners of NHS services don’t have the capacity to do the right thing and fund what works,” he argues, and stressed: “If this government is serious about prioritising mental health they need to ensure new funding gets directly to providers of care and not channelled through layers of bureaucracy where it is lost”.