The announcement of 15 new mental health units, in itself potentially positive news, contradicts the announcement only days earlier of ten pilot specialist mental health crisis centres being set up around the country.
There’s no denying an urgent need for more capacity to ensure that people with mental health needs who attend emergency departments get the care and support they need. However, once again, key questions remain unanswered. Why the rapid fire contradictory statements? Is a bigger plan now in place?
How was the figure of “Up to 15” new mental health assessment centres decided? Are the numbers of units the result of attempting to match new units to centres of greatest need, or are NHS policy wonks simply totting up how many units could be built for £26m?
Indeed, at an average cost of just £1.7m, what does one of these centres look like? Is a “centre” simply a secure room to hold one patient at a time, located in the Emergency Department, or a larger-scale separate facility?
The Royal College of Psychiatrists, although broadly welcoming the Plan and committing to “support the UK Government’s efforts to improve emergency care,” argues that the new centres should be integrated with the existing emergency departments:
“Additional mental health crisis centres have the potential to provide a more therapeutic environment for people in mental health crisis but to be truly effective, they need to be based within general emergency departments so that physical health needs don’t go unmet and waiting times in England can be reduced.”
The RCP is also pleased to see the plans for additional in-patient beds to avoid long-distance placement of mental health patients, often to poor-value private hospital beds.
“Too many people with mental illness are also sent far from home for care due to a lack of available beds locally. We welcome the reaffirmed commitment to ending this awful practice, which leaves extremely vulnerable people feeling isolated and hinders their recovery.
“People who receive care locally as soon as they need it are much less likely to develop a more serious illness. The DHSC Neighbourhood Health Hub model mirrors the Community Mental Health Framework, and can play a key role in delivering targeted treatment as soon as symptoms arise, and also facilitate partnership working with the voluntary sector to address people’s housing, financial and social needs.”
However, with £75m allocated to open up additional inpatient mental health capacity, the obvious question is how this money is to be divided? How many beds are expected to be opened, and where? To what extent does this address inequalities in access?
An FOI investigation by the RCN published last month revealed that over a million (1.3) people presented to A&E departments in a mental health crisis in the previous five years, with waits of 12 hours or more increasing from 1,090 to 5,260 per year (a 383% rise).
Mental health bed numbers have fallen by 3,375 (almost 19%) in the past 10 years, but by just 140 in the last five years as the pressure on mental health services has grown. However, the need is not just for beds or new assessment units, but also for staff to ensure safe care for patients. RCN analysis shows that the number of mental health nurses per 10,000 mental health patients in England has nearly halved in the last decade.
Some of the new centres will be self-contained units, while others will be integrated into existing Accident and Emergency (A&E) departments.
Andy Bell, the CEO of the Centre for Mental Health, told the BBC last month that any new provision needed to be adequately funded. He said he was sceptical of the potential effectiveness of the centres, which he stressed were so far untested. He also argued it is impossible to separate physical and mental health problems so simply, and called for separate facilities to be put in place “carefully.”
But, even as the pilot schemes took off, the government was already anticipating their success and not waiting for an analysis of their performance.
The DHSC told the BBC it expects similar schemes to be expanded to cover “dozens of locations” as part of its 10-year NHS plan.
So this raises yet another question: how far do the 15 new units unveiled in the latest Plan fit in with the pilot schemes, and with the promise of even more centres that may eventually be proposed some time soon in the much vaunted 10-year Plan?
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