How are acute trusts responding to patients’ mental health needs? A picture of great variation

Physical and mental health will only truly be equal when we stop viewing them as distinct from each other, says Adrian James

When I started my term as president of the Royal College of Psychiatrists, I made parity of esteem one of my top priorities. This was at the forefront of my mind when I read the recent report by the Care Quality Commission (CQC) from their assessment of mental health services in acute trusts programme

I wholeheartedly agree with the CQC that physical and mental health will only truly be equal when we stop viewing them as distinct from each other. It was clear from the report that there is a very long way to go to make this a reality. There is great variation in how acute trusts are responding to their patients’ mental health needs—with some brilliant and forward thinking service models. 

However, in some trusts the experiences described by patients were shocking. Not having access to medication, adequate food, or a safe place to wait when in extreme distress; having repeated assessments with different staff; or being stigmatised should not be happening in any service to any person. I’m saddened that despite so much work to drive mental health up the healthcare agenda, people’s needs often aren’t fully understood or even properly comprehended. 

That said, I’m also aware that healthcare professionals are working very hard with stretched time and resources—something that has been exacerbated tenfold by the pandemic. It was clear from the report that staff were often doing their best to help patients in challenging circumstances, where many contributing factors were out of their control. 

If we want to improve, there is a role for all the different players in our health system. I would absolutely agree with the need for more joint working and cross-sector planning. I would also strongly support the CQC’s recommendations to step up mental health focus at acute trust board level, including with a named board member having responsibility for mental health and a comprehensive mental health strategy that goes beyond crisis care in an emergency setting. Liaison psychiatrists are well placed to provide clinical and operational leadership in these efforts. 

We in the mental health sector can and should also help drive change. We need to work more closely with our colleagues with expertise in physical health, and help staff develop their knowledge, particularly in application of the Mental Health Act. We will continue to promote our Psychiatric Liaison Accreditation Network (PLAN) standards on best practice to help support trusts to develop safe, therapeutic environments. We’re aware that for staff to be able to meet the needs of patients their own mental health and wellbeing needs to be supported, which is another of my top priorities as president of the college, and which we’re also working on. 

I also reflected on the fact that implementation of the long term plan will significantly help overcome some of the issues highlighted in the report. For example, we must keep up work to implement and resource 24/7 crisis and liaison services for all ages. And we must continue to improve crisis care in the community. But there is more that could be done. For example, extending the hospital discharge programme to include mental health providers so that people can access health and social care support after discharge, lessening the likelihood of them needing crisis services.

Finally, we’re calling on the government to invest a minimum of £90m of capital funding to procure age appropriate alternative forms of mental health crisis provision by 2023/24, building on the revenue funding already committed as part of the long term plan. We’re also calling for a minimum of £20m of capital funding to develop age appropriate assessment spaces in A&E and acute hospitals for people with mental health/learning disability needs by 2023/24, investing in additional adult inpatient beds where relevant, and ensuring hospitals (current and future) have appropriate space for integrated mental healthcare to be delivered.

Realising these goals is going to take some work, but if we’re to truly achieve parity of care, we should make it our priority to do so. 

Adrian James is president of the Royal College of Psychiatrists and is a forensic psychiatrist working in the South West of England. Twitter @DrAdrianJames

Competing interests: None declared.