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Mental health under pressure, The King’s Fund briefing paper

DBDr Deborah Biggerstaff, Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School discusses the pressures facing mental health care that have been highlihgted in this week's (w/c 8 November) report.

This briefing paper, which makes for uncomfortable reading in places, is a timely reminder that mental health services need support to deliver appropriate care that meets patients’ needs. People’s needs are often complex when it comes to mental illness since we are talking about patients who need professional support when they are at their most vulnerable. Many professionals working in the NHS and related services acknowledge that this change is long over-due. Mental health services today are now so over-stretched and under-resourced that this has led to high levels of stress among the very professionals committed to care for them. The system in which they work is perceived by many to be close to breaking-point. Certainly many mental health professionals feel they are currently working in less than ideal situations. The report highlights that change is imperative. However, backing is needed for any such reform and this would involve a sustained financial commitment and support for this policy from all involved. There is much rhetoric but this needs to translate into reality and delivery for these reforms.

Mental healthcare is complex, often involving a variety of professionals trying to deliver services to patients in their care when they are at their most vulnerable. Often these patient groups need help for a variety of different conditions. Adult mental health services, for instance, are currently defined as being for the over 16s, yet we know that teens and younger adults would benefit from services more tailored to the specific mental health needs frequently encountered in this age group i.e. those relating to adolescence and young adults (for example treatment and support for eating disorders; early onset psychosis; serious depression and anxiety that need specialist treatment; psychological / developmental problems).

The King’s Fund briefing document draws our attention to the very real issues and challenges facing crisis care with the attendant increased risk of suicide for those individuals when they experience acute mental health problems. Evidence is provided from other sources highlighting the current lack of resources for urgent care when individuals and their families seek help (e.g. Care Quality Commission, 2015).

The overall message is troubling: pressures facing our mental health services are now critical with stressors in one area having a negative effect another part of the system. This is such that patients frequently report not feeling safe in the very system that should be providing them with care and support. The potential therapeutic effect of any treatment offered, whether acute care, or in the community, by overworked and stressed health professionals, is unlikely to help patients find relief from their symptoms, neither does it bode well for the chance of a meaningful recovery in the longer term; these patients then return into the system and thus the cycle continues.

It remains challenging for the NHS to get the balance right between ‘voice and choice’ especially since patients, and their families or carers, may not be in a position to either want, or be able to demand access to information about their care when unwell. This dilemma is one that many working in NHS mental health services acknowledge; change is needed but support is needed for this and any proposed reforms need to be mindful of mental health care patients’ needs. However, these views and concerns do need to be heard and acted on, if patient trust and care delivery is to become truly more ‘patient centred’ in future.

For further details please contact Nicola Jones, Communications Manager, University of Warwick 07824 540863 or