Mental health care

Mental health is a key area where we have previously raised concerns about the lack of community care and early diagnosis and support. Primary care is the first port of call for people with mental health needs, and accessing this help has been disrupted in the pandemic. It is likely that people who have not accessed primary care services since the onset of COVID-19 will be looking for more help going forward. Enhanced mental health support will be needed for people and communities.

Not being able to access the right care at the right time can lead to people reaching crisis point and ending up in hospital. In our October 2020 report on the care for people with mental health needs in acute hospitals, we have highlighted our concerns that, once in hospital, people are not receiving the care that they need, with poor co-ordination and joint working between acute and mental health services and delays in assessments and securing beds. These delays can then be made worse if there is a lack of availability of mental health beds, with people in distress having to stay in inappropriate and sometimes unsafe environments.

Workforce issues and an ongoing decline in the number of inpatient mental health nurses continue to add to difficulties with people accessing acute services, for example leading to longer waiting lists. During the early stages of the pandemic, in April 2020, there was a sharp fall in mental health activity – for example there were only 7,646 admissions to mental health hospitals, compared with 9,933 in April 2019, and almost 100,000 fewer mental health referrals in April 2020 compared with April 2019 (a fall of 31%). Although activity has started to pick up again, this will have affected people’s ability to access services during this time, and add pressure to waiting lists.

Ensuring accessible and appropriate mental health provision will be critical if the right care is to be available to those that need it.

A lack of access to local community services can lead to people being placed in hospital far from home. Although the total number of inappropriate out of area placements fell sharply in April 2020, this was in line with overall reductions in referrals and admissions, and the numbers started to rise again in May and June.

As highlighted in our report on the care for people with mental health needs in acute hospitals, the noise and environment of hospital wards can often be distressing for people, particularly those with a learning disability and autistic people, and can lead to them being segregated or secluded. This risk has increased during the pandemic as wards are often unsuitable environments in which to socially distance.

Being placed far from home and families also increases the risk of closed cultures developing. A closed culture is a poor culture in a health or care service that increases the risk of harm. This includes abuse and human rights breaches. We are concerned that this risk has increased during the pandemic, with restrictions on people’s movements and services having to restrict or stop families from visiting their loved ones. As part of our work on closed cultures, over the next year we will be working with people who use services, families, providers, frontline staff and other stakeholders to improve the way that we regulate services where there is a closed culture, or a high risk of a closed culture developing.

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