We need more than money to solve the mental health crisis
There has been only negligible momentum, and even less intelligently directed spending, to develop self-management models of healthcare in the UK.
We started the week with a government announcement of an additional £1.3 billion worth of spending on mental health services in the UK. We end it with the depressing everyday reality of mental health care as summarised in the words of Lord Justice Munby when he highlighted the case of a vulnerable 17 year old who is a risk to herself, and perhaps to others, and for whom no appropriate care could be found.
That the system needs urgent reform is undeniable. Extra money must be a part of that. So must additional staff. That this is no simple matter has already been underlined by the Royal College of Nursing who noted that the number of mental health nurses has decreased by 5000 since 2010. Full Fact’s research suggests that the drop may be higher still, at 7000.
These figures should be understood in the context of a larger workforce crisis in the NHS. There are 3000 unfilled posts for mental health nurses currently. Trainee nurse numbers are falling. Fewer medical students are opting for psychiatric training. This is all exacerbated by Brexit, and the uncertain status of EU nationals working in the health service. This is, too, in the context of high rates of closures amongst GP practices.
Our own research on community-centred mental health suggested that the government’s approach to mental health spending would not effectively deliver the change that is needed to better meet the needs of patients.
It is equally unlikely to meet the needs of staff.
Although there have been slight improvements in staff morale measured by the national NHS staff survey, 37% of staff still report feeling unwell due to work related stress. 60% reported coming to work in the previous 3 months despite feeling unable to perform their duties. 47% report that there are insufficient staff levels for them to do their job well.
The standard model in the NHS couples unit cost models of spending with large-scale, centralised and siloed forms of delivery. There are good reasons for thinking that when it comes to the care of the increasingly large proportion of patients who have long-term chronic, rather than short-term acute, conditions, this model is flawed.
Well-connected, self-managing teams of community-centred practitioners offer an alternative that could marry better services with happier staff. Self-management reduces costs which increases staff numbers and face-to-face patient time. It also leads to fewer targets, more autonomy and higher staff satisfaction.
Where these models exist, staff morale is high, with Buurtzorg Nederland regularly winning the Best Employer category in the Dutch national ratings.
There has been only negligible momentum, and even less intelligently directed spending, to develop those models in the UK.
Where they do exist, early indications are promising. An integrated pathway for enhancing the quality of end-of-life care was introduced into a community setting in Liverpool, with initial data suggesting a decrease in crisis intervention and unnecessary hospital admissions and an increase in nurses’ confidence.
There is also solid evidence that community engagement interventions have a positive impact on health behaviours, self-efficacy, and social support outcomes, across various conditions.
Community business could offer a means of accelerating the development of these models by drawing on three core offers: a rooted financial investment through community shares and asset transfer; increased responsibility and self-management for staff teams through innovative models of shared ownership; and responsive community engagement through accountable governance.
If we want to stop failing both vulnerable patients and dedicated staff, now is the time to champion these new models with cash, advocacy, and evidence.
Shout out to Alex Defroand for his research into community models of nursing and his contributions to this blog.