Patient preferences are crucial to mental health services

Hannah Browes, Research Associate at Picker, urges community mental health services not to default to remote care delivery and, instead, prioritise patient preferences to ensure impactful care and treatment.

Like most NHS services, the pandemic rewrote how mental health care was delivered. Before Covid-19, community mental health trusts provided predominantly in-person services and have since experienced a significant shift in how they are required to provide care and treatment. Despite lockdown measures no longer being in place, a blended approach to care continues to be used as part of the ‘new normal’ for community mental health trusts who have embraced remote delivery methods such as telephone and video conferencing.

There are clear benefits to including remote delivery methods to care due to the cost and time effectiveness. However, there are concerns that these methods are inappropriate for all service users and should not be considered a default method. A recent survey conducted by Mind found that 1 in 4 people who tried to access support during the pandemic could not do so because they were uncomfortable using phone or video call technology, with some citing concerns over confidentiality as the reason for discomfort.

Representatives from community mental health trusts have also expressed concern that some service users do not have access to a PC or Wi-Fi or may have poor connection speeds, which acts as a barrier to accessing support. Therefore, it is vital that service users are consulted immediately on their preferences rather than defaulting to remote delivery methods. Services should resist a ’one size fits all’ model and put the service user at the centre of decisions where possible. This echoes one of the critical messages reflected in the guidelines published by the National Institute for Health and Care Excellence (NICE), which promotes respect for patient-centred values and shared decision-making in that decisions should be based partly on an individual’s personal preferences.

If the blended approach continues as the norm, consideration of service user choice is imperative to remove barriers to accessing support. In the 2022 Community Mental Health Survey (CMHS), new questions were added that sought to determine whether service users were given a choice about their delivery method and whether their care and treatment were being delivered in line with the decision that was made.

Overall, results were largely positive; 71% of respondents had agreed with someone from NHS mental health services about how their care and treatment would be delivered in the last 12 months. Of those who had had this agreement, 68% said that they had “always” received their care and treatment in the way that was agreed, with a further 26% saying that they had “sometimes” received it in the way that was agreed. It would seem then that, where these agreements are being made, trusts can deliver care and treatment in line with service user choice.

However, 18% of respondents still said they had not agreed with someone in NHS mental health services on how their care and treatment would be delivered. This indicates that almost 1 in every 5 service users had not been given a choice, suggesting some may have received care and treatment in a way that was not suitable for them. While it is not clear whether there is a direct link between those who had not decided how their care and treatment would be delivered and those reporting worse care experiences, this decision-making gap means that the possibility cannot be ruled out.

Looking at the 2022 CMHS by sub-group has revealed that those service users receiving their care and treatment via multiple delivery methods reported worse overall experience than those receiving treatment solely by either video-conferencing or face-to-face. This demonstrates that the experience of care varies by delivery method and carries the implication that, for some service users, their experience of care may have been impacted by receiving care and treatment in a way they did not choose.

Clearly, there is still a gap to bridge when it comes to prioritising patient preferences. To achieve sufficient person centred care, its critical trusts address this gap in decision-making to ensure patients receive care and treatment that positively impacts their health and experience.

You can find our summary of the latest 2022 Community Mental Health Survey here and an infographic summarising the results here.

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