Results from the NHS community mental health survey raise concerns over the provision of services in England

People with mental health needs in England face difficulties in accessing services and often lack involvement in decisions about their care and treatment, according to results from a survey published today. The results suggest a need for investment and improvement in community mental health care to meet the needs of the population at a time when demand for these services is expected to rise.

The 2020 community mental health survey – coordinated by Picker for the Care Quality Commission – collected feedback from more than 17,000 people in contact with services between September and November 2019. It asked about people’s experiences in a range of areas, including accessing and receiving routine care, medications, therapies, and crisis care.

Less than half of the survey’s respondents (47%) said that they had received NHS therapies that did not involve medication over the last 12 months: a further 29% said that they would have liked these therapies. Of those in receipt of NHS therapies, 44% said the waiting time was too long, and only half (50%) said they were “definitely” involved as much as they wanted to be in deciding what therapies to use. Most (85%) found that NHS therapies helped their mental health, although only 42% said that therapies were “definitely” helpful.

There were also poor results for questions relating to person centred care. Only around half of respondents (53%) said that the last mental health professional they saw “definitely” understood how their mental health needs affected other areas of their life. Similarly, less than half (42%) had agreed their care requirements with someone from NHS mental health services. Of the 79% who said this had happened at least “to some extent”, only 53% were “definitely” involved in agreeing what care they would receive and just 47% said the agreement “definitely” took account of needs in other areas of their life.

Commenting on the findings, Chris Graham, CEO of Picker, said:

Today’s results raise real concerns over the availability and quality of community mental health services in England. Far too many service users say that they face delays in accessing care or are unable to see mental health professionals regularly enough. This is particularly concerning as experts expect demand for mental health care to rise sharply as a consequence of the Covid-19 pandemic: this will put more pressure on services and, on the evidence of this survey, it is difficult to see how this can be met. It is even more troubling to note that the survey only covers people already receiving services – and recent research from the Royal College of Psychiatrists has shown that a significant proportion of people on waiting lists for mental health care resort to emergency or crisis services before their treatment begins. The NHS Long Term Plan commits to improving access to mental health services – this will need sustained attention to deliver improvements in this context.

It is also very worrying that the results fail to show a holistic approach to treating people as individuals. Respecting individuals’ needs and preferences is a key principle of person centred care, but only around half of service users report good levels of involvement and say that mental health provision takes account of their wider lives. The poor results may be understandable given the evident pressure on the system, but they are very troubling and demonstrate an urgent need for improvement.

Notes to editors

• The survey was coordinated by Picker on behalf of the Care Quality Commission. Full results and details of the survey findings are available from CQC at https://www.cqc.org.uk/publications/surveys/community-mental-health-survey-2020.
• 55 providers of Community Mental Health services in England took part in the survey. This includes combined mental health and social care trusts, foundation trusts and community healthcare social enterprises that provide mental health services.
• Service users were eligible to participate if they:
  • were aged 18 or above at the time of drawing the sample;
  • were seen by someone face-to-face between 1 September and 30 November 2019; and
  • had at least one other contact (face-to-face, phone or email) either before, during or after the sampling period (excluding calls to query appointment times).
• 17,601 service users responded, a response rate of 26%.
• The survey was conducted between February and June 2020.
• Results from the survey cannot be directly compared to previous years because of the impact of the Covid-19 pandemic. Survey responses were collected both before and after England’s national lockdown measures were introduced in March, and analysis of the results suggests that people responding later in the survey were more favourable than would usually have been expected. This may reflect an increased level of public gratitude to the NHS in the wake of the crisis. Nevertheless, there is little in the findings to suggest a significant improvement in results since 2019.