Mental health survey shows parity of esteem is still way off

Results from the 2015 national survey of community mental health servicer users, published yesterday by the Care Quality Commission, make difficult reading. 

Although the majority of service users report good interpersonal care, there is significant room for improvement in many of the areas most important to users and frequently there is evidence of a decline in user reported quality.

Some of the most troubling findings relate to the most fundamental aspects of person centred care.

This year, 73 per cent of service users said that they were “always… treated with respect and dignity by NHS mental health services” – but this represented a 2 per cent point drop from a figure of 75 per cent in 2014. It is difficult to make direct comparisons of this figure to other care settings, but earlier research by the Picker Institute has shown that acute hospital patients who self-identify as having mental health conditions are markedly less likely to report being treated with respect and dignity compared with others. 

Taken together, these findings raise concerns about the extent to which services are realising the ideal of “parity of esteem” for people with mental health conditions. 

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Good person centred care

It is known that some of the most important components of good person centred care are clear communication, active involvement, and effective coordination.

Unfortunately, each of these areas saw declines in survey results between 2014 and 2015. 

A majority of service users still report positive experiences with mental health professionals, but this is in spite of sizable declines in three key questions about interactions with health and social care workers. Respondents were asked about their last contact with a health or social care worker and in 2015:

• 70 per cent said that that person “definitely” listened carefully to them – down from 73 per cent in 2014.
• 62 per cent said that they were “definitely… given enough time to discuss [their] needs and treatment” – down from 66 per cent in 2014.
• 55 per cent said that the person they saw “definitely” understood how their mental health needs affected other areas of their lives – down from 58 per cent in 2014.

Questions about service users’ involvement in their care showed falls or no change.  Almost a quarter of respondents (23 per cent) said that they had not agreed with someone from NHS mental health services what care they would receive.

Similarly, 28 per cent said that they had not had a formal care review meeting in the last 12 months – up from 26 per cent last year. When these processes did occur, many service users felt that they were not as involved as they would have liked. More than two in every five (44 per cent) respondents said they were not involved as much as they wanted to be in agreeing the care they would receive, and a similar proportion (39 per cent) were not fully involved in discussions about their care at care review meetings. 

Gaps in involvement

The biggest gap in involvement, though, was around medicines: although 84 per cent of service users receive medication for their mental health condition, only half (50 per cent) were “definitely” involved in decisions about their medicine – a decline of 3 percentage points from 53 per cent in 2014.

Finally, the survey identified a number of issues around the coordination of care. The proportion of people who reported a change over the last 12 months in the healthcare professional that they saw for their care or services increased from 41 per cent in 2014 to 43 per cent in 2015. 

This change occurred both for patients on the care programme approach and for other service users.

‘More could be done to ensure that services match users personal circumstances and preferences’

While a change in the care professionals an individual is in touch with need not automatically be a problem, there was an increase – from 27 per cent in 2014 to 29 per cent in 2015 – in the proportion who said that their care “got worse” as a result. 

The results also suggest that more could be done to ensure that services match users personal circumstances and preferences: only two in five said that mental health professionals “always… understand what is important to you in your life” (41 per cent) and “always… help you with what is important to you” (41 per cent).

User experience is recognised as one of the three components of quality in the NHS. Good experiences happen when services are centred on users and their needs. Much is known about the needs and preferences of people with mental health conditions.

Last year’s No Assumptions: a Narrative for Personalised, Coordinated Care and Support in Mental Health encapsulates this as providers working together to value service users’ goals and experiences and to providing responsive care by focusing on “who I am”, “how I wish to be supported”, “what’s important to me”, and “how people behave with me”. 

Delivering on this narrative is a challenge, particularly when finances are strained – but yesterday’s survey shows that action is needed to improve the quality of person centred care for people with mental health conditions.

Chris Graham is director of research and policy for the Picker Institute, and is responsible for coordinating the community mental health survey on behalf of CQC